pharm antidiabetic part 1 Flashcards
HA1C levels of diabetic
6.5 %
blood fasting glucose of a diabetic
> 7 mmol/l
other signs of diabetes
polyuria, phagia and dipsia, weight loss, fatigue, blurred vision
type 1 diabetes
lack of insulin or production of defective insulin
what percent of cases are type 1 diabetes
fewer than 10%
complications of diabetes
diabetic ketoacidosis and hyperosmolar hyperglycemic state
type 2 diabetes is caused by
insulin deficiency and insulin resistance
what happens in type 2 insulin resistance
reduced number of receptors or receptors become less responsive
type 2 diabetes comorbid conditions
obesity, coronary heart disease, dyslipidemia (high cholest), hypertension, microalbuminemia (protein in urine), risk for stroke
do ppl develop type 2 diabetes after giving birth
usually goes away after birth but 30% of ppl get it within next 10-15 years
long term complications of diabetes (macrovascular)
coronary arteries (mycardial infraction), cerebral arteries (stroke), peripheral vessels (PVD)
long term complications of diabetes (microvascular)
retinopathy, neuropathy, nephropathy
prediabetic HA1C levels
6-6.4%
prediabetic fasting plasma glucose levels
6.1>6.9
how often should diabetic screening happen for 40yo
every 3 years
does type 1 always require insulin therapy
yes
lifestyle changes for type 2
weight loss, diet, stop smoking and drinking , exercise
glycemic goal of treatment (ha1c, fasting and postprandial)
ha1c- less that 7%
fasting- 4-7 mmol/l
2 hour postprandial-5-10 mmol/l
treatment for type 1diabetes
insulin therapy
treatment for type 2 diabetes
lifestyle changes, oral drug therapy, insulin when there’s no more glycemic control
insulin restores the diabetic pts ability to
-metabloize carbs, fats and proteins
- store glucose in liver
- convert glycogen to fat stores
rapid acting insulin
insulin lispro
short acting insulin
regular insulin
intermediate acting insulin
insulin NPH
long acting insulin
insulin detemir and glargine
rapid onset of action of insulin
10-15 minutes
insulin peak
1-2 hours
insulin duration rapid
3-5 hours
does the pt need to eat after an insulin injection
yes
examples of rapid-acting insulin
insulin lispro and insulin aspart
both have rapid onset, short lasting, similar to endogenous insulin
how is rapid-acting insulin given
subcutaneously or continuous subcutaneous infusion pump
short acting insulin examples
humulin R and novolin ge Toronto
short acting insulin routes of administration
IV bolus, IV infusion, intramuscular
onset of short acting insulin
30 min
peak of short acting insulin
2-3 hours
duration of short acting insulin
6.5 hours
Insulin NPH other name
insulin isophane suspension
milky
onset- 1-3 hrs
peak- 5-8 hrs
duration- up to 18
insulin glargine stuff (OPD and referred to as)
clear
referred to as basal insulin
usually dosed once daily
onset- 90 mins
peak- none
duration- 24 hrs
insulin detemir
duration- dose dependant
fixed combinations of insulin
humulin 30/70
novolin 30/70, 40/60, 50/50
what do the fixed combination insulins contain
- one intermediate acting
- either one rapid or one short
insulin contraindications
drug allergy and pts with pork restriction
insulin adverse effects
hypoglycemia, tachycardia, headache, treamors, blurred vision, dry mouth
insulin interactions (reduced effects)
result in elevated bg
B blockers, corticosteroids, epinepherine, thyroid hormones
insulin interactions (increased effects)
results in lowered bg
alc, anabolic steroids, ace inhibitors, sulfa drugs, MAOIs, salicylates
sliding scale insulin dosing
rapid acting or short acting insulin given according to blood glucose results.
sliding scale is mainly used for
hospitalized patients, pt on tube/enteral feeding
sliding scale disadvantages
insulin only administered when hyperglycemia occurs resulting in large swings of glucose control
basal bolus insulin dosing
preferred for hospitalized diabetics, mimics pancreas by delivering basal insulin constantly and then as needed as a bolus
basal insulin is _____ acting
long acting
insulin glargine
bolus insulin ex
insulin lispro or insulin aspart
injectable antidiabetic drug adverse effects
amylin agonist- nausea, anorexia
incretin mimetics- hemorrhagic pancreatitis, weight loss
