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Clin Med II Liza > Diabetes drugs > Flashcards

Diabetes drugs Flashcards

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0
Q

TZDs

A

PioGlitazone (Actos) and RosiGlitazone (Avandia) / sensitizer: decreases insulin resistance and ins-sparing: decr ins requirements
- may worsen CHF!!!!!!!!! Don’t use in stage 3 or 4
- take 3-8 wks to see result, WGT GAIN, LIVER TOX (LFTs)
- Rosi: Black Box increased MI/angina and stroke?
- SE: LIVER TOXICITY (need freq LFT monitoring)
WGT GAIN

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1
Q

Metformin

A

(BiGuanides) / insuline sensitizer
DOC DM2 initial Tx for all types: under-over wgt and normal wgt
-reduces BS only (no effect on Insulin levels):
reduces hepatic glucose production and increases glucose uptake by cells
-NO HYPOglycemia, NO WGT GAIN
SE:
1) GI (bloat, gas) so TITRATE SLOWLY: start with 500mg before largest meal for 1 week, then increase to 500 BID for 1 wk, then to 1000 BID
2) LACTIC ACIDOSIS: cleared by kidney so avoid if cr >1.5 (men) cr > 1.4(women)
3) Iodine CONTRAST DYE: stop 2 days BF contrast and resume only after check cr and kidney fx is normal

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2
Q

SulfonuUreas

A

Ins Secretagogue

  • Blocks K channels on B cells -> increase Ins secretion
  • SE: HYPO and WGT GAIN (C/I: sulfa allergy)
  • Glipizide and Glimepiride are once daily
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3
Q

Meglitinides

A

Insulin secretagogues: increase ins secretion

  • RepaGlinide and NateGlinide
  • RAPID onset and 1/2 life: take 30 min BF meal
  • good for ppl with irratic eating schl, kinda like short-acting (“regular”) insulin
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4
Q

Which drug is not used in overwgt bc can cause wgt gain?

A

Sulfonylureas and TZD

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5
Q

Alpha-Glucosidase Inhibitors

A 
"carb blockers": delay absorption,
- helps with PostP hyperglycemia
- aCARBose, MigLitol
- SE: GAS, safe, work in all who can tolerate farting
(no wgt changes)
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6
Q

DM pathogenesis

A
  • increasing insulin resistance of liver, muscle receptors (type 2)
  • Decreasing insulin secretion by panctiatic B cells
  • excessive GLUCAGON section by alpha cells of pancreas
  • impaired INCRETIN hormones (incretin mimetics: boyetta, victoria, trucitia)
  • When DM appears, 80% of beta cells are gone
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7
Q

Incretin hormones

A

GLP-1 acts like insuline (looks like glucagon)
GIP: glucose-dependent Insulinotropic Polypeptide
- Both are stimulate insulin secretion in response to food consumption
- eat -> GIP and GLP1 secreted _> bind to b cells -> increase insulin section
(Resist GPP4 degradation)

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8
Q

Byetta/Exenatide

A

Incretin mimetic (synthetic version of GLP1)
GLP1 receptor Anogist -> binds to Beta cells -> increase insulin secreted
- MAY INCREASE BETA CELL # AND MASS!!!!!!!!!!!
- beta cell release insuline ONLY IF BS is high
decrease glucagon
- decreases hepatic glucose production (reducing insulin demand)
- increases SATIETY = eat less
- slows emptying - good for overwgt

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9
Q

When is Byetta/Exenatide indicate

A
  • in DM2, when failedt to respond to metformin, sulfonyreas or combo
  • SE: N/D, WGT LOSS (good!), hypoglycemia
  • BID subQ injection (has a once weekly injections Bydureion)
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10
Q

Necrotizing Pancreatitis is a SE of

A

Byetta/Edenatide

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11
Q

PrAMlintide

A

synthetic Amylin

  • in COMBO with insulin lowers BS
  • use in both type 1 and 2, control PP sugar
  • must inject separately before a meal
  • control PP sugar
  • less commonly used
  • comes in a pen
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12
Q

DPP4 inhibitors

A

“gliptins” (Sita, Saxa)

  • DPP4 degrades incretins
  • prevent GLP1 degradation by DPP4 -> GLP1 binds to b cell - > increase insulin secretion and glucose uptake by tissues, decreasing BS
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13
Q

SGLT2 inhibitors

A

Pee!out
CanAgliFLOzin 100-300 mg PO daily bf 1st meal!!!
dapagliFLOzin (farxiga) 5-10 mg PO qAM

  • MOA: inhibit Na-Glucose contrasporter (SGLT2) in kidney -> reduces glucose reabsorption from nephron -> pee out
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14
Q

Which med to use if you have pancreatic failure (decreased insulin production) - type 1

A 
Sulfonylueras
Incretin mimetic (byetta, victoria, trucilia)
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15
Q

Which med to use if you have glucose overproduction by liver (When would that happen except early AM?)

A

metformin - DOC for type 2

DPP4 inhibitor -> increase incretin binding to Beta cells -> increase insulin section -> decrease BS

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16
Q

which drug to use for overeating (high PP glucose)

A

Byetta (exenatide) (INCRETIN mimetic)
aCARBose (migLitol) (alpha gluconodase inh)
DPP4 inhibitor (“glipins”) – why?
Why not metformin - no wgt changes in pharm and wgt loss Clin med

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17
Q

which drug to use in insulin resistance (type 2)

A

metformin

TZD (Pio, Rosi) - prophylactic

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18
Q

which to use in combo glucotherapy

A

when single drug not enough

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19
Q

Metformin is DOC for type 2

A

bc wgt loss and reduces insulin resistace (and good for heart: decrease MI, Strokes)

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20
Q

Tx of type 2

A
  • start with metformin (decreases insulin resistance)

- if taget HgA1c ( hunger -> wgt gain -> increase resistance

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21
Q

Insulin injection

A

Must give to DM1, may need in DM2

- normally don’t add oral agents in DM1

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22
Q

When to start insulin - A1C of

Study These Flashcards
A

near 8% in spite of optimal oral therapy in DM2

in DM 2, earlier use of insulin may help with better glycemic control

23
Q

Goals of insulin therapy

Study These Flashcards
A
  • achieve normal fasting glucose levels (which are 80-130) (act if >140 or < 7% (act if >8%)
24
Rapid acting insulin
``` Lispro(line), Aspart(ate), GluLisine ONSET on action: 15 MIN!!! Peak: 1 hr Effective for : 2-4 hrs - shouldn't take earlier than 5-15 min bf meal - can induce hypoglycemia after eating ```
25
Short acting insulin
REGULAR (humilin) Onset: 30 min - 1 hr Peak: 2-3 hr Effective for: 3-6 hr
26
intermediate acting insuline
NPH Onset: 2-4 hr Peak: 6-12 hr Effective for: 10-16 hr
27
Long acting insuline
Glargine (Lantus), Detemir Onset: 1-2 hr NO PEAK Effective for: 20-24+ hrs
28
When injecting rapid with intermediate or long insulin
injet 15 before meal | make sure insulins are compatibel
29
Premixed insulins | Humilin 70/30
70% NPH (intermediate) and 30% Regular (short acting/not rapid)
30
Humulin 50/50
50% NPH (int) and 50 Regular (short acting)
31
Humalog 75/25
75 intermediate lispro and 25 RAPID lispro (not regular/short)
32
1 ml insulin syringes are for
insulin doses up to 100 units
33
1/2 ml syringes are for
insuline doses 50 units or less
34
Start DM2 patients on injectable insulin when their A1C is what?
near 8% | Or if fail to achieve glycemic control with triple therapy
35
Injectable insulin regimen for DM2
- Add insulin after triple therapy fails, dc oral drugs except Metformin: -decrease dose by 50%?.. Or to 25% ???? - BEST: Metformin + once daily long BASAL insulin (Glargine/Determir) - BASAL-BOLUS regimen: once daily long basal + 3 pre-meal rapid injections (lispro, aspart, glulisine) - Twice daily premixed insulin (70/30 intermediate and short) - Ins Pump - can d/c some or all oral agents but continuation of metformin or TZD may help minimize insulin RESISTANCE.
36
When does intermediate insulin peak? (NPH)
6-12 hrs after admin (onset is 2-4 hr) lasts 10-16 hrs
37
when does Regular insuline (short acting) peak?
2-3 hr after admin onset is 30 min-1 hr effective for 3-6 hrs
38
when does rapid acting insulin peak? (lispro, aspart)
peaks 1 hr after admin onset is 15 min after admin lasts for 2-4 hr
39
Mixed insulin regimen 2 injections:
give 2/3 of 70(intermediate)/30(rapid or regular) bf breakfast give 1/3 of 70/30 or 50/50 15 min before evening meal
40
Traditional 3 injection mixed insulin:
2/3 of daily 70(interm)/30(rapid or regular) BF breakfast 30% rapid or regular before supper 70% intermediate BEFORE BED (+/- rapid or reg bf lunch if necessary)
41
Best insulin regimen for both type 1 and 2
-"peakless" glargine (Lantus) as BASAL once a day + rapid acting BEFORE EACH meal: - flexible meals, adjust rapid according to carbs - avoids "stacking" of insulins (which increases hypoglycemia) - need 3-4 injections but greater safety
42
Bolus insulin is
prandial insulin: rapid insulin (lispro, aspart, lisine) injected before meals
43
How much insulin for type 1?
Split Total Dialy Insulin (TDI) dose (precalculated) 50-50 between basal (garglin) and BOLUS ("prandial"): Basal: give all 50% as one dose in am or can give intermediate (NPH) BID as 1/2 dose Bolus: divide 50% into 3 doses: before breakfast, lunch and dinner (if 50% of 30 units TDI is 15, then devide by 3 and give 5 units TID)
44
Physiologic vs Nonphysiologiv Insulin regimen
Physiologic: mimics natural Beta cell secretions typically replace "basal" and "prandial/bolus" insulin separately (what does this mean?) Traditionally, intermediate was said to be a basal insuline and REgular was a prandial insulin but both have basal and prandial effects
45
What is an example of nonphysiologic insulin
Gargine (Lantus) by itself | NPH (intermediate) by itself
46
example of physiologic insulin regimen
GLargine plus Lispro or Aspart | Long/peakless plus rapid acting (to decrease postprandial hyperglycemia)
47
When would you use a 3 injection regimen: 2/3 breakfast, 30% rapid Lispro at supper and 70 NPH intermediate at bed?
When pt has high pre-breakfast BS levels ("due to waning or insulin" or GH increasing insulin between 3 am and 7 am): this way NPH intermediate will peak 6-12 hrs after admin - at the time of next breakfast, preventing high pre-breakfast BS
48
How to start insulin in Type 2 DM?
Continue but reduce oral agents to - 50% of max dose if using NPH intermediate or pre-mixed insulins. - 25% if using glargine/detemir at bed Begin: 0.1-0.2 units/kg (15 units max) in : - NPH intermediate, Glargine or detemir at bed - 70/30 mix given 30 min before dinner - 75/25 mix (Humalog) before dinner Monitor BS and adjust accordingly Goal is morning glucose of 90-120 more than 50% of the time, WITHOUT HYPOglycemia
49
what is the goal of insulin tx in DM2
AM glucose of 90-120 more than 50% of the time without HYPOglycemia
50
Basal insulin
Supresses glucose production between meals and overnight | USE FOR 50% of daily needs
51
Bolus insulin (prandial/mealtime)
- limits hyperglycemia after meals - immediate rise and peaks 1-2 hrs after meal - 10-20% OF TOTAL DAILY INSULIN PER MEAL (ADDS UP TO 50% OF TOTAL)
52
How many grams of carbs can be offset by how many units of Lispro rapid acting insulin?
1 unit of Lispro covers 15 gr of carbs (CHO)
53
Diabetic follow-up
-ask ab sx of hypo or hyperglycemia - get result of SMBG - Sx of complications (infections, etc) - Vital signs - wgt, BP - fundoscopic, cardiovascular, skin, feet exam, neuro exam: MONOFILAMENT (?), PINPRICK (?), vibraion, ankle DTRs - Labs: A1C, LIPIDS, U/A (to check for albuminuria (UACR), urine glucose, ketones), BUN/Cr,
54
Rx for diabetic Dyslepidemias (on boards)
STATINS! 75 with no risk factors: NO STATIN or moderate Statin for 75 40-75 with NO RISK: MODERATE STATIN with CVD risk: HIGH STATIN overt CVD: HIGH STATIN CVD rist factors: LDL > 100, HBP (?), smoking, overwgt Overt CVD: Hx of prev CV event or Acute Coronary Syndrome
55
CVD rist factors:
LDL > 100, HBP (?), smoking, overwgt | Overt CVD: Hx of prev CV event or Acute Coronary Syndrome

Clin Med II Liza (6 decks)

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