MEDS (NOT READY!) Flashcards
6 class of Oral HYPOglycemics
1) Sulfonylureas
2) Meglitinides
3) Alpha-glucosidase inhibitors
4) Thiazolidinediones
5) Biguanide
6) DPP-4 Inhibitors
Sulfonylureas - how do they work?
Type II DM
- stimulate pancreas to release more insulin
- NOT dependent on BG
- can –> HYPOglycemia (monitor BG because of this)
- NEVER use on Type 1 (IDDM)
Sulfonylureas - examples
1st gen:
Diavinese
2nd gen:
Glipizide (Glucotrol)
Glyburide (Diabeta, Micronase, Glynase)
3rd gen:
Glimepiride (Amaryl)
SIDE EFFECTS: Nausea, Diarrhea, Constipation
Diavinese
- 1st Gen Sulfonylurea
- not used often. stress on kidney. Renal function can be altered
Glipizide (Glucotrol)
- 2nd gen Sulfonylurea
- given 30 min B4 1st meal, breakfast
SE: Nausea, Diar, Constip
Glyburide (Diabeta, Micronase, Glynase)
- 2nd gen Sulfonylurea
- given 1x day w 1st meal
SE: Nausea, Diar, Constip
Glimepiride (Amaryl)
- 3rd gen Sulfonylurea
- 1x day w 1st meal
SE: Nausea, Diar, Constip
Meglitinides - how do they work?
- stim pancreas to release insulin
- Glucose DEPENDENT
- Taken 30min B4 meal
once pt eats, UP BG, then pancreas w stim insulin. absorption happens in sm intestines. Med will already be working
Meglitinides - examples
- Prandin (Repaglinide)
- Starlix (Nateglinide)
- stim pancreas to release insulin
- Glucose DEPENDENT
- Taken 30min B4 meal
Alpha-glucosidase Inhibitors - how do they work?
- prolong absorption of carbs in stomach & intestines. BLOCKS enzyme needed to digest starch.
- slows post prandial, UP BG
- given w EACH meal on 1st bite, not convenient
Alpha-glucosidase Inhibitors - i.e.
Precose (Acarbose)
not convenient because have to remember for each meal.
Precose (Acarbose)
w EACH meal on 1st bite.
Thiazolidinediones - how do they work? (like Biguanides)
-UP insulin sensitivity at insulin receptors
-LO amount of glucose released by liver
-taken daily w NO regard to meals
-similar to Biguanide’s
UP risk/rate of bladder CA. Contraindicated in pts w Hx of Bladder CA
Thiazolidinediones - i.e.
Avandia (risk for MI) not used anymore
Actos (Pioglitizone)
- UP insulin sensitivity at insulin receptors
- LO amount of glucose released by liver
- taken daily w NO regard to meals
Actos (Pioglitizone) class
Thiazolidinedione
- UP insulin sensitivity at insulin receptors
- LO amount of glucose released by liver
- taken daily w NO regard to meals
Biguanide -(2 uses, Bi) how does it work?
- used in combo w Sulfonylureas
- LO hepatic glucose output
- UP insulin sensitivity at cell. so don’t need as much
- taken w 1st meal, 1x day
- DOES NOT cause HYPOglycemia because it doesn’t raise insulin. only makes insulin already there more effective.
- RISK hepatotoxicity. don’t use on pts using contrast mediums because dyes are nephrotoxic. drug already hard on kidneys
Metformin (Glucophage) class
Biguanide
- taken w 1st meal, 1x day
- DOES NOT cause HYPOglycemia because it doesn’t raise insulin. only makes insulin already there more effective.
- used in combo w Sulfonylureas
- LO hepatic glucose output
- UP insulin sensitivity at cell. so don’t need as much
DPP-4 Inhibitors aka (Gliptins) - how do they work?
- hormone in GI tract sign pancreas to produce insulin
- glucagon like polypeptide 1 (GLP-1)
- DPP-4 is protein found in blood. it stops breakdown of diff hormones to UP insulin to LOWER BG.
- short acting in blood
- taken w/out regard to food
- Only for Type II, dependent on insulin releasing cells
i.e. Januvia
Januvia class
Gliptin (DPP-4 Inhibitor)
-taken w/out regard to food. anytime
Glucagon
- converts Glycogen to Glucose
- Emergency med
- UP BG levels
- Rx for unconsios pt (subQ, IV, IM, parenteral)
- must be constituted STAT before injection
- RISK for bleeding with pts on Cumadin
Types of Insulin
Rapid, Sort (Regular), Intermediate, Long Acting
Rapid Acting Insulin - ONSET/Peak/Duration
(sailing down the rapids on a log) fastest
Fastest Acting, the logs
Lispro (Humalog)= 0.25 / 0.5-2.5 / 3-6.5
Aspart (Novolog)= 0.25 / 1-3 / 3-5
Glulisine (Apidra)= 0.25 / 0.5-1.5 / 3-5
Short Acting Insulin - ONSET/Peak/Duration
Regular
Novolin-R, Humulin-R: 0.5-1 / 2-3 / 4-6
Intermediate Acting - ONSET/Peak/Duration
NPH (NovolinR, HumulinR)= 1-2 / 6-14 / 16-24
Novolin NPH 70/reg 30= 0.5 / 4-8 / 24
