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Flashcards in Antidiabetic Meds Deck (85):
0

Is a contributing factor to the development of cardiovascular disease, hypertension, renal failure, blindness and stroke.

Diabetes Mallory's

1

What predisposes individuals by destroying the beta cells leading to type 1 DM

Toxins and viruses

2

An autoimmune disorder in which beta cells of the pancreas are destroyed in a genetically susceptible person

Type 1 DM

3

NO insulin is produced

Type 1 DM

4

10% of diabetes population, occurs in childhood of adolescence mostly, causes or to be thin and underweight

Type 1

5

What can lead to ketoacidosis?

Type 1

6

A metabolic disease that results from either the loss of receptor sensitivity to insulin, poor control of liver glucose output, and decreased beta cell function

Type 2 DM

7

More frequent among obese, represents 90% of diabetic population, usually in middle age, older adults.

Type 2 DM

8

Insulin resistant: decreased ability to respond to insulin, increased hepatic glucose production

Type 2 DM

9

Glucose intolerance with onset or first recognition during pregnancy.

Gestational diabetes mellitus

10

What is gestational DM diagnoses based on?

OGTT/ 100-g oral glucose tolerance test

11

What population is most affected by diabetes?

African American, American Indian, and Hispanic.

12

Level of glycosylated hemoglobin (HbA1c) to be diabetes

>/= 6.5%

13

Level of fasting plasma glucose to be diabetes

> 126mg/dL

14

2-hr plasma glucose to be diabetes

> 200 mg/dL post 75-g oral glucose challenge

15

Random plasma glucose level for diabetes

> 200 mg/dL with symptoms of diabetes (polyuria, polyphagia, and polydipsia)

16

Biguanide class

Glucophage (metformin) and glucophage XR

17

Glucophage (metformin)

2-3 times a day

18

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

Metformin (glucophage)

19

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

Metformin

20

Has GI side effects, transient, start slow then increase, take with food to decease GI effects

Metformin

21

What should be discontinued when having general anesthesia or procedure with contrast dye?

Glucophage (don't restart for 48-72 hours until serum creatinine is documented)

22

1st generation sulfonlyureas

Orinase and diabenese

23

2nd generation sulfonlyureas

Glucotrol, glynase, diabeta

24

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

2nd generation sulfonlyureas

25

3rd generation sulfonlyureas

Amaryllis

26

Main site of action for sulfonlyureas

Pancreas (stimulates beta cell production by pancreas)

27

Side effects of sulfonlyureas

Hypoglycemia and weight gain

28

Lowers A1c by 1-2% and stimulates insulin production

Sulfonlyureas

29

Meglitinides

Prandin (repaglinide) and starlix

30

Meglitinides main site if action

Pancreas (stimulates pancreas to produce more insulin)

31

Side effects of meglitinides

Hypoglycemia and weight gain

32

Onset more rapid than sulfonlyureas and duration shorter

Meglitinides

33

Take only with meals!

Meglitinides

34

Lowers A1c by 1-1.5% and targets pp glucose to mimic insulin secretion, must be taken 15- 20 min before each meal

Meglitinides

35

Alpha glucosidase inhibitor

Precose (acarbose) glyset (migitol)

36

Main site of action of alpha glucosidase inhibitors

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

37

Side effects if alpha glucosidase inhibitors

Flatulence, diarrhea, abdominal discomfort

38

Thiazolidinediones

Actos (pioglitazone) and Avandia (rosiglitazone)

39

Main site of action for thiazolidibediones

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

40

Side effects of thiazolidinediones

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

41

Lowers A1c 1-1.5%, insulin sensitizer, edema, may have connection to bladder cancer

TZDs (actis and Avandia)

42

What function must be monitored for TZDs?

Liver

43

DPP4

Januvia, onglyza, trajenta --DPP-4 inhibitor

44

Increases insulin made in pancreas and decreases glucose produced by liver

DPP4

45

Lowers A1c by 0.5-1.0%, increases glucose-dependent insulin release and suppresses glucagon secretion.

DPP4 inhibitor

46

Weight neutral, oral, nausea and pancreatitis reported

DPP4

47

Metabolized in liver and excreted thru kidney

DPP4

48

Bike acid sequestrant

Welch ok

49

Now indicated for treatment of type 2 diabetes, lowers A1c 0.5-1%, clean drug, rare side effects

Bike acid sequestrant

50

Also treats cholesterol, take 2 tabs x3 a day, constipation side effect

Bile acid sequestrant

51

GLP

Byetta, Victoza, pre filled injectable pens

52

Injectable med for type 2 but NOT and insulin, inject twice a day within 60 min of bfast and dinner

Byetta

53

Inject once daily

Victoza

54

Signals pancreas to make right amount of insulin after eating. Decreases glucose production by liver, reduces appetite

GLP - 1

55

Side effects of GLP-1

Nausea and vomiting, take within 1 hour of eating

56

Natural hormone released from small intestine, 1-1.5% A1c lowering, inhibits hepatic glucose production

GLP1- receptor agonist, Victoza

57

For type 1 and 2 who don't have good control with insulin

Smylin

58

Amylin mimetics

Smylin (pramlintide)

59

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

60

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

Basal insulin

61

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

Prandial insulin or bolts insulin

62

Rapid acting insulin U-100

Humalog, novolog, apidra

63

Short acting insulin U-100

Regular

64

Intermediate acting insulin

NPH

65

Long acting insulin

Lantus and Levemir

66

Combination

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

67

What can you not mix with other insulin?

Lantus and Levemir

68

Basal insulin

NPH and glargine (lantus) and detemir (Levemir) daily or BID

69

Prandial or Bolus insulin

Rapid acting insulin analogue or regular

70

Onset, peak, and duration of NPH (intermediate)

Onset: 1-3 hours
Peak: 4-10 hours
Duration: 10-18 hours (12 mostly)

71

Lantus and Levemir peak, onset and duration

Virtually peak less
Onset: 1 hour
Duration: 24 hours

72

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

They can crystallize

73

Regular (short acting) onset, peak, and duration

Onset: 30 min to 1 hour

74

What is being used more in insulin pump

U-500 R, 5X stronger than regular insulin

75

Onset, peak, and duration or rapid acting insulin

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

76

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

Rapid-acting

77

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

Onset: 30 min to 1 hour

78

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

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

79

Novolog 70/30 onset peak and duration

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

80

Availability of insulin

All available in 10cc vials of U-100

81

Expiration of insulin

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

82

What to teach

Insulin type, technique, response, storage, and complications

83

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

Lipodystrophy/lipohypertrophic

84

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

Lipoatrophy