Chapter 60 - Drugs for Diabetes Mellitus Flashcards
(130 cards)
1
Q
Diabetes poses risk for:
A
-heart attack
-stroke
-kidney failure
-blindness
-leg and foot amputations
2
Q
When does T1DM develop?
A
during childhood or adolescence (maybe adulthood)
3
Q
What % of DM cases are T1?
A
5%
4
Q
What is the primary defect in T1DM?
A
destruction of pancreatic BETA cells due to an AUTOIMMUNE process
5
Q
What group is currently facing the largest growth of T2DM cases?
A
indigenous people
6
Q
What is the primary defect of T2DM?
A
insulin resistance and impaired insulin secretion
7
Q
T2DM is linked to ________ and __________
A
weight gain and obesity
8
Q
What are short-term diabetes complications?
A
-hyperglycemia
-ketoacidosis
-hypoglycemia
9
Q
What are long-term diabetes complications?
A
-macrovascular damage (heart disease, htn, stroke)
-microvascular damage (retinopathy, nephropathy, sensory/motor neuropathy, gastroparesis, amputation, erectile dysfunction)
10
Q
What does the placenta produce that can enhance diabetes in pregnant women?
A
hormones that antagonize insulin action
11
Q
Why is diabetes during pregnancy dangerous?
A
affects mom and can be teratogenic
12
Q
How do you treat diabetes during pregnancy?
A
-monitor BG levels
-adjust insulin and food intake
13
Q
How is gestational diabetes (developed during pregnancy) treated?
A
-monitor BG
-control diet
-insulin (prevent birth defects)
14
Q
____% of gestational diabetes patients develop T2DM within 10-15 years.
A
30%
15
Q
Women who give birth to babies >___ lbs are at greater risk of developing diabetes later on.
A
9
16
Q
What does the hemoglobinA1C test show?
A
-average blood sugar level for past 2-3mo
-% of Hb coated with sugar
17
Q
What is the A1C goal for diabetics?
A
<7%
18
Q
What is a normal A1C?
A
6%
19
Q
What is a good A1C for frail elderly folks?
A
<8.5%
20
Q
What tests are based on glucose?
A
-fasting PG
-random PG
-oral glucose tolerance test
21
Q
What is prediabetes?
A
a state that places an individual at high risk of developing diabetes
22
Q
What are the criteria for prediabetes?
A
-impaired FG
-impaired GT
-A1C 6.0-6.4%
23
Q
What are the criteria for DIAGNOSING diabetes?
A
-FPG >7.0 mmol/L
-A1C >6.5%
-2hPG in a 75g OGTT >11.1 mmol/L
-random PG >11.1 mmol/L
24
Q
What is a good diet for T1DM?
A
-maintaining glycemic index
-eat higher-glycemic-load food
25
What drugs reduce risk for diabetic nephropathy?
ACEI or ARB
26
What drugs are used for dyslipidemia?
statins
27
What is the time target to achieve A1C levels with T2DM?
by 3 months
28
What is step 1 in T2DM management?
lifestyle then add metformin
29
What is step 2 in T2DM management?
lifestyle, metformin, + another drug
30
What is step 3 in T2DM management?
add another drug (maybe insulin)
31
What is step 4 in T2DM management?
add insulin
32
What drug should be added to T2DM pts with CV dx?
SGLT2 inhibitor with CV benefits
33
What number indicates hypoglycemia?
below 2.8 mmol/L
34
What are the early symptoms of hypoglycemia?
-confusion
-irritability
-tremor
-sweating
35
What are the later symptoms of hypoglycemia?
-hypothermia
-seizures
-coma
-death
36
IV 50% dextrose in water is used to __________ BG
elevate
37
What is an injection used to elevate BG?
glucagon
38
What are the ae of glucagon injection?
N&V
39
Who is an exception and has a higher A1C goal?
-limited life expectancy
-frail elderly
-end of life
40
Lispro, aspart, and glulisine are all what type of insulin?
short duration: rapid acting
41
Regulin insulin (humulin R) is what type of insulin?
short duration: short acting
42
nph insulin (Humulin N) and mixed insulin are what type of insulin?
intermediate duration and acting
43
Glargine and detemir are what type of insulin?
long duration: long acting
44
Insulin degludec has the longest duration of ____h
24
45
What is the onset of Lispro?
15-30 min after SubQ injection
46
What is the duration of Lispro?
3-6hrs
47
When should Lispro be injected relative to food?
-5-10 mins before food or 20mins after
48
Can you mix lispro with NPH insulin?
yes only if used immediately
49
What is the onset of gluslisine?
10-30 mins
50
How long does glulisine last?
3-5hrs
51
Can you mix glulisine with other insulin?
NO
52
What is the onset of humulin R?
30-60mins
53
How long does humulin R last?
up to 10hrs
54
What is NPH (humulin N) insulin used for?
glycemic control between meals and overnight (injected 2-3x daily)
55
Which is the only insulin that can be mixed with short-acting insulin?
NPH (humulin N)
56
What is special to note about NPH/humulin N?
it is a cloudy suspension that must be rolled before administration
57
What is the duration of glargine insulin?
20-24hrs
58
Does glargine insulin have a peak?
no
59
Why does glargine insulin have pain at the injection site?
it has an acidic pH
60
What is the duration of detemir insulin?
16-24hrs
61
Detemir and degludec insulin shouldn't be given ___
IV or mixed
62
What is the duration of degludec insulin?
12-42 hrs
63
What is the MOA of icodec insulin (ultra-long acting)?
binds reversibly to albumin in circulation and is released slowly
64
What must icodec be mixed with?
rapid or short acting insulin to cover mealtime requirements
65
ICODEC can be combined with...
oral T2DM agents
66
What are the adverse effects of ultra-long acting ICODEC?
-hypoglycemia
-weight gain
-peripheral edema
-injection site rxn
67
How often is icodec administered?
weekly
68
Can you mix long-acting insulins?
no
69
Do you draw up short or long acting insulin first?
shortest
70
Insulin is measured in ________
units
71
Insulin requires a _________
double signature
72
All patients with T___DM require insulin
1
73
When is IV insulin used?
diabetic ketoacidosis
74
Insulin aids in the diagnosis of _____ deficiency
growth hormone (GH)
75
When is sliding scale used for insulin dosing?
-hospitalized patients
-pts on TPN or tube feedings
76
What are complications of insulin treatment?
-hypoglycemia
-lipohypertrophy
-allergic reactions
-hypokalemia
77
Insulin promotes uptake of ____ by cells
K+
78
When should non-insulin antidiabetics?
-active hypoglycemia
-liver or kidney disease
-heart failure
79
What category of drug is Metformin?
Biguanides
80
What is the first choice drug for T2DM?
Metformin
81
What is another use for Metformin?
polycystic ovary syndrome
82
How does Metformin act?
inhibits glucose production in the liver and increases insulin sensitivity and cellular glucose uptake
83
What are the adverse effects of Metformin?
-GI upset
-B12 deficiency
-lactic acidosis (rare)
84
How is metformin excreted?
unchanged in urine
85
Does metformin undergo hepatic metabolism?
no
86
What does metformin interact with?
alcohol - causes lactic acidosis
87
How do sulfonylureas act?
stimulate insulin secretion from beta cells and improves sensitivity to insulin, lowering BG
88
Chloropropamide and tolbutamide are ____ gen sulfonylureas
1st
89
GLYBURIDE, glimepiride, gliclazide are ____ gen sulfonylureas
2nd
90
Sulfonyleureas should not be used when...
the patient has a sulfa allergy
91
What are the side effects of sulfonylureas?
-hypoglycemia
-weight gain
-headache
-GI upset
-photosensitivity
-cardiotoxicity
92
What do sulfonylureas interact with?
alcohol
93
What kind of drug is Repaglinide?
a meglitinide
94
How does repaglinide act?
stimulates insulin release by blocking ATP-sensitive K+ channels on beta cells - and facilitating CA2+ influx
95
What is repaglinide used for?
T2DM
96
What are the adverse effects of Repaglinide?
-hypoglycemia (more flexible with food intake - eat within 30 mins of taking drug)
97
What group is Pioglitazone?
thiazolidinedione
98
How does Pioglitazone act?
reduce glucose levels by decreasing insulin resistance
99
What are the adverse effects of pioglitazone?
-edema
-URT infection
-headache
-sinusitis
-myalgia
-risk of HF
100
What group is acarbose in?
alpha-glucosidase inhibitor
101
How does acarbose act?
on the brush border of the intestine to delay absorption of carbohydrates
102
What are the adverse/side effects of acarbose?
-flatulence
-cramps
-abdominal distention
-diarrhea
-liver dysfunction (increase LFTs)
-renal failure
103
What % of acarbose is converted to inactive products via bacteria and enzymes?
2%
104
Acarbose should be avoided with chronic ______ disease
GI
105
How is acarbose doses?
with first bite of meal
106
Sitagliptin is what kind of drug?
dipetidyl peptidase-4 inhibitors aka gliptins
107
How does sitagliptin act?
slows breakdown of incretin hormones and increases insulin secretion - HIGHLY SPECIFIC FOR DPP-4 receptor, suppresses glucagon
108
Sitagliptin undergoes ___________ absorption and is excreted ___________ in urine
extensive; unchanged
109
What are the side/adverse effects of sitagliptin?
-sore throat
-headache
-nausea
-diarrhea
-weight loss
-pancreatitis
-hypersensitivity reaction
110
Sitagliptin has a minimal risk of ______________
hypoglycemia
111
What kind of drug is canagliflozin?
SGLT-2 inhibitor
112
What are side effects of canagliflozin?
-genital fungal infections in female patients
-UTIs
-increased urination
-hypotension
113
What drug group is Liraglutide and semaglutide (Ozempic)?
glucagon-like peptide-1 receptor agonists
114
How does liraglutide act?
slow gastric emptying that stimulates glucose-dependent insulin release and reducing apetitie
115
What are the side/adverse effects of liraglutide?
-GI upset
-injection site pain
-pancreatitis
116
What is the xultophy injection made of?
insulin degludec and liraglutide
117
Xultophy is not used in...
-children
-adolescents
-pregnancy
-family hx of thyroid carcinoma (RISK FOR C-CELL TUMORS)
118
Xultophy should not be...
administered IV or mixed
119
Do not use Xultophy for T_DM
1
120
What are the side effects of Xultophy?
-N&V
-constipation
-headache
-lowered appetite
-hypoglycemia
121
What are the cardinal features diabetic ketoacidosis and hyperosmolar hyperglycemic state?
-hyperglycemic crisis
-fluid and electrolyte loss
-life-threatening
122
Is hyperglycemia more severe with DKA or HHS?
HHS
123
Is ketoacidosis present in HHS?
no
124
Diabetic Ketoacidosis is characterized by:
-hyperglycemia
-ketoacids
-acidosis
-coma
125
Altered glucose metabolism causes:
-hyperglycemia
-water loss
-hemoconcentration
126
Altered fat metabolism causes production of ____________
ketoacids
127
What is the treatment for diabetic ketoacidosis?
-fluid and electrolytes
-insulin replacement
-bicarbonate for acidosis
128
What happens to blood in a hyperosmolar hyperglycemic state?
blood thickens
129
When does HHS occur?
-T2DM acute infection, illness, or stress
130
Untreated HHS can lead to...
-coma
-seizures
-death
