Diabetes Flashcards
(33 cards)
0
Q
Rapid-Acting Insulin Analogs (3 drugs)
A
- Lispro
- Aspart
- Glulisine
(a fast GAL)
1
Q
Insulin Products (4 types)
A
- Rapid Acting
- Short Acting (Regular)
- Intermediate Acting (NPH)
- Long Acting
2
Q
Short-Acting (Regular) Insulin Analogs (2 drugs)
A
- Humulin R
- Novolin R
3
Q
Intermediate-Acting (NPH) Insulin Analogs (2 drugs)
A
- Humulin N
- Novolin N
4
Q
Long-Acting Insulin Analogs (2 drugs)
A
- Glargine
- Detemir
5
Q
Onset of:
- Rapid Acting
- Regular Acting
- NPH
- Long Acting
A
- ~ 0.5 hour
- 0.5-1 hour
- 2-4 hours [TQ]
- 1-2 hours
6
Q
Peak of:
- Rapid Acting
- Regular Acting
- NPH
- Long Acting
A
- 1-2 hours
- 2-3 hours
- 4-6 hours [TQ]
- NONE
7
Q
Duration of:
- Rapid Acting
- Regular Acting
- NPH
- Long Acting
A
- ~3-4 hours
- 3-6 hours
- 8-12 hours [TQ]
- ~16-24 hours
8
Q
3 Insulin Regimen Components
A
- Basal
- Mealtime (Prandial)
- Supplemental (Correctional)
9
Q
Basal Insulins
A
- Long/Intermediate acting insulins
- Types:
- Glargine (long)
- NPH (intermediate)
- Detemir (intermediate-long)
- Meets fasting needs
- Given regardless of fasting status
- Replaces/is the amount of insulin the pancrease would normally secrete if there is no nutrition intake
10
Q
Basal Insulins: NPH
A
- Has an earlier peak which may allow for insulin coverage at school
- Once daily (breakfast or bed), or BID (breakfast and bed)
11
Q
Basal Insulins: Glargine
A
- MOA: microcrystalline precipitate in SQ tissue which delays absorption and constant insulin release (basal)
- Rapid acting insulin can be added for meal coverage
- Less nocturnal hypoglycemia
- Can’t be mixed with other insulins (don’t shake)
- Given any time of day, but must be same time
- Increased pain at injection site due to acidic pH
12
Q
Basal Insulins: Detemir
A
- MOA: self-aggregates into hexamers at injection site that dissociates into dimers and monomers, binds to albumin
- Once or twice daily
- Don’t mix with other insulins
- Less weight gain and nocturnal hypoglycemia than NPH and glargine
13
Q
Mealtime Insulins
A
- Short acting insulins to cover enteral/oral caloric intake
- Take within 15 minutes of a meal
- HOLD if patient is NPO
- SQ short or rapid acting insulins
- Types:
- Lispro
- Gluisine
- Aspart
- Humulin R
14
Q
Supplemental Insulins
A
- Administered to maintain glucose within a normal range
- SQ short or rapid acting insulins
- Covers glucose excursions above target value (>150mg/dl)
- Administered regardless of nutrition intake
- May be added to mealtime insulin
15
Q
Rapid Acting Insulin
A
- Drugs: Lispro, Aspart, Glulisine
- Use: Postprandial hyperglycemia control
- Dosing:
- Lispro: 15 min before or immediately after meal
- Aspart: immediately before meal
- Glulisine: 15 min before or within 20 min starting meal
- Pros: Replicates normal physiology, less risk of late postprandial and nocturnal hypoglycemia
- Cons: May cause early-onset of hypoglycemia
16
Q
Concentrated Regular Insulin
A
- U 500 (standard is 100 units/ml)
- CONCENTRATED regular insulin for patients with insulin resistance that need high doses
- Should be prescribed by endocrinologist (safety risks)
17
Q
Types of Oral Diabetes Medications (8)
A
- Sulfonylureas
- Meglitinides
- Metformin
- Thiazolidinediones (“glitazones”)
- Alpha-Glucosidase Inhibitors
- DPP-4 Inhibitors
- Incretin Analogs
- Pramlinitide
(P.S. DAMMIT)
18
Q
Sulfonylureas
A
- Drugs: glyburide, glipizide, glimepiride
- MOA: stimulate pancreas to secrete insulin
- Onset: 1-4 hours
- Duration: 12-24 hours
- Dosing: 30 min before meal
- Effects: lowers HA1c 0.8-1.7%, lowers FBG 50-70mg/dl
- ADRs: modest weight gain, hypoglycemia (renal impairment increases risk, esp. glyburide)
19
Q
Metformin
A
- DOC for Type II
- MOA: decreases hepatic glucose production, increases glucose disposal, decreases glucose absorption
- Dosing: initially 500 mg/day (max 2550 mg/day with meals), delayed onset of effect (2 weeks) so titrate dose up
- Monitor: bg and HgbA1C
- Won’t cause weight gain or hypoglycemia
- ADRs: GI (nausea, pain, anorexia, metallic taste, diarrhea), lactic acidosis
- Lactic Acidosis:
- contraindicated in elderly, high SCr, CHF, low ClCr, alcohol
- hold for radio procedures with contrast, and 48 hr after [TQ]
20
Q
Thiazolidinediones
A
- Drugs: pioglitazone, rosiglitazone
- MOA: increase insulin receptors, increase hepatic glucose metabolism, better tissue response to insulin and decreased BG
- Won’t cause hypoglycemia
- Delayed onset of action (2-4 weeks)
- For: patients with obesity or insulin resistance
- Dosing: adjust every 4-8 weeks
- Monitoring: liver function tests (not for ALT >2.5x upper limit), serum BG
- ADRs: cardiac problems (ischemia, angina, MI; esp. rosiglitazone), edema, weight gain, HF (don’t use in class 3 or 4 CHF), liver problems, fracture risk, bladder cancer risk
- Pioglitazone has a benefit on lipid profiles
21
Q
Metaglinides
A
- Drugs: repaglinide, nateglinide
- MOA: stimulate pancreatic insulin secretion [TQ]
- kt come back
23
Q
Alpha-Glucosidase Inhibitors
A
- Drugs: acarbose, miglitol
- MOA: prevent starch breakdown, delay carb absorption, reduce postprandial glucose (by 50 mg/dl) [TQ]
- Effects: lowers HA1c 0.4-0.8%
- Won’t cause hypoglycemia as a monotherapy
- ADRs: abdominal pain, diarrhea, increased LFTs
- Glucose (juices, milk) is more reliable to raise blood sugar over sucrose (soft drinks, sugar)
- Drug interactions: pancreatic enzyme tablets reduce effectiveness
24
Q
DPP4 Inhibitors
A
- Drugs: sitagliptin, saxagliptin, linagliptin
- MOA: prolongs activity of gut incretin hormones GLP-1 and GIP, decreases glucagon and increases insulin levels, slows gastric emptying, decreases appetite [TQ]
- For: Type II
- ADRs: abdominal pain, nausea, vomiting, rash, allergy, pancreatitis
- Renal dose adjustment
25
Incretin Analogs
- Drugs: exenatide, liraglutide
- MOA: GLP-1 analog, lowers post prandial glucose by increasing insulin secretion, moderating glucagon secretion and slowing gastric emptying [TQ]
- Pen-injector
- ADRs: necrotizing pancreatitis, thyroid C cell cancer, renal failure, nausea, vomiting, diarrhea
26
Amylin Analog
- Drugs: pramlintide
- MOA: amylin analog, lowers postprandial glucose by slowing gastric emptying, decreasing meal-related glucagon secretion and appetite suppression
- Type I: lower dose (15-30 mcg/ml); Type II higher dose (60-120 mcg/ml) before meals
- When starting pramlintide, decrease inulin dose by 50%
- ADRs: hypoglycemia, nausea, vomiting
27
Canagliflozin
- MOA: inhibits kidney sodium-glucose transporter, causing glucose excretion
- ADRs: hyperkalemia, UTI, cadidiasis, renal probs, hypoglycemia
28
Bromocriptine
- MOA: dopamine agonist
- Low pulse daily dose in AM decreases insulin resistance and glucose production
- Type II only
- ADRs: dizziness, hypotension, hypoglycemia, cramping, nausea, vomiting
- Dosing: within 2 hours of walking
29
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Combination products:
Glucovance
Metaglip
Duetact
Actoplus Met
```
- Metfomin + Glyburide
- Metformin + Glipzide
- Pioglitazone + Glimepiride
- Pioglitazone + Metformim
30
Drugs that can cause hypoglycemia
- Sulfonylureas (esp. glyburide)
- Metaglinides
- Amylin Analogs
- Canagliflozin
- Bromocriptine
31
Drugs that don't cause hypoglycemia as monotherapy
- Metformin
- Thiazolidinediones
- Alpha Glucosidase Inhibitors
- DPP4 Inhibitors
- Incretin Analogs
32
Drugs that cause weight gain
- Insulin
- Sulfonylureas
- Thiazolidinediones
- Metaglinides
33
Drugs that cause natural/slight weight loss
- Metformin
- Alpha Glucosidase Inhibitors
- DPP4 Inhibitors
- Incretin Analogs
- Bromocriptine
