Week 2 - Diabetes Meds Flashcards
what is the MOA of alpha-glucosidase inhibitors
- delay absorption of carbs in the intestine = reduces the rise in BG after a meal
- does this by blocking the anzyme alpha-glucosidase which is responsible for breaking down carbs
what are the 5 categories of insulin?
- rapid acting
- short acting
- intermediate acting
- long-acting
- combination insulin
what are incretin mimetics also known as?
- glucagon-like peptide 1 receptor agonists
what is the treatment for type 2 diabetes? (3)
- lifestyle changes
- oral drug theraoy
- insulin when the above no longer provide glycemic control
list the effects of incretin hormones (4)
- slow gastric emptying (digestion)
- stimulate glucose-dependent pancreatic release of insulin
- inhibit post prandial release of glucagon
- decreases appetite
describe the duration, onset of action, and peak of long-acting insulin
- duration = up to 24 hrs
- onset = 1-3 hr
- no peak
what is the prototype of sulfonylureas
- glyburide (diabeta)
what type of insulin cannot be combined with other insulins?
long acting
when is rapid-acting insulin given? why?
- given with meals –> either with, immediately before, during, or immediately after
- purpose: to counteract postprandial BG spike
- also, rapid acting is very intense, so the food will avoid hypoglycemia as well
what is the purpose of rapid acting insulin?
- they are administered in associated with meals to control the postprandial rise in BG
describe the duration for rapid-acting insulin
- shorter duration
when is long acting insulin given?
- at the same time each day
how do DPP-4 inhibitors and incretin mimetics differ?
both incretin agents but…
- DPP-4 inhibitors = boost the effects of incretin hormones by slowing their degradation by the enzyme DPP-4
- incretin mimetics = boost the effects of incretin hormones by activating receptors for GLP-1
what is the prototype of apha-glucosidase inhibitors
- acarbose (glucobay)
what are incretin hormones
- endogneous compounds that stimulate the glucose-dependent release of inulin & suppress release of glucagon
allergic cross sensitivity may occur with sulfonylureas & _____ (2)
- loop diuretics
- sulfonamide antibiotics
what are 2 types of long acting insulin
- glargine (lantus)
2. detemir (levemir)
SGLT-2 inhibitors are _____ and _____ protective
-renal & cardio
should long acting insulin be given with food?
- it can be given without food
can long-acting insulin be administered IV?
- no, it is chemically modified
why does weight loss occur with SGLT-2 inhibitors?
- bc loss of calories in urine
list 3 examples of rapid acting insulin
- insulin lispro (humalog)
- insulin aspart (novolog)
- insulin glulisine (apidra)
list 3 things that may reduce hypoglycemic effects
- corticosteroids
- adrenergics
- thiazides`
what types of insulins can be mixed?
- short-acting
- NPH (intermediate)
typically, how long does it take for BG to increase after meals
- 15min - 1 hr
what can sulfonylureas negatively interact with? what does this cause?
- beta blockers
= unawareness of SNS symptoms like tachycardia if the pt becomes hypoglycemic
why is there side effects of gential yeast infections & UTIs with SGLT-2 inhibitors?
- increased conc of glucose in the urine
what is a prototype of glinides
- repaglinide (prandin)
what is the MOA of incretin mimetics?
- activate receptors for GLP-1 = cause the same effects of incretin hormones
what is the treatment for type 1 diabetes?
- insulin therapy
what are 2 types of DPP-4 inhibitors
- stigaliptin
2. alogliptin
what is a prototype of glitazones/thiazolidinediones
- rosiglitazone (Avandia)
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describe the administration of short-acting insulin
- only insulin product that can be given by IV bolus, IV infusion (bc it is unmodified)
- can be given IM and subcut as well
list 2 side effects associated with GLP-1 receptor agonists
- weight loss
- nausea (goes away w time)
what are the primary adverse effects of metformin (5)
primarly affects the GI tract:
- abdominal bloating
- cramping
- nausea
- diarrhea
- feeling of fullness
what do biguanides NOT do? what does this cause?
- does not increase insulin secretion from the pancreas
- therefore, biguanides do not have a risk of hypoglycemia
what is the MOA of glinides/meglitinides
- same mechanism of sulfonylureas –> stimulation of pancreatic insulin release
- except shorting acting & non-sulfa
why cant rapid acting insulin be given via IV
- it is chemically modified which means it will irritate the veins
what is the MOA of dipeptidyl peptidase 4 (DPP-4) inhibitors
- enhances the actions of incretin hormones
- does so by inhibiting DPP-4, an enzyme that inactivates incretin hormones
why are TZDs unpopular? (4)
- can cause weight gain (due to increased fat storage)
- fluid retention
- CV risk
- fractures
list the 8 families of oral antidiabetic drugs
- biguanides
- sulfonylureas
- meglitinides/glinides
- thiazolidinediones/glitazones
- alpha-glucosidase inhibitors
- sodium-glucose cotransporter 2 inhibitors
- dipeptidyl peptidase 4 (DPP-4) inhibitors
- incretin mimetics
what is the onset and peak for rapid-acting insulin
- onset = 10-15 min
- peak = 30-90 min
what is long-acting insulin also referred to as? why?
- basal insulin
- bc it gives the body a steady, low level insulin to maintain BG
describe the onset, duration, and peak of isophane insulin (humulin N)
- onset = 1-3 hr
- more prolonged in duration than endogenous insulin
- peak = 4-8 hr
what is the first line of oral antidiabetic drugs?
- biguanides
since sulfonylureas work by stimulating insulin secretion, what must be present for sulfonylureas to be effective?
- beta cells must be present –> will not work in patients with type 1
what is the goal of insulin therapy?
- tight glucose control
- to reduce incidence of long-term complications
list 3 other adverse effects of metformin
- may cause metallic taste
- reduced B12 & folic acid absorption
- hepatic induced lactic acidosis –> rare but lethal
what must meglitinides be taken with? why?
- must be taken with meals
- because they are shorter actin =more intense effect
when should you use caution when giving metformin
- use caution with renal dysfunction –> metformin is excreted unchanged by the kidneys = can build up toxic levels if kidney impairment
what is the main side effect of alpha-glucosidase inhibitors
GI upset:
- flatuelnce
- cramos
- abdominal distension
- diarrhea
describe the appearance of long-acting insulin
- clear, colorless solution
what 2 types of insulin should always be given in conjuction w caloric intake?
- rapid & short acting
what is a type of intermediate-acting insulin
- isophane insulin suspension (NPH or humunlin-N)
how do sulfonylureas promote insulin release?
- they bind with ATP-sensitive K+ channels in the cell membrane
- this causes the membrane to depolarize, causing an influx of Ca++, causing insulin release
describe the administration of rapid acting insulin
may be given :
- SC
- via continuous SC infusion pump
- NOT iv
what is insulin derived from?
- human-derived using recombinsnt DNA tech
list 2 examples of combined insulin
- NPH 70% and regular insulin 30% = Novulin 30/70
2. NPH 50% and regular insulin 50% = Humulin 50/50
what should you be cautious about when giving sulfonylureas?
- caution in sulfa allergy
what is the MOA of thiazolidinedione (glitazones) (2)
- increases cellular response (sensitized tissue)
2. partly decreases liver production of glucose
what are 2 major side effects of sulfonylureas
- hypoglycemia
- weight gain
what are glinides a good alternative for?
- good for patients who cannot take sulfonylureas
how many families of oral antidiabetic drugs are there?
8
what is a type of short-acting insulin
- regular insulin (Humulin R)
what is the prototype of biguanides?
- metformin (glucophage)
when is short-acting insulin given?
- ~20-30 min before or with meal
what is the MOA of biguanides (3)
- inhibits glucose production by the liver
- sensitizes insulin receptors in tissues –> increased uptake of glucose
- slightly reduces glucose absorption in the gut
what is the MOA of sulfonylureas
- stimulate insulin secretion from the beta cells of the pancreas = increased insulin levels
list 5 side effects of SGLT-2 inhibitors
- gential yeast infections
- UTIs
- weight loss
- increased urination
- low bp
sulfonylureas have an increased hypoglycemic effect with… (3)
- alcohol
- anabolic steroids
- & other drugs
why cant insulin be given orally?
- due to its peptide structure, it would be inactivated by the digestive system
what is the action of insulin lispro
- similar action to endogenous insulin
if an episode of hypoglycemia occurs while taking alpha-glucosidase inhibtors, what cant you do? why not?
- cannot take simple sugar bc the acarbose will delay the absorption
describe the appearance of isophane insulin (humulin N)
- cloudy appearance
is there a risk of hypoglycemia with GLP-1 receptor agonists? why or why not?
- low risk
- bc insulin secretion is glucose dependent
what is a prototype of SGLT-2 inhibitors?
- canagliflozin (invocana)
what is the onset of action, duration, and peak for short-acting insulin
- onset = 30-60 min
- short duration
- peak = 2-3 hr
what is the MOA of sodium-glucose co-transporter 2 inhibitors?
- inhibits the sodium-glucose co-transporter 2 in the kidney = prevents reabsorption of glucose = increase urinar excretion of glucose
when is intermediate insulin given? why?
- early am or at HS
- to cover in the background over the course of day or overnight
what is an example of incretin mimetics (GLP1 receptor agonists)
liraglutide (saxenda)
