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Week 9 Notes Flashcards

1
Q

What is endogenous insulin?

A

Insulin made in the body.

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2
Q

Why do all type 1 diabetes patients require insulin therapy?

A

Their pancreas is not producing any or enough insulin.

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3
Q

What happens to beta cell function over time in type 2 diabetes?

A

Beta cell function decreases, leading to inadequate insulin production.

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4
Q

True or False: A type 1 diabetic patient may not need insulin if they have a pancreas transplant.

A

True.

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5
Q

What are some serious complications of delaying insulin therapy in type 2 diabetes?

A
  • Vision loss
  • Limb loss
  • Peripheral vascular disease
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6
Q

What is one use of insulin therapy aside from diabetes management?

A

Treatment of hyperkalemia.

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7
Q

What does basal insulin therapy maintain?

A

Normal blood glucose levels during fasting.

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8
Q

What does bolus insulin therapy cover?

A

Food intake to decrease post-meal blood glucose elevation.

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9
Q

List the types of insulin available.

A
  • Rapid-acting
  • Short-acting
  • Intermediate-acting
  • Long-acting
  • Ultra long-acting
  • Inhaled insulin
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10
Q

What is the onset of action for rapid-acting insulin?

A

Within 15 minutes.

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11
Q

What are the three types of rapid-acting insulin analogues?

A
  • Insulin lispro
  • Insulin aspart
  • Insulin glulisine
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12
Q

What is the onset of action for short-acting insulin?

A

30 minutes.

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13
Q

What is the clinically relevant peak of action for short-acting insulin?

A

1 to 2 hours.

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14
Q

What type of insulin is NPH?

A

Intermediate-acting insulin.

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15
Q

What is a key characteristic of insulin glargine?

A

It does not have a pronounced peak of action.

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16
Q

What is the duration of action for ultra long-acting insulin degludec?

A

Up to 42 hours.

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17
Q

What is the onset of action for inhaled insulin?

A

Very rapid.

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18
Q

What is a major adverse effect of insulin therapy?

A

Hypoglycemia.

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19
Q

What can precipitate hypoglycemia in insulin therapy?

A
  • Too much insulin
  • Insufficient food
  • Excessive exercise
  • Drug interactions
  • Alcohol
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20
Q

What condition can occur due to inadequate insulin in type 1 diabetes?

A

Diabetic ketoacidosis.

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21
Q

What should be avoided when prescribing inhaled insulin?

A

Patients with chronic lung disease.

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22
Q

What should you do if a patient has experienced a hypersensitivity reaction to insulin?

A

Do not administer the insulin.

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23
Q

In pregnancy, which type of insulin is recommended?

A

Human insulin.

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24
Q

What lifestyle modifications can improve glycemic control in diabetes?

A
  • Regular aerobic and strength training exercises
  • Proper diet avoiding simple carbohydrates
  • Maintenance of lean body weight
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25
Q

What is the drug in the biguanides class available in the United States?

A

Metformin

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26
Q

What is metformin considered for type 2 diabetes mellitus?

A

First-line therapy

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27
Q

What are some actions of metformin?

A
  • Improves insulin sensitivity
  • Prevents liver from forming glucose
  • Decreases absorption of glucose by intestines
  • Can cause weight loss or be weight neutral
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28
Q

What are some adverse effects of metformin?

A
  • Gastrointestinal side effects (bloating, nausea, diarrhea)
  • Vitamin B12 deficiency
  • Headache
  • Lactic acidosis (rare)
  • Hypoglycemia (rare)
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29
Q

What is a serious adverse effect of metformin?

A

Lactic acidosis

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30
Q

What should be monitored in patients taking metformin?

A

Vitamin B12 levels

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31
Q

What are some contraindications for metformin use?

A
  • Severe renal dysfunction
  • Acute or chronic metabolic acidosis
  • Severe liver dysfunction
  • Use of IV contrast
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32
Q

What class of drugs are glyburide and glipizide part of?

A

Sulfonylureas

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33
Q

What is the primary action of sulfonylureas?

A

Increase insulin release from the pancreas

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34
Q

What is a major risk associated with sulfonylureas?

A

Hypoglycemia

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35
Q

What are some adverse effects of sulfonylureas?

A
  • Gastrointestinal upset
  • Weight gain
  • Disulfiram-like reaction with alcohol
  • Blood cell dyscrasias
36
Q

What should patients be educated about when using diabetes medications?

A

Signs and symptoms of hypo and hyperglycemia

37
Q

What are thiazolidinediones used for?

A

Type 2 diabetes mellitus

38
Q

What are the main drugs in the thiazolidinediones class?

A
  • Pioglitazone
  • Rosiglitazone
39
Q

What action do thiazolidinediones have on insulin?

A

Decrease insulin resistance

40
Q

What are some adverse effects of thiazolidinediones?

A
  • Weight gain
  • Edema
  • Heart failure
  • Elevated liver function tests
41
Q

What should patients monitor while on thiazolidinediones?

A

Weight and edema

42
Q

What are contraindications for thiazolidinediones?

A
  • History of hypersensitivity
  • Class III or IV heart failure
  • Acute coronary syndrome
  • Hepatic dysfunction
43
Q

What are the drugs in the alpha-glucosidase inhibitors class?

A
  • Acarbose
  • Miglitol
44
Q

What is the primary action of alpha-glucosidase inhibitors?

A

Delay carbohydrate digestion in the small intestine

45
Q

What are some adverse effects of alpha-glucosidase inhibitors?

A
  • Bloating
  • Gas
  • Diarrhea
  • Abdominal pain
46
Q

What should patients take alpha-glucosidase inhibitors with?

A

The first bite of a meal

47
Q

What is the primary action of meglitinides?

A

Increase insulin secretion from beta cells

48
Q

What are the drugs in the meglitinides class?

A
  • Nateglinide
  • Repaglinide
49
Q

Are meglitinides used as monotherapy or in combination?

A

Usually in combination

50
Q

What class of drugs do nateglinide and repaglinide belong to?

A

Insulin secretagogues

51
Q

How do insulin secretagogues like nateglinide and repaglinide function?

A

They cause more insulin to be secreted by the beta cells of the pancreas

52
Q

What happens to insulin secretagogues if beta cell function is lost?

A

They will not work

53
Q

What is the timing of administration for nateglinide?

A

1 to 30 minutes prior to meals

54
Q

What is the timing of administration for repaglinide?

A

30 minutes before meals

55
Q

What are some adverse effects of insulin secretagogues?

A

Hypoglycemia

56
Q

What should be considered when using meglitinides in patients with severe hepatic impairment?

A

Cautious use and possible dose adjustment

57
Q

What is a contraindication for using repaglinide?

A

History of myocardial ischemia

58
Q

In which conditions should SGLT2 inhibitors be cautiously used?

A

Severe hepatic impairment and severe renal impairment

59
Q

What is a key action of SGLT2 inhibitors?

A

Inhibit the reabsorption of glucose in the kidney proximal tubule

60
Q

What are some adverse effects associated with SGLT2 inhibitors?

A
  • Genital fungal infections
  • Urinary tract infections
  • Diabetic ketoacidosis
  • Bone loss and fractures
61
Q

What black box warning is associated with canagliflozin?

A

Risk of amputation

62
Q

What condition should SGLT2 inhibitors not be used to treat?

A

Diabetic ketoacidosis

63
Q

What are amylin agonists used for?

A

Type 1 and type 2 diabetes as second-line therapy

64
Q

What is the drug in the class of amylin agonists?

A

Pramlintide

65
Q

What are the effects of amylin agonists?

A
  • Slow down gastric emptying
  • Decrease glucagon secretion
  • Help with weight loss
66
Q

What is a significant adverse effect of amylin agonists when used with insulin?

A

Severe hypoglycemia

67
Q

What is the mechanism of action of DPP-4 inhibitors?

A

Slow down the breakdown of GLP-1

68
Q

What does GLP-1 do in the body?

A
  • Increases glucose-dependent insulin secretion
  • Suppresses glucagon secretion
  • Slows gastric emptying
69
Q

What are some adverse effects of DPP-4 inhibitors?

A
  • Renal dysfunction
  • Bullous pemphigoid
  • Stevens-Johnson syndrome
70
Q

What should be monitored when using DPP-4 inhibitors?

A

Renal function

71
Q

What are GLP-1 receptor agonists used for?

A

Type 2 diabetes as monotherapy or combination therapy

72
Q

What are some gastrointestinal side effects of GLP-1 receptor agonists?

A
  • Nausea
  • Vomiting
  • Diarrhea
73
Q

What serious adverse effect is associated with GLP-1 receptor agonists?

A

Pancreatitis

74
Q

What is tirzepatide?

A

A dual acting GLP-1 and GIP receptor agonist

75
Q

What should not be used in combination with GLP-1 receptor agonists?

A

DPP-4 inhibitors

76
Q

What is the importance of titration in administering GLP-1 receptor agonists?

A

Helps to avoid gastrointestinal side effects

77
Q

What is a contraindication for using GLP-1 receptor agonists?

A

History of pancreatitis

78
Q

What should be avoided when prescribing amylin agonists?

A

Gastroparesis

79
Q

What should not be used together with DPP-4 inhibitors due to lack of evidence for improved glycemic control?

A

These medications

DPP-4 inhibitors have no proven benefit when combined with certain other medications.

80
Q

What type of insulin can be used with medications mentioned in the text?

A

Basal insulin

The combination depends on the clinical situation of the patient.

81
Q

What is tirzepatide classified as?

A

A dual acting GLP-1 and GIP receptor agonist

Tirzepatide acts on both GLP-1 and GIP receptors.

82
Q

What are the actions of tirzepatide similar to?

A

GLP-1 receptor agonists used alone

The effects and adverse effects mirror those of GLP-1 agonists.

83
Q

What must be present for tirzepatide and GLP-1 to work?

A

Glucose

Both drugs are incretin hormones that require glucose for action.

84
Q

True or False: Both tirzepatide and GLP-1 receptor agonists can work without glucose.

A

False

Their efficacy is dependent on the presence of glucose.

85
Q

What condition is relevant to the pathophysiology discussed in the text?

A

Type 2 diabetes

Understanding the pathophysiology of type 2 diabetes is crucial for the use of these drugs.

PHARM (12 decks)

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