Pharm One Final 5 - antidiabetics Flashcards
Name three different types of insulin medications
- Oral Hypoglycemics Type 2
- Insulin SubQ
- Non Insulin injectables
Normal fasting Blood Sugar?
60-100 mg/dl
goal for diabetics less than 150. diabetics adapted to a higher level of Blood Glucose
Symptoms of HYPOGLYCEMIA
Blood sugar less than _____
Cold and Clammy (wet) -Give them Candy (Glucose)
- Headache, light headedness
- Nervous
- Tremor
- Sweating, cold clammy skin
- Tachycardia
- Slurred speech, memory lapse, confusion
- Seizures
BLOOD SUGAR LESS THAN 60
HYPERGLYCEMIA
Blood Sugar greater than ____
High and Dry
- Extreme thirst
- Polyuria (losing urine)
- Fruity breath odor
- Rapid and thready pulse
- Dry MM, poor skin turgor
- Deep, rapid, labored breathing - KUSSMAUL BREATHING
Blood Glucose Greater than 250
HIGH and DRY
Three Types of Insulin
List Onset, Peak and Duration
MUST KNOW THE PEAK of EACH
Onset, Peak, and Duration
Rapid 30 min, 2.5 - 5 hours, 4-12 hours. Lispro
Intermediate 1-2 hours, 4-12 hours, 14-24 hours. NPH
Long. 1-1.5 hours, 6-8 hours, 24-42 hours
PEAKS: 2.5 - 5 ** 4-12 ** and *** 6-8 hours
Symptoms/Hypoglycemic will happen during the PEAK
When is rapid or short acting Insulin given?
30-60 minutes before meals
LISPRO 15 minutes
Name Rapid or Short acting Insulins
LISPRO - most common
Human Insulin Aspart
Insulin Glulisine
Human oral inhalation insulin (very fast acting - 15 minutes)
Regular insulin is not quite as fast as rapid
Clear liquid. LI=LIGHTENING =FAST
Name an intermediate acting Insulin
NPH - cloudy. contains protamine prolongs action
Onset 1-2 hours
Peak 4-12 hours
Duration 14-24 hours
N=Not Fast=Intermediate
Name a long acting Insulin
Glargine (Amylin Analogues) Given once a day, usually bedtime, rare hypoglycemia Onset 1-1.5 hours Peak 6-8 up to 12 hours Duration 24-42 hours
Can oral antidiabetic drugs be used for TYPE 1?
No, Only Type 2
Under what conditions would you LOWER the dose of an oral antidiabetic drug?
Patient -Eating less -N/V -Stomach virus -NPO going to surgery decrease dose or d/c
SULFONYLUREAS - side effects
oral antidiabetic drug
SULFONYLUREAS (ie GLIPIZIDE) - side effects
different from other oral antidiabetic drugs
Side effect
Hypoglycemia. Tachycardia.
Similar to too much insulin
Used for TYPE 2 only
SULFS/Cell Phone
SULFONYLUREAS -
Who cannot use them?
What do they interact with?
LIVER and KIDNEY disease
ASA (aspirin), NSAIDS Anticoags, MAOI, (Psych drug) Sulfonamides, NO (nitrous oxide). ETOH
SULFONYLUREAS
Name common 2nd gen
GLIPS
GLIPIZIDE GLYBURIDE, GLIMEPIRIDE
Decreases glucose production by the liver
Increases tissue response to insulin
NONSULFONYLUREAS
Name a common one
BIGUANIDES - *METFORMIN* Decreases hepatic production of glucose from stored glucagon Reduces glucose following a meal Decreases glucose from small intestine Does not cause hypoglycemia
What is only approved med for prediabetes?
Metformin - a nonsulfonylurea
METFORMIN and IV CONTRAST
Renal Impairment Potential with IV CONTRAST
Withhold METFORMIN for 48 hours before and after IV contrast
to prevent ARF or **Lactic acidosis
Name Alpha-Glycosidase Inhibitors
PO for Type 2 Diabetes
KNOW THE SIDE EFFECTS FOR TEST
ACARBOSE - for those who cannot watch diet. Inhibits the ENZYME that releases glucose from complex carbs.
MIGLITOL - same as above BUT side effect of hypoglycemia with sulfonyurea or insulin
Side Effects - ***GI Disturbance, pain, gas, diarrhea
Ends in ASE (enzyme). Ends in OSE (sugar)
Ends in -ITOL (sugar substitute)
THIAXOIDINEDIONES (INSULIN ENHANCING AGENTS)
PO Type 2 Diabetes
Contraindicated for….
*****CHF stage 3 and 4 and “GLITAZONE”. Fluid ZONE
promotes FLUID RETENTION
It decreases insulin resistance and improves blood glucose control
Pio-glitazone
Rosi-glitazone
NOT WITH CHF. FLUID RETENTION
INCRETIN MIMETICS/Modifiers
PO Type 2 Diabetes
Name 3
Side Effects
INCRETIN - “TIDE” the TIDE IS “IN”cretin
Improve BETA CELL Responsiveness
THYROID CANCER and PANCREATITIS
Exenatide
Liraglutide
Dulaglutide (Victoza, Ozempic, Trulicity)
**Thyroid cancer - watch for lumps in the neck
Increased risk of pancreatitis
Type 2 only as Type 1 will never make enough Insulin for this drug. Triggers pancreas to make more insulin
THYROID CANCER - Lump in the neck
AMYLIN ANALOGUES
Sub Q Type 2 Diabetes
PRAMLINTIDE. Pram-LIN-tide
improves postprandial glucose for those taking insulin without appr control
Sub Q
SLOWS GASTRIC EMPTYING
AMYLIN- pramLINtide
Treating MINOR Hypoglycemic Episodes
15- 20 grams of fast-acting carbs (ie juice)
If symptoms continue after 15 minutes, repeat.
Want to add PROTEIN to level Glycemic index
CHEESE SANDWICH
Preventing Hypoglycemic Episodes
- Follow hypoglycemic diet
- Reduce simple sugars. -Increase complex carbs
PROTEIN
- Do not eat a sweet snack without eating protein
- Bedtime snacks should contain protein.
- 50-60 % of the protein will become glucose in 3-4 hours
- Insulin rxn, fast acting carb with protein to stop glucose from dropping later.
Why are patients given insulin in the hospital when they are NOT diabetics?
Elevated blood sugar contributes to infections and poor wound healing.
Contributing factors to raising glucose levels.
- steroids
- Iv solutions with dextrose
Patient may NOT need insulin on discharge, but will need to be monitored.
