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Flashcards in Diabetes Rx Deck (27):
1

NPH peak and duration

peak 4-12

duration 18-26

(intermediate acting)

1

mechanism acarbose

inhibits enteric enzymes that break down complex carbs > malabsorption

2

general goals for glycemic control

fasting+preprandial glucose 70-120mg%

2 hour Post pandrial glucose, < 180mg%

Hgba1C

2

DPP4 inhibitor, mechanism

Sitagliptin

 

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

3

Mitiglinide  mechanism

binds to sulfonylurea K channel to increase insulin secretion 

 

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

3x dail dosing

4

sulfonylurea (glipizide, glyburide, glimepiride) side effects

hyponatremia

disulfiram like reaction

Rashes/GI upset

drug interactions (warfararin

hypoglycemia

5

GLP-1 analogs,

mechanism

Exenatide + liraglutide

long acting analog, increases beta cell mass

inhibits glucagon secretion

promotes weight loss

6

sulfonyurea drugs

 

 mechanism+duration

 

stimulate insulin secretion by pancreas

 

(glipizide, glyburide, glimepiride)

(all 15-24)

7

insulin side effects

hypoglycemia

insulin allergy

lipoatrophy or lipihypertrophy

insulin edema

"weight gain"

at high doses: atherosclerosis, increased cancer (?)

7

glucosidase inhibitors, mechanism

Acarbose

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

8

insulin analogs

Lispro insulin

insulin aspart

10

insulin glargine peak and duration

no peak

24-36 hours

(long acting)

12

insulin detemir peak and time course

6-14 peak

24 duration

13

stimulates insulin secretion at pancreas

sulfonylureas

(glipizide, glyburide, glimeiride)

14

contraindications metformin

Renal insufciency

Elderly

CHG

Home oxygen 

acute illness

binge drinking+ liver dysfunction

15

mechanistic advantage Lispro insulin, insulin aspart 

(insulin analogs)

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

Sitagliptin mechanism

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

17

SGTP-2 inhibitor, mechanism

canagliflozin

inhibits transport at sodium glucose transporter in proximal tubule 

>glucose wasting in urine

17

Canagliflozin mechanism

 

side effects

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

 

increase risk of genital yeast infection 

19

only insulin for IV use

regular insulin

20

cloudy suspension aggregated with protamine and zinc

longer time course

NPH insulin

22

decreases peripheral insulin resistance

 

decreases central insulin resistance 

central - metformin

 

perpheral - Thiazolidinediones (rosiglitazone, pioglitazone)

23

long acting insulin analogs and specific mechanism

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

thiazolidinediones mechanism

(rosiglitazone, pioglitazone)

 

side effects

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)