Martin pharm DM part II Flashcards
what are adverse effects to insulin therapy
hypoglycemia
insuline allergy and resistance
lipoatrophy and lipohypertrophy
biggest risk factor hypoglycemia
the more rigorous attempt to achieve euglycemia
causes of hypoglycemia with Tx
inappropriate dose
mismatch of time of injection vs food intake
exercise induced increase glucose utilization
what is the dominant counter regulatory hormone for hypoglycemia in DM I patients and why
epinephrine because glucagon secretion becomres deficient
most frequent allergic reaction to insulin
IgE mediated local cutaneous reactions
occasionally anaphylactic reaction or insulin R due to circulating IgG Ab
what causes the lipohypertrophy/atrophy from insulin
site of constant injection
what are conditions that require IV insulin
ketoacidosis
perioperative control and childbirth
msot common drug induced ypoglycemic states are those caused by
ethanol, beta-adrenergic antagonists and salicylates
why can beta antagonists cause hypoglycemia
inhibit the effects of catecholamines on gluconeogensis and glycogenolysis
also mask the sympathetically mediated Sx assoc with fall in blood glucose (tremors and palpiataions)
what drugs either have direct hyperglycemic effect ot indirect
epi, glucocorticoids, oral contraceptions (direct)
phenytoin, clonidine, Ca Ch blockers (inhibit insulin secretion
some diuretics deplete K and indirectly inhibit insulin secretion
Initial monotherapy for DM II
metformin
effects of metformin
reduce haptic glucose output by inhibiting gluconeogenesis
increase insulin action in peripheral tissues
increase glucose uptake dna utilization by muscle
reduce intestinal absorption of glucose
why is metformin preferred over sulfonylureas
does not cause weight gain or provoke hypoglycemia
has lipid lowering effect
side effects metformin
abdominal discomfort, anorexia, nausea, metallic taste, diarrhea
CI to metformin
lactic acidosis, hepatic disease, renal impairment, cardiac failure, chronic hypoxic lung disease
what clears metformin
kidneys
what type of sulfonylureas are used now
the second generations
glipizide
glyburide
glimepiride
glyburide should be used cautiously in what patients
elderly with renal failure and otheres predisposed to hypoglycemia
how do sulfonylureas work
lower blood glucose by stimulating insulin release from pancreatic beta cells
bind to and bloc ATP sensitive K channel
extrapancreatic effects like increased # receprtors for insulin and LGUT transporters
what metabolizes sulfonylureas
liver
patients most likley to respond to sulfonlyureas
older than 30 recently Dx
not overtly obese
some beta cell function
<300 fasting level glucose
drug of choice if CI for sulfonlyureas
insulin
adverse reactions sulfonlyureas
hypoglycemic reactions like a coma
nausea, vomiting, cholestatic jaundice, hypoNa, agranulocytosis, aplastic anemia, HS reactions
drug drug interactions with sulfonylureas
many transiently increase hypoglycemic effects
CI to sulfonlyureas
type I DM, sulfa allergies, pregnant or nursing mothers and significant hepatic or renal insufficiency
what are the non sulfonylure secretagogues
repaglinide and natedlinide
what type of patient adheres better to repaglinide and nateflinide
those whoe are erratic eaters because rapid action if taken right before a meal
can repaglinide and nateflinide be combined with metformin
yes
how do acarbose and miglitol work
alpha glucosidase inhibitors
competitive inhibition of sugar digestion delaying absorption of carbs and limits postprandial rise in glucose
drugs most useful in newly diagnosed DM II patients with mild hyperglycemia
alpha glucosidase inhibitors
if combined with what drugs will the alpha glucosidase inhibitors cause hypoglycemia
insulin or sulfonlyureas
side effects alpha glucosidase inhibitors
flatulence, diarrhea and GI upset from undigested carbohydrate
CI for alpha glucosidase inhibitors
diabetic ketoacidosis, cirrhosis, IBD, colonic ulcers, partial intestinal obstruction
what are TZDs used for (thiazolidinediones)
poorly controlled DM II
what must you do if Tx patient with TZD
liver function tests every 3 mo
how do TZDs work
bind nuclear transcription factors PPAR-gamma site that resensitize target tissue to insulin
effects of pioglitazone TZD
reduce insulin R
improve peripheral action insulin
reduce hyperglycemia by inc glucose uptake
reduce hepatic glucose production
take several weeks to produce a clinical effect
pioglitazone is approved for regimen with what
monotherapy
insulin
sulfonylureas or metformin
side effects pioglitazone
moderate weight gain, edema, mild anemia
fluid retention
risk with rosiglitazone
MI
What is pramlintide
maylin analog
how is pramlinitide administered
SQ injection before meals
advserse effects pramlinitide
increased risk hypoglycemia, nausea
decreased appetite, comiting, stomach pain, tiredness, dizziness or indigestion
what secretes glucagon like peptide
intestinal L cells
what is the GLP analog
exenatide
effects of GLP-1 agonists
glucose dependent enhancement of endogenous insulin secretion
inhbition of endogenous glucagon secretion
appetite suppression
reduction in speed of gastric emptying
stimualte islet growth
most common adverse effects GLP-1 agonists
nausea, vomiting, diarrhea and upper resp Sx
biggest drawback to GLP-1 agonists
need 2x SQ injection
adverse effects of the Na glucose co transporter 2 inhibitors
genital mycotic infections and UTIs
diuretic effects sometimes
bladder cancer
which drug class in DM causes increased risk for acute pancreatitis and severe HS reactions
DPP-4 inhibitors
