Diabetes Rx Flashcards

(27 cards)

1
Q

NPH peak and duration

A

peak 4-12

duration 18-26

(intermediate acting)

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1
Q

mechanism acarbose

A

inhibits enteric enzymes that break down complex carbs > malabsorption

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2
Q

general goals for glycemic control

A

fasting+preprandial glucose 70-120mg%

2 hour Post pandrial glucose, < 180mg%

Hgba1C

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2
Q

DPP4 inhibitor, mechanism

A

Sitagliptin

inhbition of DPP-4 prevents degradation of GLP-1 to prolong action in portal circulation

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3
Q

Mitiglinide mechanism

A

binds to sulfonylurea K channel to increase insulin secretion

(OK in patients with Renal failure, vs sulfonylurea drugs)

3x dail dosing

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4
Q

sulfonylurea (glipizide, glyburide, glimepiride) side effects

A

hyponatremia

disulfiram like reaction

Rashes/GI upset

drug interactions (warfararin

hypoglycemia

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5
Q

GLP-1 analogs,

mechanism

A

Exenatide + liraglutide

long acting analog, increases beta cell mass

inhibits glucagon secretion

promotes weight loss

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6
Q

sulfonyurea drugs

mechanism+duration

A

stimulate insulin secretion by pancreas

(glipizide, glyburide, glimepiride)

(all 15-24)

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7
Q

insulin side effects

A

hypoglycemia

insulin allergy

lipoatrophy or lipihypertrophy

insulin edema

“weight gain”

at high doses: atherosclerosis, increased cancer (?)

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7
Q

glucosidase inhibitors, mechanism

A

Acarbose

inhibits enteric enzymes that break down compelx carbohydrates, causing malabsorption > reduces post-prandial hyperglycemia

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8
Q

insulin analogs

A

Lispro insulin

insulin aspart

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10
Q

insulin glargine peak and duration

A

no peak

24-36 hours

(long acting)

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12
Q

insulin detemir peak and time course

A

6-14 peak

24 duration

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13
Q

stimulates insulin secretion at pancreas

A

sulfonylureas

(glipizide, glyburide, glimeiride)

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14
Q

contraindications metformin

A

Renal insufciency

Elderly

CHG

Home oxygen

acute illness

binge drinking+ liver dysfunction

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15
Q

mechanistic advantage Lispro insulin, insulin aspart

(insulin analogs)

A

do not form hexamers as does regular insulin, allowing them to have a quicker onset of action more similar to normal meal-induced secretion

16
Q

Sitagliptin mechanism

A

DPP-4 inhbitor > slows degradation of GLP-1 in portal circulation

17
Q

SGTP-2 inhibitor, mechanism

A

canagliflozin

inhibits transport at sodium glucose transporter in proximal tubule

>glucose wasting in urine

17
Q

Canagliflozin mechanism

side effects

A

inhibits SGTP glucose transporter in proximal tubule > glucose wasting in urine

increase risk of genital yeast infection

19
Q

only insulin for IV use

A

regular insulin

20
Q

cloudy suspension aggregated with protamine and zinc

longer time course

22
Q

decreases peripheral insulin resistance

decreases central insulin resistance

A

central - metformin

perpheral - Thiazolidinediones (rosiglitazone, pioglitazone)

23
Q

long acting insulin analogs and specific mechanism

A

insulin glargine - soluble at pH4, poorly at pH7
SubQ, forms fine percipitate in interstitial fluids

**Insulin detemir - **self-association at SubQ sites, also binds to albumin in blood stream

24
Q

thiazolidinediones mechanism

(rosiglitazone, pioglitazone)

side effects

A

activate PPAR to increase peripheral insulin sensitivity

liver toxicity

weight gain and fluid retention

contraindicated in heart failure

Rosiglitazone - ishemic cardiac events, increased bladder cancer

25
Exanatide+liraglutide mechanism and side effects
SubQ long acting analog, increases beta cell mass inhibits glucagon secretion promotes weight loss nausea, emyesis, diarrhea, headaches, possible pancreatitis
26
Lispro insulin and insulin aspart Peak and duration
Peak - 0.7 duration 2 (short acting)
27
Metformin mechanism and side effects
reduce insulin resistance in liver most side effects GI lactic acidosis (do not prescribe in renal failure)