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Pharmacology > 47. Antidiabetic Medications > Flashcards

47. Antidiabetic Medications Flashcards

1
Q

causes of hyperglycemia (ominous octet)

A
  • decreased glucose uptake (muscles)
  • NT dysfunction
  • increased hepatic glucose production
  • increased glucagon secretion
  • decreased insulin secretion
  • decreased incretin effect
  • increased lipolysis
  • increased glucose reabsorption (kidneys)
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2
Q

MOA of insulin

A
  • promote use of glucose by body cells

- store glucose as glycogen in muscles

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3
Q

Meds that increase glucose (need higher insulin dose)

A
  • thiazides
  • glucocorticoids
  • estrogen
  • thyroid drugs
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4
Q

Meds that decrease glucose (need lower insulin dose)

A
  • TCAs
  • MAOIs
  • ASA (not major)
  • oral anticoagulants (not major)
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5
Q

3 types of rapid-acting insulin (clear)

A
  • lispro
  • aspart
  • glulisine
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6
Q

onset of action, peak, and duration of rapid acting insulin

A
  • onset: 15-30 min
  • peak: 30-90 min
  • duration: 3-5 hrs
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7
Q

type of short-acting insulin (clear)

A

regular

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8
Q

onset of action, peak, and duration of short-acting insulin

A
  • onset: 30 min
  • peak: 2.5-5 hrs
  • duration: 4-12 hrs
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9
Q

type of intermediate-acting insulin (cloudy)

A

NPH (insulin isophane)

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10
Q

onset of action, peak, and duration of intermediate-acting insulin

A
  • onset: 1-2 hrs
  • peak: 4-12 hrs
  • duration: 14-24 hrs
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11
Q

type of long-acting insulin (clear)

A

glargine

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12
Q

onset of action and duration of long-acting insulin

A
  • onset: 1-1.5 hrs

- duration: 24 hrs

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13
Q

when is long-acting insulin generally given

A

once a day (in morning or at bedtime)

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14
Q

What types of insulins are combined together?

A
  • short and intermediate

- rapid and intermediate

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15
Q

when is rapid-acting insulin given

A

0-15 minutes before meal

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16
Q

when is short-acting insulin given

A

about 30 minutes before a meal

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17
Q

when is intermediate-acting insulin given

A

AC & HS (before meals and before bed)

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18
Q

insulin injection sites

A
  • ABD
  • arm
  • thighs
  • buttocks
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19
Q

What class of medication is Metformin

A

Biguanides

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20
Q

MOA of metformin

A
  • decreasing hepatic production of glucose from stored glucose (prevents rise in glucose but doesn’t cause drop in glucose)
  • may increase insulin receptor sensitivity
21
Q

Why isn’t metformin recommended for patients w/ renal impairment?

A

they are at risk for lactic acidosis

22
Q

Why should metformin be held 48 hours before and after a procedure using contrast dye?

A

can cause renal failure or lactic acidosis

23
Q

side effects of metformin

A
  • nausea

- diarrhea (biggest complaint)

24
Q

T/F: metformin causes renal failure

A

False; drug is not damaging but can cause lactic acidosis if kidneys can’t clear the medication

25
Q

What class of medication is glipizide

A

sulfonylurea (chemically similar to sulfa abx)

26
Q

MOA of glipizide

A

directly stimulates beta cells to secrete insulin (onset in 90 minutes -> given before meal)

27
Q

Side effects of glipizide

A
  • weight gain (can make type 2 DM worse)

- does not work longterm

28
Q

What class of medication is sitagliptin phosphate

A

incretin modifier (DPP4 inhibitor)

29
Q

MOA of sitagliptin phosphate

A

increases level of incretin hormones -> increases insulin secretion and decreases glucagon secretion to reduce glucose production

30
Q

Use of sitagliptin phosphate

A

adjunct to tx w/ exercise and diet to reduce fasting and post-prandial glucose levels

31
Q

What class of medication is Dulaglutide?

A

glucagon-like peptide 1 agonists

32
Q

MOA of dulaglutide

A
  • enhancement of glucose-dependent insulin secretion
  • slowed gastric emptying
  • reduction of postprandial glucagon and food intake
33
Q

side effects of dulaglutide

A
  • GI distress (due to slowed gastric emptying)
  • hypoglycemia (due to combo of meds)
  • weight loss
34
Q

how is dulaglutide administered

A

injectable given once a week

35
Q

What class of medication is Empagliflozin

A

selective sodium-glucose transporter 2 (SGLT-2)

36
Q

MOA of Empagliflozin

A

promote renal excretion of glucose (does not change amount of urine produced)

37
Q

contraindications for Empagliflozin

A

GFR < 45 or Hx of DKA

38
Q

side effects of Empagliflozin

A
  • candidiasis (genital yeast infection)
  • cystitis
  • hypoglycemia (due to combo of meds)
  • hypotension (glucose in urine takes water with it)
39
Q

What class of medication is Rosiglitazone

A

Thiazolidinediones (TZD)

40
Q

MOA of Rosiglitazone

A

decrease insulin resistance and improve blood glucose control

41
Q

contraindications of Rosiglitazone

A
  • not to be used for mono therapy

- class 3 and 4 heart failure due to dose-related fluid retention

42
Q

What class of meds are meglitinides like Repaglinide similar to?

A
  • similar to sulfonureas (Glipizide)
  • simular MOA (stimulate beta cells to release insulin)
  • similar side effects
43
Q

contraindications of Repaglinide

A

liver failure due to decreased liver metabolism rate -> leads to drug accumulation and hypoglycemia

44
Q

What class of medication is Acarbose

A

Alpha-Glucosidase inhibitors

45
Q

MOA of Acarbose

A

inhibits digestive enzymes in the small intestine responsible for release of glucose from the complex cards in the diet

46
Q

Use of Acarbose

A

intended for pts who don’t achieve results w/ diet alone

47
Q

T/F: Acarbose causes hypoglycemia

A

False; simply delays glucose release which reduces post-prandial hyperglycemia

48
Q

What drugs is used for hypoglycemia

A

Glucagon (hypoglycemia emergency drug)

49
Q

How to treat hypoglycemia in alert and unconscious patients

A
  • alert: give oral glucose (juice (short acting) and food (longer acting))
  • unconscious: D50 IV push if IV access; glucagon injection if no IV access

Pharmacology (22 decks)

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