Antidiabetic Meds Flashcards by Karlee Porter

What medication is in the Biguanide class?

Glucophage (metformin) and glucophage XR

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How often should you take Glucophage (metformin)?

2-3 times a day

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

Metformin (glucophage)

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

Metformin

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What are the GI side effects of Metformin?

Anorexia, nausea, diarrhea

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When should Glucophage/Metformin be discontinued

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

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What are the 1st generation sulfonlyureas?

Orinase and diabenese

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What are the 2nd generation sulfonlyureas?

Glucotrol, glynase, diabeta, Glyburide, Glipizide

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

2nd generation sulfonlyureas

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3rd generation sulfonlyureas

Amaryl, Glimepiride

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Main site of action for sulfonlyureas

Pancreas, stimulates beta cell production by pancreas

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Side effects of sulfonlyureas

Hypoglycemia and weight gain

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How much do sulfonlyureas lower A1c?

1-2%

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What are the drugs in the Meglitinides class?

Prandin (repaglinide) and starlix

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Meglitinides main site if action

Pancreas (stimulates pancreas to produce more insulin)

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Side effects of meglitinides

Hypoglycemia and weight gain

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Onset more rapid than sulfonlyureas and duration shorter

Meglitinides

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Alpha glucosidase inhibitor

Precose (acarbose) glyset (migitol)

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When should meglitinides be taken?

3 times a day 15-20 minutes before each meal

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Side effects if alpha glucosidase inhibitors

Flatulence, diarrhea, abdominal discomfort

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What are the Alpha glucosidase inhibitor drugs?

Precose (acarbose) glyset (migitol)

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Main site of action of alpha glucosidase inhibitors

Small intestine

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What are the Thiazolidinediones drugs?

Actos (pioglitazone) and Avandia (rosiglitazone)

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Side effects of thiazolidinediones

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

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Main site of action for thiazolidibediones

Peripheral tissues

What function must be monitored for TZDs?

Liver

How much do TZDs lower A1c?

1-1.5%

What are the DPP4 drugs?

Januvia, onglyza, trajenta --DPP-4 inhibitor

What is the action of DPP4?

Increases insulin made in pancreas and decreases glucose produced by liver

How much do DPP4 lower A1c?

0.5-1%

Possible side effect of DPP4?

weight loss, nausea (rare), and pancreatitis

Where is DPP4 metabolized and excreted?

Metabolized in liver and excreted in kidneys

What is the Bile acid sequestrant drug?

Welchol

How much does Welchol lower A1c?

0.5-1%

What does Welchol also treat?

cholesterol, modest reduction in LDL

What are the GLP drugs?

Byetta, Victoza, pre filled injectable pens, Bydureon

Inject once daily

Victoza

How often is Victoza injected?

once daily

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

GLP - 1

Side effects of GLP-1

Nausea and vomiting

How much do GLP1 reduce A1c?

1-1.5%

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?

Insulin

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

Prandial insulin or bolts insulin

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

Basal insulin

What are the Rapid acting insulin U-100?

Humalog, novolog, apidra

What is the Short acting insulin U-100?

Regular

Long acting insulin

Lantus and Levemir

Intermediate acting insulin

NPH

Combination

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

What can you not mix with other insulin?

Lantus and Levemir

how is basal insulin given?

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

Prandial or Bolus insulin

Rapid acting insulin analogue or regular

What are the Prandial or Bolus insulin?

Rapid acting insulin analogue or regular

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

They can crystallize

Lantus peak, onset and duration

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

Regular (short acting) onset, peak, and duration

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

What is being used more in insulin pump

U-500 R, 5X stronger than regular insulin

Onset, peak, and duration or rapid acting insulin

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

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

Rapid-acting

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

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

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

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

Novolog 70/30 onset peak and duration

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

Availability of insulin

All available in 10cc vials of U-100

Expiration of insulin

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

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

Lipoatrophy

What to teach about insulin

Insulin type, technique, response, storage, and complications

What is lipodystrophy/lipohypertrophic?

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

How often should glucophage XR be taken?

once a day

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

liver and peripheral tissues

How does Metformin work at peripheral tissues?

enhances peripheral uptake by tissues

How does Metformin work on the liver?

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

After discontinuation of Metformin, when can it be restarted?

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

What allergy needs to be checked for before administering sulfonylureas?

sulfa allergy

What is the main action of sulfonylureas?

stimulates insulin production

What is the action of meglitinides?

targets pp glucose to mimic insulin secretion

What is the action of alpha glucosidase inhibitors?

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

What is the action of thiazolidinediones?

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

What drug may exacerbate CHF due to increasing intravascular volume?

TZDs

Which drug is an insulin sensitizer?

TZDs

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

DPP4

Welchol side effect?

constipation

When should Byetta be administered?

inject twice a day within 60 min of bfast and dinner

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

Decreases glucose production by liver, reduces appetite

How often is Bydureon given?

once weekly

What is a gut-derived peptide?

GLP-1 Mimetics

What does insulin enable?

cells to store and use carbohydrates, fat, and protein

Levemir onset, peak and duration

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

when is Human 70/30 given?

30-45 min before eating

What are the fastest absorption injection sites?

abdomen then deltoid then thigh

Once opened, how long is insulin good for?

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

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

dawn phenomenon

When are the blood glucose levels increased with dawn phenomenon?

5:00-6:00 am

How can dawn phenomenon be managed or prevented?

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

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

Somogyi Effect

How is somogyi effect managed and prevented?

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

What are insulin pumps?

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

What are the pros and cons to insulin pumps?

Offer convenience and flexibility Less blood glucose variability Expensive

What about hospital visits may increase glucose?

stress, steroids, parenteral nutrition, inactivity, meds

What in hospital visits may decrease glucose?

more rigid diet, observed compliance with regimen, meds

How does exercise effect insulin?

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

How does exercise effect glucose?

Improved glucose metabolism

How does exercise effect circulation and stress?

Improved circulation | Stress management

Is exercise safe in Type 1 diabetes?

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

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

exercise will make blood glucose increase due to hepatic glucose production

How do you prevent exercise induced hypoglycemia?

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

Antidiabetic Meds Flashcards

(105 cards)