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From Flashcardlet > Antidiabetic Meds > Flashcards

Antidiabetic Meds Flashcards

1
Q

What medication is in the Biguanide class?

A

Glucophage (metformin) and glucophage XR

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2
Q

How often should you take Glucophage (metformin)?

A

2-3 times a day

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3
Q

What lowers A1c by 1-2% and decreases glucose production

A

Metformin (glucophage)

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4
Q

What drug Is weight neutral or weight loss and is FIRST line of therapy after diet and exercise

A

Metformin

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5
Q

What are the GI side effects of Metformin?

A

Anorexia, nausea, diarrhea

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6
Q

When should Glucophage/Metformin be discontinued

A

on morning when patient may have general anesthesia or a procedure with contrast dye

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7
Q

What are the 1st generation sulfonlyureas?

A

Orinase and diabenese

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8
Q

What are the 2nd generation sulfonlyureas?

A

Glucotrol, glynase, diabeta, Glyburide, Glipizide

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9
Q

Tends to have fewer side effects but are more predictable and expensive

A

2nd generation sulfonlyureas

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10
Q

3rd generation sulfonlyureas

A

Amaryl, Glimepiride

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11
Q

Main site of action for sulfonlyureas

A

Pancreas, stimulates beta cell production by pancreas

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12
Q

Side effects of sulfonlyureas

A

Hypoglycemia and weight gain

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13
Q

How much do sulfonlyureas lower A1c?

A

1-2%

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14
Q

What are the drugs in the Meglitinides class?

A

Prandin (repaglinide) and starlix

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15
Q

Meglitinides main site if action

A

Pancreas (stimulates pancreas to produce more insulin)

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16
Q

Side effects of meglitinides

A

Hypoglycemia and weight gain

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16
Q

Onset more rapid than sulfonlyureas and duration shorter

A

Meglitinides

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18
Q

Alpha glucosidase inhibitor

A

Precose (acarbose) glyset (migitol)

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18
Q

When should meglitinides be taken?

A

3 times a day 15-20 minutes before each meal

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20
Q

Side effects if alpha glucosidase inhibitors

A

Flatulence, diarrhea, abdominal discomfort

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20
Q

What are the Alpha glucosidase inhibitor drugs?

A

Precose (acarbose) glyset (migitol)

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21
Q

Main site of action of alpha glucosidase inhibitors

A

Small intestine

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23
Q

What are the Thiazolidinediones drugs?

A

Actos (pioglitazone) and Avandia (rosiglitazone)

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23
Q

Side effects of thiazolidinediones

A

Weight gain (increase intravascular volume so may not be used in patients with CHF)

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24
Q

Main site of action for thiazolidibediones

A

Peripheral tissues

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25
Q

What function must be monitored for TZDs?

A

Liver

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26
Q

How much do TZDs lower A1c?

A

1-1.5%

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28
Q

What are the DPP4 drugs?

A

Januvia, onglyza, trajenta –DPP-4 inhibitor

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29
Q

What is the action of DPP4?

A

Increases insulin made in pancreas and decreases glucose produced by liver

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30
Q

How much do DPP4 lower A1c?

A

0.5-1%

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31
Q

Possible side effect of DPP4?

A

weight loss, nausea (rare), and pancreatitis

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32
Q

Where is DPP4 metabolized and excreted?

A

Metabolized in liver and excreted in kidneys

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33
Q

What is the Bile acid sequestrant drug?

A

Welchol

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34
Q

How much does Welchol lower A1c?

A

0.5-1%

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35
Q

What does Welchol also treat?

A

cholesterol, modest reduction in LDL

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36
Q

What are the GLP drugs?

A

Byetta, Victoza, pre filled injectable pens, Bydureon

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36
Q

Inject once daily

A

Victoza

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38
Q

How often is Victoza injected?

A

once daily

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39
Q

What Signals pancreas to make right amount of insulin after eating?

A

GLP - 1

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40
Q

Side effects of GLP-1

A

Nausea and vomiting

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41
Q

How much do GLP1 reduce A1c?

A

1-1.5%

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42
Q

What is the Hormone secreted by beta cells of pancreas which carry glucose from bloodstream into cells binding to receptors on the cell membrane allowing glucose to make energy?

A

Insulin

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43
Q

Controls post- prandial glucose spikes or correct hyperglycemia, covers amount of food eaten

A

Prandial insulin or bolts insulin

43
Q

Controls glucose in between meals and suppresses overnight hepatic glucose production, background insulin

A

Basal insulin

45
Q

What are the Rapid acting insulin U-100?

A

Humalog, novolog, apidra

46
Q

What is the Short acting insulin U-100?

A

Regular

47
Q

Long acting insulin

A

Lantus and Levemir

47
Q

Intermediate acting insulin

A

NPH

48
Q

Combination

A

Human 70/30, novolog mix 70/30, humalog mix 75/25, humalog mix 50/50

49
Q

What can you not mix with other insulin?

A

Lantus and Levemir

51
Q

how is basal insulin given?

A

Given as NPH twice daily
Glargine (Lantus) daily (and occasionally BID)
Detemir (Levemir) daily or BID

52
Q

Prandial or Bolus insulin

A

Rapid acting insulin analogue or regular

52
Q

What are the Prandial or Bolus insulin?

A

Rapid acting insulin analogue or regular

53
Q

Why don’t you mix lantus and Levemir with other insulin?

A

They can crystallize

54
Q

Lantus peak, onset and duration

A

Onset: 2-4 hours
Peak: none
Duration: 20-24 hours

55
Q

Regular (short acting) onset, peak, and duration

A

Onset: 30 min to 1 hour
Peak: 2-4 hrs
Duration: 4-8 hours

56
Q

What is being used more in insulin pump

A

U-500 R, 5X stronger than regular insulin

57
Q

Onset, peak, and duration or rapid acting insulin

A

Onset: 10-15 min
Peak: 1-2 hours
Duration: 3-5 hours

58
Q

Must be given no more then 15 min before eating but can be given immediately after meals

A

Rapid-acting

59
Q

Human 70/30 and human 50/50 onset peak and duration

A

Onset: 30 min to 1 hour
Peak: 2-10 hrs
Duration: 10-18 hrs

60
Q

Humalog 75/25 and humalog 50/50 onset peak and duration

A

Onset: 10-15 min
Peak: 1-3 hours
Duration: 10-16 hours

61
Q

Novolog 70/30 onset peak and duration

A

Onset 10-20 min
Peak 1-4 hours
Duration 10-16 hours

62
Q

Availability of insulin

A

All available in 10cc vials of U-100

63
Q

Expiration of insulin

A

Good for 30 days once opened or until expiration date if never opened and refrigerated

65
Q

Loss of subcutaneous fat in areas of repeated injection, need to rotate sites to prevent

A

Lipoatrophy

65
Q

What to teach about insulin

A

Insulin type, technique, response, storage, and complications

66
Q

What is lipodystrophy/lipohypertrophic?

A

Spongy swelling at it around injection site, need to rotate sites to prevent

67
Q

How often should glucophage XR be taken?

A

once a day

68
Q

Where is the main site of action for Metformin /Glucophage?

A

liver and peripheral tissues

69
Q

How does Metformin work at peripheral tissues?

A

enhances peripheral uptake by tissues

70
Q

How does Metformin work on the liver?

A

decreases the amount of glucose secreted by the liver, thus reducing glucose levels

71
Q

After discontinuation of Metformin, when can it be restarted?

A

do not restart for 48-72 hours until normal serum creatinine is documented

72
Q

What allergy needs to be checked for before administering sulfonylureas?

A

sulfa allergy

73
Q

What is the main action of sulfonylureas?

A

stimulates insulin production

74
Q

What is the action of meglitinides?

A

targets pp glucose to mimic insulin secretion

75
Q

What is the action of alpha glucosidase inhibitors?

A

slows digestion of starchy food in small intestine so absorption of sugar into blood is delayed helping prevent surge of it

76
Q

What is the action of thiazolidinediones?

A

increases sensitivity of peripheral tissues to insulin, thus improving glucose control

77
Q

What drug may exacerbate CHF due to increasing intravascular volume?

A

TZDs

78
Q

Which drug is an insulin sensitizer?

A

TZDs

79
Q

What drug increases glucose-dependent insulin release and suppresses glucagon secretion?

A

DPP4

80
Q

Welchol side effect?

A

constipation

81
Q

When should Byetta be administered?

A

inject twice a day within 60 min of bfast and dinner

82
Q

What is the effect of GLP-1 on liver and appetite?

A

Decreases glucose production by liver, reduces appetite

83
Q

How often is Bydureon given?

A

once weekly

84
Q

What is a gut-derived peptide?

A

GLP-1 Mimetics

85
Q

What does insulin enable?

A

cells to store and use carbohydrates, fat, and protein

86
Q

Levemir onset, peak and duration

A

onset: 3-8 hours
peak: none
duration: 5.7-23.2 hours

87
Q

when is Human 70/30 given?

A

30-45 min before eating

88
Q

What are the fastest absorption injection sites?

A

abdomen then deltoid then thigh

89
Q

Once opened, how long is insulin good for?

A

28 days in or out of the refrigerator (as long as it is stored at room temperature)

90
Q

What is fasting hyperglycemia resulting from nocturnal release of growth hormone secretion called?

A

dawn phenomenon

91
Q

When are the blood glucose levels increased with dawn phenomenon?

A

5:00-6:00 am

92
Q

How can dawn phenomenon be managed or prevented?

A

increasing the overnight insulin so check in the middle of the night

93
Q

What happens when morning hyperglycemia resulting for a counterregulatory response to nighttime hypoglycemia?

A

Somogyi Effect

94
Q

How is somogyi effect managed and prevented?

A

adequate dietary intake at bedtime (peanut butter snack) and evaluating insulin dose or PM exercise

95
Q

What are insulin pumps?

A

Small, electronic device which deliver insulin by way of basal/bolus insulin

96
Q

What are the pros and cons to insulin pumps?

A

Offer convenience and flexibility
Less blood glucose variability
Expensive

97
Q

What about hospital visits may increase glucose?

A

stress, steroids, parenteral nutrition, inactivity, meds

98
Q

What in hospital visits may decrease glucose?

A

more rigid diet, observed compliance with regimen, meds

99
Q

How does exercise effect insulin?

A

Increased insulin sensitivity and Improves receptor performance
Increased numbers of receptors and lowers insulin requirements

100
Q

How does exercise effect glucose?

A

Improved glucose metabolism

101
Q

How does exercise effect circulation and stress?

A

Improved circulation

Stress management

102
Q

Is exercise safe in Type 1 diabetes?

A

exercise can be safe if individual does self glucose monitoring and gives multidose insulin
Must be VERY CAREFUL with exercise plan

103
Q

If have a insulin deficiency and blood glucose is elevated to 250 or more, what can happen with exercise?

A

exercise will make blood glucose increase due to hepatic glucose production

104
Q

How do you prevent exercise induced hypoglycemia?

A

eating protein/carbohydrate snack before exercise and every 30 minutes if sustained

From Flashcardlet (107 decks)

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