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Pharm 323 Spring 22 > diabetes - non insulin > Flashcards

diabetes - non insulin Flashcards

1
Q

what are the 6 types of non-insulin meds used to treat type 2 DM? (broad MOA, not class)

A
  1. sensitize body to insulin / control liver glucose production
  2. stimulate pancreas to make more insulin
  3. slow absorption of starches
  4. act on incretins
  5. manipulate glucose excretion by kidneys
  6. synthetic amylin
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2
Q

what are the 2 classes of drugs that sensitize the body to insulin and or control glucose production by the liver?

A
  1. biguanides - Metformin

2. glitazones (TZD) - pioglitazone

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3
Q

what is the prototype for biguanides?

A

metformin (Glucophage)

“BIGuanides [big guys] = MetFORMIN [four men]” important meds, know these

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4
Q

what is the MOA of metformin? (2)

A
  1. increases sensitivity to insulin / decreases insulin resistance
  2. decrease glucose production by liver
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5
Q

what is our DOC + 1st line therapy for tx of type 2 DM?

A

metformin

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6
Q

what are SE of metformin? (1 broad) + what is most common one?

A

GI effects

MOST COMMON = flatulence
“the farts of 4 men (formin)”

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7
Q

what is the rare AE of metformin? what patients do we often see this in?

A

lactic acidosis MEDICAL EMERGENCY

often in renal patients or liver disease

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8
Q

b/c of risk of lactic acidosis with metformin, what lifestyle education should we give these patients?

A

avoid ETOH excess!!!

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9
Q

what is the prototype for TZD/”glitazones”?

A

pioglitazone

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10
Q

what is the MOA of pioglitazone?

A
  1. decrease insulin resistance

2. decrease glucose production by liver

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11
Q

SE of pioglitazone (4)

there’s another card for more serious/AE

A
  1. URI
  2. sinusitis
  3. HA
  4. myalgias

= inflammation + pain

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12
Q

AE of pioglitazone (4)

A
  1. fluid retention (increased fluid reabsorption in kidneys)
  2. bladder cancer
  3. fractures (suppressed bone formation)
  4. unintended pregnancy (stimulates ovulation)
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13
Q

b/c of one of the AE of pioglitazone, this drug should be used cautiously in what population of patient?

A

HF patients or those at risk for fluid retention

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14
Q

when should metformin be given?

A

with meals

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15
Q

metformin puts people at risk for deficiencies of what? (2)

A
  1. B12

2. folic acid

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16
Q

describe the risk of hypoglycemia and metformin use…..

A

low risk of hypoglycemia when used as MONOtherapy

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17
Q

metformin therapy has a contraindication with what? why? what are the protocols?

this contraindication is not supported by current evidence, but may take time to reflect in clinical practice

A

IV contrast dye

can cause ARF –> leading to lactic acidosis

protocol: stop 1-2 days before IV contrast and 2 days after

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18
Q

what are the 2 classes of drugs that stimulate the pancreas to make more insulin?

A
  1. sulfonylureas
  2. meglitinides / “glinides”

“Secrete More, Please”
(Sulfonylureas Meglitinides Pancreas)

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19
Q

what is the prototype for sulfonylureas?

A

glipizide

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20
Q

what is the MOA of glipizide? (2)

A
  1. stimulates insulin release from the pancreas

2. increase sensitivity of insulin receptors

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21
Q

patients should have functioning _______ to use glipizide (based on MOA)

A

PANCREAS

must still be making insulin b/c this causes a release of insulin from islet cells

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22
Q

most common SE of glipizide

A

hypoglycemia

dose dependent

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23
Q

SE of glipizide (3)

A
  1. hypoglycemia
  2. weight gain
  3. antabuse effect w/ETOH “no SIPS with GLIPS”
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24
Q

what is prototype of meglitinides / “glinides”?

A

rePAglinide

stimulates PAncreas

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25
Q

what is MOA of repaglinide?

A

stimulate pancreas to release insulin

short duration + rapid onset - very similar to body

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26
Q

what is duration of repaglinide?

A

2-4 hrs

27
Q

when should we give repaglinide?

A

with meal or 30 mins before

28
Q

what is SE of repaglinide? (2)

A
  1. hypoglycemia**

2. weight gain

29
Q

the sulfonylureas and meglitinides have 2 SE in common. what are they? (think of mechanism of action)

A
  1. hypoglycemia

2. weight gain

30
Q

what drug class are drugs that slow the absorption of starches?

A

alpha-glucosidase inhibitors

31
Q

what is the prototype for alpha-glucosidase inhibitors?

A

acarbose

“A Carb, OH!!!!”

32
Q

what is MOA of acarbose?

A

blocks enzyme in gut that breaks down starches

33
Q

SE of acarbose (2 - one is long term)

A
  1. GI (abd cramping, diarrhea, flatulence, borborygmus) often intolerable
  2. long term –> liver dysfxn (elevation in other enzyme that damages liver)
34
Q

when should acarbose be taken?

A

w/ 1st bite of food

35
Q

does acarbose cause hypoglycemia?

A

NO, not as monotherapy

36
Q

if hypoglycemia develops from acarbose therapy, what does the patient need? what will NOT work?

A

patient needs oral glucose

sucrose won’t work b/c of how acarbose works

37
Q

what are incretins?

A

hormones released by intestine following a meal when blood glucose is elevated –> tell pancreas to increase insulin secretion and liver to stop producing glucagon

38
Q

what are the 2 drug classes that act on incretins?

A
  1. DPP-4 inhibitors “gliptins” (prevent the breakdown of incretins): sitagliptin
  2. GLP-1 receptor agonists (incretin mimetics): exenatide
39
Q

what is the prototype for DPP 4 inhibitors / “gliptins”?

A

sitagliptin

40
Q

what is MOA of sitagliptin?

A

enhance action of incretin hormones (for pts that can make insulin)

41
Q

SE of sitagliptin (1)

A

cold symptoms

“SIT down, get some LIPTIN tea, you have a cold”

42
Q

rare AE of sitagliptin (2)

A
  1. pancreatitis

2. hypersensitivity rxns

43
Q

what is the prototype for incretin mimetics/ GLP-1 receptor agonists ?

A

exantide

“incretins EXIT from the GI”

44
Q

what is MOA of exantide?

A

mimics actions of incretins (stimulate pancreas to release insulin)

45
Q

what is dosing/admin of sitagliptin?

A

one pill daily w/or w/o food

46
Q

what is dosing/admin of exantide?

A

subQ BID ; 30-60 mins BEFORE meal

you gotta go under the tide to swim (sub) and the tide goes out 2x/day + you should eat BEFORE so you have strength to swim

47
Q

SE of exantide (1 - broad)

A
  1. GI

* working on pancreas / GI system = GI effects*

48
Q

re: exantide and the GI side effects, what can we do to mitigate the nausea?

A

low fat diet ◡̈

49
Q

rare AE of exenatide (2)

A
  1. pancreatitis

2. hypersensitivity rxns

50
Q

exantide can cause hypoglycemia if combined with what drug class?

A

sulfonylureas

51
Q

re: oral drugs and exantide, what should happen regarding administration?

A

give oral drugs 1 hr before injection b/c exantide slows gastric emptying (incretin)

52
Q

what is the drug CLASS that mimics kidney excretion of glucose?

A

SGLT-2 inhibitors

“So much Glucoe is Leaving your Tubes”

canagliflozin

53
Q

what is the prototype for SGLT-2 inhibitors?

A

canagliflozin

“So much Glucose Leaving your Tubes”

“your GLucose is FLOwin’ into the CAN”

54
Q

what is MOA of canagliflozin?

A

increases glucose excretion through urine

55
Q

SE of canagliflozin (4)

A
  1. UG fungal infections (b/c of increased glucose)
  2. UTI
  3. polyuria
  4. weight loss
56
Q

canagliflozin puts patient at a risk of what (think what the MOA is…)

A

DEHYDRATION

“your GLucose is FLOwin’ into the CAN”

57
Q

rare/serious AE of canagliflozin (3)

A
  1. DKA
  2. urosepsis
  3. pyelonephritis (kidney infection)
58
Q

what is prototype for synthetic amylin / amylin mimetics?

A

pramlintide (Symlin)

“baby Amy Lin is in her little pram”

59
Q

what is MOA of pramlintide? (3)

A
  1. delays gastric emptying
  2. suppresses glucagon secretion
  3. decrease post meal glucose elevations
60
Q

what is admin (r/t food) / route for pramlintide? + interaction with oral meds?

A

subQ w/meals

give oral drugs 1 hr before pramlintide b/c of delayed gastric emptying

61
Q

what type of DM is pramlintide used with?

A

both type 1 and type 2 DM

62
Q

SE of pramlintide (2; 1 ONLY if used with another drug)

A
  1. nausea

2. hypoglycemia (only if used with insulin)

63
Q

nursing protocols for hypoglycemia tx (5)

will be on order, but some general ideas

A
  1. start with least invasive 1st if can swallow and alert + oriented + are not NPO
  2. 120 mL oj, non diet soda, spoon of honey, candy, glucose tabs
  3. foods with protein to sustain
  4. IV 50% dextrose
  5. glucagon

Pharm 323 Spring 22 (18 decks)

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