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Pharm 2 > Glucose control > Flashcards

Glucose control Flashcards

1
Q

medications that induce hyperglycemia

A
  • glucocorticoids
  • antipsychotics
  • HIV medications
  • Octreotide
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2
Q

insulin MOA

A
  • binds to insulin receptors which facilitates glucose diffusion into the cells
  • stimulates uptake of amino acids, phosphate, K, mag
  • shifts glucose into storage (glycogenesis)
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3
Q

insulin resistance

A
  • impaired insulin signal that results in decreased glucose uptake
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4
Q

insulin receptor saturation

A
  • occurs with low circulating concentrations of insulin
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5
Q

insulin receptor number

A
  • inversely related to plasma concentration of insulin
  • insulin can regulate the population of receptors
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6
Q

half-life of insulin

A
  • 5-10 min
  • effects can last 30-90 minutes
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7
Q

basal rate of insulin by the pancreas

A
  • 1 unit/ hr
  • insulin response to glucose is greater for oral than IV
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8
Q

long-acting insulin

A
  • glargine (lantus)
  • 3-4 hr onset
  • 24 hour duration
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9
Q

intermediate acting insulin

A
  • NPH
  • 1-2 hour onset
  • 18 hour duration
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10
Q

short acting insulin

A
  • regular
  • 30 min onset
  • 6-8 hr duration
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11
Q

rapid acting insulin

A
  • aspart, lispro, gluisine
  • onset 30-90 min
  • duration 3-4 hours
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12
Q

what insulin can be given IV

A
  • only short acting (regular) insulin
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13
Q

hypoglycemia

A
  • symptoms from increased norepi (diaphoresis, tachycardia, HTN)
  • CNS symptoms (confusion and seizures)
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14
Q

somogyi effect

A
  • rebound hyperglycemia caused by sympathetic nervous system activity in response to hypoglycemia
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15
Q

insulin effect on electrolytes

A
  • K into cells
  • mag into cells
  • phos into cells
  • Na out of cells
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16
Q

afreeza

A
  • inhaled insulin
  • rapid acting
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17
Q

sulfonylureas action

A
  • act at pancreatic beta cells to stimulate insulin release
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18
Q

side effects of sulfonylureas

A
  • most common complication is hypoglycemia
  • DOA is up to 7 days
  • can cross placenta
  • weight gain and GI disturbances
  • avoid in pt with liver disease
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19
Q

contraindications to sulfonylureas

A
  • hypersensitivity to sulfa drugs
  • pts with hypoglycemic unawareness
  • poor renal function
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20
Q

2nd gen sulfonylureas names

A
  • glyburide
  • glipizide (good for 3 years without tolerance)
  • glimepiride
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21
Q

meglitinides names

A
  • repaglinide
  • nateglinide
22
Q

meglitinides MOA

A
  • increase insulin secretion from islet cells
  • active only in the presence of glucose (actively eating)(decreased risk of hypoglycemia)
23
Q

side effects of meglitinides

A
  • hypoglycemia
  • weight gain
  • URI
24
Q

biguanides name and what it does

A
  • metformin
  • decrease BG concentrations (low hypoglycemia risk)
  • positive effect on lipid concentrations
  • lead to mild weight reduction
25
Q

biguanides MOA

A
  • dec hepatic glucose concentration
  • dec glucose absorption from intestine
  • increases insulin sensitivity
26
Q

side effects of metformin

A
  • anorexia, nausea, diarrhea
  • black box warning = lactic acidosis
27
Q

metformin peri-op considerations

A
  • risk of lactic acidosis , d/c 48 hours pre-op
  • monitor ABG, pH, lactate and renal function intra-op
  • increased nephrotoxicity with IV dye
28
Q

metformin contraindications/ precautions

A
  • renal impairment
  • contraindicated SCr >1.5 males >1.4 females
  • contraindicated eGFR < 30 ml/ min
  • do not initiate with GFR < 45
  • age > 80
  • hepatic impairment
29
Q

Thiazolidinediones names

A
  • rosiglitazone
  • pioglitazone
30
Q

thiazolidinediones MOA

A
  • decreases insulin resistance
  • decreases hepatic glucose output
  • require the presence of insulin, especially effective in obese pts
31
Q

side effects of thiazolidinediones

A
  • weight gain
  • hepatoxicity
  • peripheral edema
  • CHF exacerbations
  • risk of bone fractures
  • increase in MI and CV death
32
Q

DPP (dipeptidyl peptidase) - 4 inhibitors

A
  • sitagliptin
  • saxagliptin
  • linagliptin
  • aloglipitin
  • end in “gliptin”
33
Q

DPP 4 inhibitors MOA

A
  • increases pancreatic insulin secretion
  • limits glucagon secretion
  • slows gastric emptying
  • promotes satiety
34
Q

side effects of DPP-4 inhibitors

A
  • URI and UTI
  • may activate lymphocytes
  • headache
  • low risk of hypoglycemia
  • pancreatitis, angioedema, stevens johnson
35
Q

incretin mimetics names (GLP- 1 analogs)

A
  • exanatide
  • liraglutide
  • albiglutide
  • dulaglutide
  • semaglutide
  • end in “tide”
36
Q

GLP- 1 analogs effects

A
  • prolong gastric emptying
  • reduce postprandial glucagon secretion
37
Q

GLP- 1 side effects

A
  • N/V/D
  • pancreatitis
  • ARF
  • weight loss
38
Q

incretin mimetics amylin analog

A
  • pramlinide
  • black box warning for hypoglycemia in type 1
  • gastroparesis
39
Q

SGLT2 inhibitors names

A
  • canagliflozin
  • dapagliflozin
  • empagliflozin
40
Q

SGLT2 inhibitors effects

A
  • increased urinary glucose and Na excretion
  • can improve outcomes in CHF pts
41
Q

SGLT2 inhibitors side effects/ contraindications

A
  • Contraindication: CrCl <30 ml/ml, ESRD, HD
  • hypotension, urinary side effects, mycotic infection
  • increased risk of amputations - primarily toe
  • Increased risk of perioperative euglycemic ketoacidosis
42
Q

SGLT2 inhibitors stop time prior to surgery

A
  • increased risk of ketoacidosis
  • stop 3-4 days prior to surgery
43
Q

armour thyroid

A
  • made from desiccated animal thyroid (pig)
  • suppress the responsiveness and cause regression of TSH sensitive malignant tumors
  • 4:1 ratio of T4 to T3
44
Q

levothyroxine

A
  • 7 day half life and so dose can be held
  • T4
  • deiodinated and converted to T3 by the body
45
Q

liothyronine (T3)

A
  • isomer of T3 (3x as potent as levothyroxine)
  • rapid onset and short DOA
  • higher cardiac side effects
  • not for long-term use
46
Q

antithyroid drugs

A
  • propylthiouracil
  • methimazole
47
Q

antithyroid med MOA

A
  • inhibit formation of thyroid hormone
  • blocks peripheral deiodination of T4 to T3
  • requires several days for full effect
48
Q

side effects of antithyroid medications

A
  • transient leucopenia
  • rash
  • arthralgias
  • lupus-like symptoms
  • fever
  • granulocytosis
49
Q

iodines

A
  • lugol’s solution and saturated KI solution
50
Q

iodines effect

A
  • inhibits release of thyroid hormone into circulation
  • combined use with propranolol for the treatment of hyperthyroidism before thyroidectomy
51
Q

treatment of thyroid storm

A
  • cold IV solution
  • sodium iodide
  • cortisol
  • propranolol (non-selective beta-blockers)
  • propylthiouracil
    (avoid ASA)

Pharm 2 (10 decks)

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