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vanessa endocrine ppnp > diabetes pharmacology > Flashcards

diabetes pharmacology Flashcards

(61 cards)

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1
Q

what is insulin usually used for?

A
  1. type 1 diabetes
  2. ketoacidosis
  3. type 2 (chronic)
  4. gestational DM
  5. hyperkalemia (too much potassium)
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2
Q

what are the different kinds of diabetes?

A
  1. rapid acting
  2. short acting
  3. intermediate
  4. long acting
  5. mixed
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3
Q

what are the different kind of rapid insulin?

A
  1. lispro, longest onset
  2. aspart
  3. glulisine
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4
Q

what is the onset of rapid acting insulin?

when to take the med

A

15mins onset

take medication with food

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5
Q

what are the different kind of short acting insulin?

A
  1. regular
  2. antrapid
  3. humulin R
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6
Q

what is the onset for short acting insulin?

when to take the medication?

A

30min-60min onset of action

take the medication 30min before food

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7
Q

what are the different type of intermediate insulin

A
  1. insulatard

2. humulin N

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8
Q

what is the onset of action for intermediate insulin?

when to take the medication?

A

1-4 hour onset of action

does not matter when medication is taken

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9
Q

what are the different long acting insulin?

A
  1. glargine

2. detemir

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10
Q

what is the onset of action for long acting insulin?

when to take the medication?

A

1-4 hour

does not matter when medication is taken

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11
Q

what are the different pre mixed insulin?

A
  1. mixtard 30 = 30regular(shortacting) 70intermediate

2. mixtard 50 = 50regular(shortacting) 50intermediate

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12
Q

what is the onset for premixed insulin?

when to take the medication?

A

30-60mins onset

taken immediately with food

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13
Q

what insulin are suitable for post prandial control?

A

rapid and short acting insulin help control the surge of sugar from meals

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14
Q

what insulin is suitable for fasting basal control?

A

intermediate and long acting insulin help control the sugar produced by the body

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15
Q

what are cloudy insulin ?

A

intermediate and longacting

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16
Q

what are clear insulin?

A

rapid and short acting insulin

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17
Q

what is the route of insulin?

A

usually S/C

emergency and ketoacaidosis IV (10min onset action)

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18
Q

which insulin take the longest to work? (longest onset of action)

A

NPH (intermediate insulin)

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19
Q

which insulin has the highest risk of hypoglycemia ?

A

NPH (intermediate)

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20
Q

what is antrapid sliding scale used for?

A

to correct any hyperglycemic episode

regular/ rapid acting insulin is given as S/C injection

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21
Q

example of antrapid sliding scale

A

10.1 - 14 give 2
14.1 - 18 give 4
18.1 - 22 give 6
more than 22 give 8

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22
Q

for patients going for surgery and on bolus and basal insulin what to do?

A
  1. continue basal or decrease percentage if needed
  2. stop bolus
  3. stop all PO medication
  4. start 5% dextrose drip
  5. sliding scale every 4 hours
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23
Q

for patients going for surgery on premixed insulin what to do?

A
  1. convert to basal insulin, follow the intermediate one
  2. stop all PO medication
  3. start dextrose 5%
  4. sliding scale every 4 hours

but do serve mixtard at dinner the day before

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24
Q

for patient going surgery without any insulin

A

for a short fasting (1 meal)

  • omit the PO drugs
  • start antrapid scale

for long fasting (2 meals or more)

  • omit PO drugs
  • start insulatard (0.1unit/kg)
  • start dextrose 5%
  • sliding scale every 4 hours
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25
what is the first line diabetes drug?
metformin
26
what is the mechanism of metformin?
1. increase insulin sensitivity 2. stimulate glycolysis in tissue (direct use of insulin by tissue) 3. decrease gluconeogenesis in liver and kidney (formation of glucose) 4. slow glucose absorption in GI tract
27
what are the side effects of metformin?
1. GI upset (nausea, bloating, diarrhoea) | 2. reduced B12 absorption
28
what are the contra for metformin?
1. renal dysfunction (kidney) 2. tissue not enough oxygen 3. hepatic dysfunction (liver) 4. alcoholism
29
why is metformin a first line drug?
1. cheap, safe | 2. reduce the risk of cardiovasular risk and death
30
what are the different classes of drugs for diabetes
insulin secretagogues insulin sensitizer insulin sparing agents
31
what is under the insulin secretagogues ?
sulfonylurea
32
what is under insulin sensitizer?
thiazolidinedione | biguanide
33
what is under insulin sparing agents
1. acarbose 2. GLP 1 receptor agonist 3. DPP 4 inhibitor 4. SGLT2 inhibitor
34
what is the easy way to remember sulfonylurea? | what are the medication for sulfonylurea
MIDE Glibenclamide (longest acting) tolbutamide chlorpropamide
35
what is the function of sulfonylurea?
it increases the secretion of insulin sulfonylurea binds to its receptors on the K+ ATP channels causing them to close and the cell will depolarise causing Ca channel to open and secrete insulin
36
what are the key adverse effect of sulfonylurea ?
1. hypoglycemia 2. weight gain 3. allergic skinrash 4. bone marrow damage 5. increased CVS death
37
what kind of patient profile will have a higher risk of hypoglycemia ?
Elderly poor renal function hepatic dysfunction people with irregular eating habits
38
what is the easy memorizing for thiazolidinedione ? | what are the medication for thiazolidinedione?
ZONE rosiglitazone pioglitazone
39
what is the mechanism for thiazolidinedione?
bind to PPAR and upregulate 1. lipoprotein protease (convert triglycerol to glycerol and fatty acids) 2. fatty acid transport protein ( transport into cell) 3. Glut 4 transport of glucose into the cell for storage helps to decrease triglyceride in body reduce glucose output increase glucose uptake into muscle tissue increase insulin sensitivity at adipose tissue and muscles
40
what are the adverse effects of thiazolidinediones (TZD)
1. hypoglycemia (when with sulfonylureas or insulin) 2. hepatotoxicty 3. fluid retention, peripheral edema, increased risk of hF 4. weight gain
41
will obese patient be suitable for TZD
Ideally not recommended as the drug can cause weight gain
42
contra of TZD
liver disease | heart failure
43
what is the name of drug for alpha glucosidase inhibitor?
acarbose : glucobay can be used as monotherapy or with sulfonylurea / biguanide
44
what is the mechanism of acarbose?
acts as competitive inhibitor and bind to glucosidases and delay the digestion of polysaccarides and the increase in blood glucose level will be less steep\ by decreasing the amount of glucose in the body, the amount of insulin produced by the body decreases too
45
when to take acarbose?
taken just before ingesting a meal
46
what are the side effects of acrabose ?
1. elevated liver enzymes 2. flatuence (farting) 3. diarrhoea (no longer digesting the food)
47
what kind of patients are contra for acrabose
Gastrointestinal diseases like Inflammatory bowel disease | severe renal and hepatic disease
48
which two drugs work on the same pathway?
Dipeptidyl peptidasae-4 inhibitors, | GLP-1 receptor agonist
49
what are is the easy name for GLP-1 receptor agonist ? | what are the names of the drugs of GLP-1 receptor agonist?
``` TIDE exenatide liraglutide albiglutide dulaglutide ```
50
what is the mechanism of GLP-1 receptor agonist ?
GLP is usually released in small and large intestine in response to presence of food agonist increases insulin release and reduce glucagon's secretion
51
how are GLP-1 administered?
subcutaneosly
52
what is the easy name for DPP-4inhibitors? | what are the medication name of dpp4 inhibitors
LIPTIN ``` sitagliptin saxagliptin linagliptin alogliptin vildagliptin ```
53
what is the mechanism of DPP4 inhibitors ?
DPP 4 usually deactivate GLP, therefore DPP4 will allow GLP to be active
54
what are the adverse effect of GLP-1 agonist and DPP4 inhibitor ?
GI related issues | pancreatitis (not recommended for patients with a history of pancreatitis
55
what are the benefits of GLP-1 agonist and DPP4 inhibitors ?
Weight loss | improved cardiovascular outcomes
56
what is the easy names for SGLT2 inhibitors ? Sodium glucose co transporter inhibitor what are the drug names of SGLT2 inhibitors ?
GLIFLOZIN canagliflozin dapagliflozin empagliflozin
57
what is the mechanism of SGLT2 inhibitors ?
they block the reabsorption of glucose in the kidney to increase glucose excretion, thus lower blood glucose levels also allow increased insulin sensitivity and uptake of glucose in muscle cells
58
what are the patients that you usually use SGLT2 inhibitors on?
diabetes with cardiovascular disease reduced risk of hospitalizaton due to heart failure and reduced risk of worsening renal function
59
what are the adverse effect of SGLT2 inhibitors?
increased genital infections | urinary tract infection due to more glucose in urine= infection
60
Which hypoglycemic agents are associated with weight gain?
sulfonyureas thiazolidinedione meglitinides
61
Which hypoglycemic agents are associated with more favorable cardiovascular disease outcomes?
Metformin, SGLT-2 inhibitors, GLP-1 receptor agonist

vanessa endocrine ppnp (8 decks)

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