Diabetes Flashcards
(11 cards)
Insulin:
Lispro (humalog)- rapid
Regular (humulin R)- short
NPH (humulin N)- intermediate
Glargine (lantus)- long
MOA: promotes uptake of glucose, converts glucose into glycogen and promotes storage, moves potassium into cells
Use: T1DM
Complications: hypoglycemia, hypokalemia, lipohypertrophy
Contraindications: preg, lactation, reproduction
interactions: beta blockers can mask effects of hypoglycemia, thiazude diuretics and glucocorticords can raise BG
admin: adjust dose for needs, mixing insulin: clear before cloudy, subQ injections
Amylin mimetics: pramlintide (Symlin)
MOA: mimics actions of hormone amylin to decrease gastric emptying time and inhibit secretion of glucagon.
use: both T1 and T2DM
complications: nausea, reaction to site
contraindications: preg, lactation, kidney failure/dialysis, thyroid disease, osteoporosis, alcohol use disorder
interactions: use with insulin increase hypoglycemia, meds that delay food absorptions
admin: thigh or ab subQ before meals, oral med 1 hr before or 2 hrs after pramlintide injections
Hypoglycemic agent: glucagon (glucagen)
MOA: increase BG by increasing breakdown of glycogen into glucose
use: emergency management of hypoglycemic reactions if unable to do oral, decrease in gastric motility for radiological procedures
complications: GI distress
contraindications: lactation, cardiovascular disease
admin: subQ, IM, or IV, provide oral as soon as consciousness regained
Alpha-glucosidase inhibitors: Acarbose (Precose)
MOA: slows carb absorption and digestion
use: oral T2DM
complications: ab distention, hyperactive bowels, diarrhea, gas, anemia due to decrease iron, hepatotoxicity with long term use, impaired breakdown of sucrose
contraindications: GI disorders
interactions: sulfonylureas or insulin can increase hypo
admin: take with 1st bite of food TID, if missed dose take dose at next meal not 2 at once
Biguanides: Metformin (Glucophage)
MOA: suppresses gluconeogenesis in liver, increase glucose uptake, decrease glucose absorption in GI
use: T2DM
complications: anorexia, n/d, weight loss, vit b12 and folic acid deficiency, lactic acidosis
contraindications: severe infection, shock, kidney impairment, hypoxic, alcohol use disorder
interactions: alcohol and cimetidine increase lactic acidosis, iodine media can cause acute kidney failure
admin: 2 tabs daily with breakfast and dinner
Sulfonylureas: Glipizide (Glucotrol)
MOA: insulin release from pancreas, can increase tissue sensitivity over time
use: T2DM
complications: hypoglycemia and weight gain
contraindications: preg, lactation
interactions: disulfiram like reaction with alcohol. NSIADS, sulfo antibiotics, cimetidine additive effects. beta blockers mask hypogly and inhibit insulin release
admin: best 30 min before breakfast, withhold if not eating
Thiazolidinediones: Pioglitazone (Actos)
MOA: decrease insulin resistance, increase glucose uptake and decrease production
use: T2DM
complications: fluid retention, high LDLs, hepatotoxicity, ovulation in perimenopausal
contraindications: severe HF, bladder cancer, active hepatic disease, older adults
interactions: insulin can cause fluid retention, increased levels with ketoconazole and gemfibrozil, decrease levels with rifampin and cimetidine
admin: once daily with or without food
Meglitinides: Repaglinide (Prandin)
MOA: insulin release from pancreas
use: T2DM
complications: hypoglycemia and weight gain
contraindications: preg, lactation
interactions: gemifibrozil inhibits metabolism leading to hypogly
admin: within 30 mins of meal time TID
Dipeptidyl peptidase-4 (DPP-4): Sitagliptin (Januvia)
MOA: increase incretin, lowers fasting and postprandial BG
use: T2DM
complications: nausea, HA, joint pain, hypersensitivity pancreatitis
contraindications: lactation
interactions: insulin and glipizide can increase hypogly
admin: once a day with or without food
Sodium-glucose co-transporter 2 (SGLT-2): Canagliflozin (Invokana)
MOA: limits postprandial, excretes glucose in urine by preventing kidney reabsorption, promotes weight loss
use: T2DM
complications: cystitis, candidiasis, polyuria, dizziness, hypotension
contraindications: preg only if benefitted, lactation
interactions: decrease effect with rifampin, phenytoin, phenobarbital. increase effect with thiazide and loop diuretics
admin: once a day before breakfast
Glucagon-like peptide-1 (GLP-1): Semaglutide (Ozempic, Wegovy, Mounjaro)
MOA: mimics incretin hormone GLP-1 the body uses
use: T2DM
complications: nausea, loss of appetite, pancreatitis
contraindications: T1DM
interactions: agents that increase insulin can increase hypogly
