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Pharmacotherapeutics > Week 7- Drugs that control blood glucose > Flashcards

Week 7- Drugs that control blood glucose Flashcards

1
Q

Is the pancreas an endocrine or exocrine gland?

A

both endocrine and exocrine

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2
Q

Where are the endocrine hormones of the pancreas produced?

A

Produces hormones in the islets of langerhans

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3
Q

What exocrine function does the pancreas gland have?

A
  • releases sodium bicarbonate and pancreatic enzymes into the common bile duct to be released into the small intestines
  • neutralizes chyme
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4
Q

What ethnicities are as higher risk for diabetes?

A

hispanic, asian, aboriginal and …

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5
Q

What is insulin?

A
  • Hormone produced by the beta cells of the islets of Langerhan
  • Released into circulation when glucose levels around the cells rise
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6
Q

What does insulin do?

A
  • Released when glucose levels increase around the cells
  • Stimulates the synthesis of glycogen, the conversion of lipids into adipose tissue and the synthesis of needed protein from amino acids
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7
Q

Define hyperglycemia in occurrence of insufficient insulin

A

increased blood sugar

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8
Q

Define glycosuria in occurrence of insufficient insulin

A

Sugar in the urine

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9
Q

Define polyphagia in occurrence of insufficient insulin.

A

Increased hunger

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10
Q

Define polydipsia in occurrence of insufficient insulin.

A

increased thirst

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11
Q

Define lipolysis in occurrence of insufficient insulin.

A

Increased breakdown of fats

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12
Q

Define ketosis in occurrence of insufficient insulin

A

ketones cannot be removed effectively

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13
Q

Define acidosis in occurrence of insufficient insulin.

A

lover cannot remove all of the waste products

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14
Q

What are the metabolic changes that occur when there is insufficient Insulin released?

A 
Hyperglycemia
Glycosuria
Polyphagia
Polydipsia
Lipolysis
Ketosis
Acidosis
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15
Q

What is Diabetes Mellitus?

A
  • Complex disturbance in metabolism that affects carbs, proteins and fat metabolism
  • Signs: hyperglycaemia & glucosuria
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16
Q

What is normal glucose?

A

4-6 mmol/L

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17
Q

Consideration when checking for glucosuria…

A

in pregnancy it is common to have glucose in the urine

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18
Q

Define Atherosclerosis.

A

heart attach and stroke related to the development of atherosclerotic plaque in the vessel lining

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19
Q

Define retinopathy

A

with resultant loss of vision as tiny vessels in the eye are narrowed and closed

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20
Q

Define neuropathies

A

with motor and sensory changes in the feet and legs and progressive changes in other nerves as the oxygen is cut off

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21
Q

Define nephropathy.

A

with renal dysfunction related to changes in the basement membrane off the glomerulus

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22
Q

What are some disorders related to diabetes?

A
  • Atherosclerosis (macrovascular change)
  • Retinopathy (microvascular change)
  • Neuropathies
  • Nephropathy
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23
Q

How do you minimize associated disorders with diabetes?

A

tight glucose control

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24
Q

What are the classifications of diabetes mellitus?

A

Type 1- Insulin dependant diabetes mellitus (IDDM)

Type 2- Non-insulin dependent diabetes mellitus (NIDDM)

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25
Q

What are the characteristics of type 1 DM?

A
  • usually a rapid onset; seen in younger people

- connected in many cases to viral destruction of the beta cells of the pancreas

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26
Q

What are the clinical signs and symptoms of hyperglycaemia?

A

fatigue, lethargy, irritation, glucosuria, polyphagia, polysipsia, skin itching

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27
Q

What is more common, type 1 or type 2 DM?

A

type 2

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28
Q

What is type 2 DM caused by?

A

insulin deficiency and insulin resistance (reduced number of insulin receptors, or less responsive insulin receptors)

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29
Q

First line treatment for Type 2 diabetes is…

A

lifestyle changes

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30
Q

What things make you more susceptible to developing type 2 diabetes?

A
  • Increased risk African, aboriginal, south Asian
  • Gestational diabetes means you are more likely to develop type 2
  • Polycystic ovarian system are more likely to develop type 2
  • Cortical steroids and antipsychotics increase risk
  • High glycemic index and low exercise increase risk
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31
Q

What is OGTT?

A

oral glucose tolerance test

- for diagnosis of of DM 2hPG in a 75g OGTT would be greater than or equal to 11.1 mmol/L

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32
Q

What is A1C?

A
  • gives an average of blood glucose control over 2-3 months

- for diagnosis of DM, would be greater than or equal to 6.5% in adults

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33
Q

What is FPG?

A

fasting concentration of blood glucose (fasting meaning no caloric intake for at least 8 hr)
- for diagnosis of DM would be greater than or equal to 7.0 mmol/L

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34
Q

What is random PG

A

testing glucose concentration any time of day with out regards to the last meal
- for diagnosis of DM would be greater than or equal to 11.1 mmol/l

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35
Q

For a diagnosis of DM what criteria is met?

A
  • for diagnosis of of DM 2hPG in a 75g OGTT should be greater than or equal to 11.1 mmol/L
  • for diagnosis of DM, would be greater than or equal to 6.5% in adults
  • for diagnosis of DM would be greater than or equal to 7.0 mmol/L
  • for diagnosis of DM would be greater than or equal to 11.1 mmol/l
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36
Q

What type of weight puts you at higher risk of developing DM?

A

abdominal obesity

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37
Q

For controlling DM what are the recommendations for glucose control?

A
  • A1C less than or equal to 7%
  • Preprandial (before eating) PG between 4-7 mmol/L
  • 2-h postprandial PG between 5-10 mmol/L (5-8 mmol/L if AIC is not at target)
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38
Q

What does prandial mean?

A

relating to meals

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39
Q

What are the normal glucose ranges?

A

Normal ranges:

  • Fasting glucose 4-6 mmol/L
  • 2h after eating glucose should be 5-8mmol/L
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40
Q

What are the treatments for DM type 1?

A
  • Characterized by a lack of insulin production or the production of defective insulin
  • Insulin therapy
  • Oral antidiabetic drugs are not effective
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41
Q

What are the treatments for DM type 2?

A
  • Lifestyle changes
  • Oral drug therapy (help your pancreas start releasing it)
  • Insulin when the above no longer provide glycemic control
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42
Q

When are oral anti diabetic medications not effective?

A

When beta cells are not working

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43
Q

What are the routes for insulin?

A 
Routes for insulin
SC
IV
IM
Pump

NO INSULIN ORALLY- gets digested and is ineffective

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44
Q

What are the different types of anti diabetic drugs?

A
  • insulins

- oral hypoglycemic drugs

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45
Q

What is the action of insulin?

A
  • Hormone that promotes the storage of the body’s fuels
  • Facilitates the transport of various metabolites and ions across cell membranes
  • Simulates the synthesis of glycogen from glucose
  • Reacts with specific receptor sites on the cells
46
Q

What are the indications for insulin treatment?

A
  • Treatment of type 1 diabetes mellitus

- Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents

47
Q

What are the contraindications or cautions for insulin?

A

just one caution

- pregnancy and lactation

48
Q

What are the adverse effects of insulin treatment?

A

hypoglycemoia and ketoacidosis

49
Q

What drugs do insulins interact with?

A
  • when given with any drug that decreases glucose levels

- beta blockers

50
Q

What are the 4 categories of insulin?

A

Bolus (pradial) insulins

  • Rapid-actng insulin analogues (clear)
  • Short-acting insulins (clear)

Basal Insulins

  • Intermediate-acting insulins (cloudy)
  • Long-acting basal insulin analogue (clear)
51
Q

Name the 3 types of Bolus insulins.

A
  • insulin aspart (NovaRapid)
  • insulin glulisine (Apidra)
  • Insulin lispo (Humalog)
52
Q

What is the onset, peak and duration of rapid-acting insulin analogues?

A

Onset 10-15m
Peak 1-1.5h
Duration 3-5h

with slight variation in Humalog

53
Q

Name the 2 types of short acting insulins.

A
  • Insulin regular (Humulin-N)

- Insulin regular (Novolin geToronto)

54
Q

What is the onset, peak and duration of short acting insulins?

A

Onset 30m
Peak 2-3h
Duration 6.5h

55
Q

Name the 2 types of Intermediate-acting insulins (cloudy).

A
  • Insulin NPH (Humulin-N)

- Insulin NPH (Novlin ge NPH)

56
Q

What is the onset, peak and duration of intermediate-acting insulins?

A

Onset 1-3h
Peak 5-8h
Duration Up to 18h

57
Q

Name the 2 long-acting basal insulin analogues.

A
  • Insulin determir (Levemir)

- Insulin glargine (Lantus)

58
Q

What are the onset, peak, and duration of Long acting basal insulin analogues?

A

Onset 90m
Peak n/a
Duration Up to 24h

59
Q

Can you give rapid acting insulin IV

A

NO

60
Q

Which insulins can you NOT mix?

A

Long acting insulin analogues

61
Q

What is the only insulin that is given IV bolus, IV infusion, and IM?

A

Intermediate acting insulin-

Insulin regular

62
Q

When is basal insulin given?

A

once or twice a day

63
Q

When is Bolus insulin given?

A

at meal times

64
Q

What is hypoglycemia?

A

abnormally low blood glucose levels (below 4mmol/L if on insulin or secretagogue)

65
Q

When can hypoglycemia occur?

A
  • Starvation
  • Lowering the blood sugar too far with treatment of hyperglycemia
  • More physical activity
  • Not eating on time
  • Eating insufficient amounts
  • Alcohol consumption
66
Q

What kind of symptoms develop from hypoglycemia?

A

Neurogenic or neuroglycopenic symptoms

67
Q

What are some Neurogenic (autonomic) symptoms of hypoglycemia ?

A
  • Trembling
  • Palpitations
  • Sweating
  • Anxiety
  • Hunger
  • Nausea
68
Q

What are some Neuroglycopeic symptoms of hypoglycemia?

A
  • Difficulty concentrating
  • Confusion
  • Weakness
  • Drowsiness
  • Vision changes
  • Difficulty speaking
  • Dizziness
69
Q

What are the early symptoms of hypoglycemia?

A
  • confusion, irritability, tremors, sweating
70
Q

What are the later symptoms of hypoglycemia?

A
  • hypothermia, seizures

- coma and death

71
Q

What is the severity scale for hypoglycemia?

A

Mild

  • autonomic symptoms present
  • individual is able to self treat

Moderate

  • autonomic and neuroglycopenic symptoms
  • individual is able to self treat

Severe

  • Requires assistance of another person
  • Unconsciousness may occur
  • Plasma glucose is typically <2.8mmol/L
72
Q

What are the steps to address hypoglycemia?

A 
Recognize
Confirm
Treat (15g fast sugars)
Retest (15m)
Eat (usual snack/meal +15g carbs+protein)
73
Q

What are some examples of 15g simple carbs?

A
  • glucose tab
  • 15ml (3tsp) or 3 packets of sugar
  • 175ml juice or soft drink
  • 6 life savers
  • 1T honey (15ml)-not for children under the age of 1)
74
Q

How do you treat severe hypoglycemia in a conscious person?

A
  • Treat (20g)
  • Retest in 15m (ensure BG>4.0mmol/L) retreat if necessary
  • Eat (usual snack/meal +15g carbs+protein)
75
Q

How do you treat severe hypoglycemia in a unconscious person?

A
  • Treat glucagon SC or IM
  • Call 911
  • Discuss with diabetes health care team
76
Q

What is the IV solution used in severe hypoglycemia?

A
  • 50% dextrose in water (D50W)
77
Q

What route would glycogen be given?

A

IM or SC

78
Q

What is the action of glucose elevating agents (glucagon (GlucaGen))?

A

Increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose

79
Q

What is the indication for glucagon?

A

hypoglycemia

80
Q

What are the pharmacokinetics of glucagon?

A
  • rapidly absorbed and distributed throughout the body

- excreted in the urine

81
Q

What are contraindications and cautions of glucagon?

A

Contraindication: known allergy, pregnancy and lactation
Caution: hepatic dysfunction/CVD

82
Q

What are the adverse effects of glucagon?

A
  • GI upset and vascular effect
83
Q

What are the drug to drug interactions of glucagon?

A
  • thiazide diuretics

- Anticoagulants

84
Q

What blood glucose reading indicates that you should not be driving?

A
  • BG>5mmol/L

- When BG has been greater than 5mmol/L for 45 min then you can drive

85
Q

What is hyperglycemia?

A

BG greater than 11mmol/L

may happen during illness or stressful time

86
Q

What are the signs of hyperglycemia?

A 
Thirsty
Fatigue, lethary
Glycosuria
Polyphagia
Polydipsia
87
Q

With high glucose reading you should …

A
  • adjust medication and/or insulin
  • adjust meal plan
  • increase physics activity
88
Q

What are the signs of dangerous complications of hyperglycemia?

A
  • fruity breath
  • dehydration
  • Kussmaul’s resp
  • loss of orientation and coma
89
Q

What is a sliding-scale insulin dosing chart?

A

chart that indicates medication (SC short acting or regular insulin) dose to use based on glucose reading

90
Q

What does TPN stand for?

A

total parenteral nutrition

91
Q

When is a sliding-scale insulin dosing chart used?

A

typically used in hospital for patients on TPN or enteral tube feedings

92
Q

What do you need to know about insulin injections?

A
  • Need to know onset, peak, and duration of different types of insulin.
  • Mixed insulin combine rapid and intermediate insulin together.
  • Never shake insulin vials.
  • Gently rotate cloudy insulin vials between hands to resuspend the particles.
  • Regular insulin is the only insulin that is given IV.
93
Q

When mixing 2 insulins what are the steps taken?

A

For an order of 30 units humulin N and 10 units humulin R

  • Inject 30 units of air humulin N (intermediate)
  • Inject 10 units of air humulin R (short)
  • Withdraw 10 units of humulin R
  • Finally with draw with the same syringe 30 units humulin N for a total volume of 40 units
94
Q

Which insulin can you NOT contaminate short or long acting?

A

cannot contaminate short acting insulin

95
Q

What is included in treatment of T2DM?

A
  • oral antidiabetic meds (may only be effective with behaviour modification)
96
Q

What are the 4 points on the T2DM checklist for pharmacotherapy?

A
  • CHOOSE initial therapy based on glycemia
  • START with METFORMIN +/- others
  • INDIVIDUALIZE therapy (base on patient and agent)
  • REACH TARGET within 3-6m of diagnosis
97
Q

If initial A1C is less than 8.5% what are your treatment options?

A

Start metformin
OR
Reassess in 2-3 months then decide on starting metformin

98
Q

If initial A1C is equal to or greater than 8.5% what are your treatment options?

A

Start metformin
AND
Consider combo therapy to achieve greater than or equal to 1.5% A1C reduction

99
Q

What are the indications for biguanide (metformin (Glucophage)

A

adjunct to diet and exercise for the treatment of Type 2 diabetics older than 10 years of age

100
Q

What is the action of metformin (Glucophage)?

A

may increase the peripheral use of glucose, increase production of insulin, decrease hepatic glucose production and alter intestinal absorption of glucose

101
Q

What route are biguanides given?

A

PO

102
Q

What are the adverse effects of metformin?

A

Hypoglycemia, lactic acidosis, GI upset, nausea, anorexia, diarrhea, heartburn, allergic skin reaction

103
Q

What do you consider when choosing treatment after metformin?

A

Patient characteristics

  • Degree of hyperglycemia
  • Risk of hypoglycemia
  • Weight
  • Comorbidities
  • Access to treatment
  • Patient preference

Agent Characteristics

  • BG lowering efficacy &durability
  • Risk of inducing hypoglycemia
  • effect on weight
  • contraindications and side effects
  • cost and coverage
104
Q

What is the action of sulfonylureas?

A

Stimulate insulin release from the beta cells in the pancreas
They improve binding to insulin receptors

105
Q

What are the indications of sulfonylureas?

A

Adjunct to diet and exercise to lower blood glucose levels in type 2 diabetes

106
Q

What are the pharmacokinetics of sulfonylureas?

A
  • Rapidly absorbed from the GI tract and undergo hepatic metabolism
  • Excreted in the urine
  • Peak and duration varies with each drug
107
Q

Who is contraindicated for sulfonylureas?

A
  • Allergy
  • Diabetic complications
  • T1DM
108
Q

What are the adverse effects of sulfonylureas?

A

Hypoglycemia
GI distress
Allergic skin reactions

109
Q

What are the drug interactions of sulfonylureas?

A
  • Drugs that acidifies the urine
  • Beta blockers
  • Alcohol
110
Q

What considerations should you have for children taking anti diabetic agents

A
  • schedule
  • understanding/
    teaching
  • self-consepts
111
Q

What considerations should you have for adults taking anti diabetic agents

A
  • work schedule

- reproduction

112
Q

What considerations should you have for older adults taking anti diabetic agents

A
  • comorbid conditions (arthritis etc)

Pharmacotherapeutics (7 decks)

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