gi pharm Flashcards
imagine the curves for insulins
rapid acting, regular, nph, determir, glargine
all insulins can be used in?
type 1, type 2, and gestational diabetes
side effects of insulin
hypoglycemia, lipodystrophy, rare hypersensitivyt reacitons
insulin rapid actings
lispro, aspart, glulisine
which insulins do not have AA modifications?
nph and regular insulin, the others all do.
when do you use rapid acting insulin?
pre meal
what do you call rapid acting insulin?
analogs
what is regular insulin additonally useful for?
DKA (IV), and HHS, hyperkalemia (+glucose), stress hyperglycemia
names of long acting
detemir, glargine
name the biguanides
metformin
metformin never causes
hypoglycemia
metformin stimulates
AMPK = adenosine monophosphate kinase
metforming advantage
modest weight loss, can be used in pts with islet fxn loss (good in advanced type 2)
avoid metformin with?
aminoglycosides
metformin mechanisms
inhhibits hepatic gluconeogenesis, and the actions of glucagon (remember wants to raise blood sugar)
increase glycoylisis in tissues (use up sugar)
increase peripheral glucose uptake by increasing sensitivity
metformin mechanisms
inhhibits hepatic gluconeogenesis, and the actions of glucagon (remember wants to raise blood sugar)
increase glycoylisis in tissues (use up sugar)
increase peripheral glucose uptake by increasing sensitivity
reduces GI absorption
metformin mechanisms
inhhibits hepatic gluconeogenesis, and the actions of glucagon (remember wants to raise blood sugar)
increase glycoylisis in tissues (use up sugar)
increase peripheral glucose uptake by increasing sensitivity (insulin falls slightly)
reduces GI absorption
metformin held in?
ill and those undergoing radiocontrast
a favorable cardiovascuar effect of metformin
decrease triglycerides, and ldl and increase HDL
first gen sulfaonyureas
chlorpropamide, tolbutamide, tolazamide
first gen sulfaonyureas
chlorpropamide, tolbutamide, tolazamide
2nd gen
glimepiride, glipizide, glyburide
sulfaonyureas also called
insuling secragouges
sulfaonyureas CI in
hepatic failure
long ancting 2nd gen sulfaonyureas
glimepiride and glyburide (increased risk of hypoglycemia)
short acting 2nd gen sulfaonyureas
glipizide (decreased risk of hypoglycemia)
sulfaonyureas additional side effect you always foregt
sulfa allergy
what is first line therapy in type 2?
metofrmin
clinical use sulfaonyureas
stimulates insuling release in type 2 diabetes, so useless in type 1
sulfaonyureas mech
works on atp depedent k channels -> closes them -> cell deplorizes -> influx of ca -> insulin release
sulfaonyureas side effecsts
risk of hypoglycemia (why prefer metofrming), risk increased in renal failure.
1st gen -> disulfarim like affects and siadh
2nd gen hypoglycemia
sulfaonyureas mech of hypoglycemia
decreased glucagon somehow
exercise or skip meals
what sulfaonyureas to usse in mild to moderate renal failure?
glimeperide, mostly hepatic clearence and has low risk of causing hypoglycemia (think about the renal failue)
glitazones/thiazolidinediones
pioglitazone/rosiglitazone -gliazones