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PC 707 Pharmacology > Module 8: Unit A Diabetes > Flashcards

Module 8: Unit A Diabetes Flashcards

1
Q

Short Duration, Rapid Acting Insulin examples

A

lispro (Humalog)
aspart (Novolog)
glulisine (Apidra)

Rapid-acting inhaled insulin
(Afrezza)

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2
Q

Indication short duration, rapid acting insulins

A

Used for postprandial glycemic control
Preferred insulin for pumps for bolus and basal glycemic control

Prandial glycemic control

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3
Q

BBW affrezza

A

Risk of acute bronchospasm in patients with chronic lung disease

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4
Q

Onset, peak and duration of rapid acting insulin (Humalog, Novalog, etc.)

A

O: 5-15 minutes
P: 0.75-3 hours
D: 3-5 hours

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5
Q

Risks with insulin

A

Hypoglycemia

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6
Q

D2D with insulins

A

Enhance hypoglycemia: anti-diabetic medications, beta-blockers, MAOIs, SSRIs, salicylates, quinolones, androgens, alcohol.

Raise glucose: Thiazide diuretics, glucocorticoids, and sympathomimetics. requiring an adjustment of insulin dosage.

Beta-blockers can delay and/or mask symptoms of hypoglycemia AND potentiate hypoglycemia by ↓ glycogenolysis.

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7
Q

Short Duration, Short-Acting Insulin examples

A

regular insulin (Humulin R, Novolin R)

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8
Q

regular insulin (Humulin R, Novolin R) uses

A

Given 30 m before meals to control postprandial hyperglycemia

Also used in insulin pumps for basal glycemic control (less expensive than rapid-acting, but slower onset)

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9
Q

Safety with regular insulin

A

Higher risk of hypersensitivity due to the presence of protamine (foreign particle can trigger an allergic reaction)

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10
Q

Onset Peak Duration: Regular insulin

A

15-30 minutes
2-4 hours
5-8 hours

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11
Q

Intermediate-Acting Insulin

A

NPH- neutral protamine (Humulin-N)

Hagedorn (Novolin N)

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12
Q

NPH neutral protamine (Humulin-N) and Hagedorn (Novolin N) uses

A

Glycemic control between meals and overnight.

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13
Q

Intermediate insulin (NPH (Humulin-N and Novolin N) onset, peak, duration

A

O: 1-2 hr
P: 4-12 hr
D: 18-24hr

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14
Q

Considerations with intermediate insulin

A

Much less expensive than long-acting/basal insulin but requires dosing 2-3 times/day along with short-acting insulin for postprandial glycemic control

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15
Q

Long and ultra-long

-acting (basal)

A

Long duration
glargine U-100 (Lantus)
detemir (Levemir)

Ultra-long duration
glargine U-300 (Toujeo)
degludec (Tresiba)

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16
Q

Use for long and ultra-long duration insulin

A

Basal coverage

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17
Q

glargine U-100 (Lantus) OPD

A

O: 1-2
P: none
D: 24 h

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18
Q

detemir (Levemir) OPD

A

detemir (Levemir)
O: 1-2 h
P: 4-8
D: 24 hr (varies by dose)

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19
Q

glargine U-300 (Toujeo) OPD

A

O: 3 h
P: none
D: up to 48 hours

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20
Q

degludec (Tresiba) OPD

A

degludec (Tresiba)
O: 30-90 m
P: none
D: >24 h

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21
Q

Intermediate-Acting/Combination Preparations

A

70% NPH/30% regular (Humulin 70/30, Novolin 70/30)
50% NPH/50% regular (Humulin 50/50)
70% aspart protamine/30%aspart (Novolog Mix 70/30)
75% lisproprotamine / 25% lispro (Humalog Mix 75/25)
50% lisproprotamine 50% lispro (Humalog Mix 50/50)

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22
Q

Mixed insulin OPD

A

Onset: 30 minutes,
Peak: 0.5-12 hours,
Duration: up to 24 hours

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23
Q

Basal bolus strategy:

A

Combination of a long or ultra-long acting insulin for basal coverage and short insulin for meal coverage

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24
Q

Insulin Pump:

A

Rapid-acting insulin (preferred) provides a steady (hourly) SQ infusion (units/hr) along with preprogrammed boluses for meal and snack coverage

25
Q

Sulfonylureas examples

A

glyburide (DiaBeta)
glimeperide (Amaryl)
glipizide (Glucotrol)

26
Q

Indication sulfonylureas

A

DM2

27
Q

MOA Sulfonylureas (glyburide, etc.)

A

Promotes insulin secretion by the pancreas and may ↓ insulin resistance/ ↑ tissue response to insulin

28
Q

Safety sulfonylureas

A

hypoglycemia- dose-dependent
weight gain
↑ effects of alcohol

29
Q

Pregnancy safety with sulfonylureas

A

contraindicated during pregnancy

30
Q

Biguanides:

A

metformin (Glucophage, Fortamet)

31
Q

metformin (Glucophage, Fortamet) indication

A

T2DM glycemic control
Prevention of T2DM

Off label:
Gestational DM
PCOS

32
Q

MOA metformin

A

↓ hepatic gluconeogenesis, ↑ tissue response to insulin, ↓ absorption of glucose in the gut (small effect)

33
Q

Safety, D2D with metformin

A

GI s/s, nausea, cramping, diarrhea, ↓ appetite.
lactic acidosis
D2D: cimetidine (Tagamet), resulting in an increase in metformin blood levels
Excessive Alcohol can cause lacitic acidosis

34
Q

BBW metformin

A

Lactic acidosis. ↑ accumulation of metformin. Highest risk with renal impairment

35
Q

Monitoring metformin

A

↓ absorption of vitamin B12 and folic acid

Renal funciton

36
Q

Thiazolidinediones (-Glitazones) examples

A

pioglitazone (Actos)

rosiglitazone (Avandia)

37
Q

indication pioglitazone (Actos) and rosiglitazone (Avandia)

A

T2DM

Often added to metformin

38
Q

Pioglitazone (Actos) and rosiglitazone (Avandia) MOA

A

↓ insulin resistance, ↑ glucose uptake by cells, ↓ hepatic gluconeogenesis

39
Q

Safety Pioglitazone (Actos) and Rosiglitazone (Avandia)

A

Contraindicated with HF and hypersensitivity
hypoglycemia (ONLY in the presence of insulin)
edema
HF, bladder CA, fracture (↑ women), promotes ovulation
Some reports of hepatic injury (rare)

40
Q

BBW Thiazolidinediones (GLITAZONES)

A

cause or exacerbate congestive heart failure (CHF

41
Q

Monitoring Thiazolidinedines (-GLIZAZONES)

A

LFTs

42
Q

Alpha-glucosidase inhibitors example

A

acarbose (Precose)

43
Q

acarbose (Precose) use

A

T2DM adjunctive therapy

44
Q

acarbose (Precose) MOA

A

Delays CHO digestion and absorption which slows postprandial glucose elevations

45
Q

acarbose (Precose) side effects

A

GI s/s flatulence, cramps, abd. distention, and borborygmus (technical term for rumbling and gurgling sounds in belly)

46
Q

Tx for hypoglycmeia with Precose

A

If hypoglycemia develops (acarbose PLUS a hypoglycemic agent), sucrose metabolism is ↓ by acarbose, so GLUCOSE must be used to treat.

47
Q

SGLT2 Inhibitors

“-Gliflozins”

A

canagliflozin (Inovkana)

dapaglifozin (Farxiga)

48
Q

MOA SGLT2 INhibitors (-Gliflozins)

A

↑ glucose excretion in urine by inhibiting SGLT-2 (↓ glucose reabsorption in tubules) which lowers circulating glucose and weight loss 2° less calories (glucose excreted in urine)

49
Q

Safety and D2D SGLT2 (-Gliflozins)

A

Genital mycotic infections (female >male), UTI, ↑ urination
orthostatic hypotension

rifampin, phenytoin, phenobarbital and similar inducers can ↓ efficacy

50
Q

Additional benefit of SGLT2 (-Gliflozins)

A

Cardioprotective

51
Q

DPP-4 inhibitors

A

-GLIPTINs
sitagliptin (Januvia)
linagliptin (Tradjenta)

52
Q

Indication DPP-4 inhibitors (-GLIPTINs)

A

T2DM

53
Q

Safety DPP-4 Inhibitors (-GLIPTINs)

A

pancreatitis, hypersensitivity
URI, HA, inflammation of the throat and nasal passages
hypersensitivity
hypoglycemia (with other agents)

54
Q

GLP-1 Receptor Agonist

incretin mimetics

A 
-TIDEs
exenatide (Byetta)
exenatide ER (Bydureon)
semaglutide (Ozempic)
liraglutide (Victoza)
dulaglutide (Trulicity)
55
Q

Indications GLP-1 receptor agonsit (-TIDES)

A

T2DM

weight loss

56
Q

GLP-1 (-TIDE) Receptor Agonist safety

A

pregnancy: risk of fetal harm
Hypersensitivity
hypoglycemia (dose-dependent), GI s/s nausea, vomiting, diarrhea, constipation, pancreatitis, renal insufficiency, increased risk for CA: medullary thyroid and theoretical risk with multiple endocrine neoplasms (MENs)

57
Q

BBW GLP-1 Receptor Agonist

A

Risk of thyroid C-cell tumors.

Semaglutide is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

58
Q

other use for semaglutide

A

Semaglutide is gaining popularity as an anti-obesity medication

PC 707 Pharmacology (39 decks)

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