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BNPH700 > Diabetic Medications > Flashcards

Diabetic Medications Flashcards

1
Q

How is blood glucose lowered by?

A

Insulin

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2
Q

How is blood glucose raised?

A
  • Glucagon
  • Adrenaline
  • Growth Hormone
  • Cortisol
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3
Q

How does adrenaline raise blood glucose?

A

stimulating your liver to release glucose so it can be used in an emergency

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4
Q

How does the growth hormone increase blood glucose?

A

by stimulating lipolysis so that lipids are available for growth leaving glucose to be available for the brain

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5
Q

How does cortisol raise blood glucose?

A

Cortisol raises blood sugar by releasing stored glucose so it can be used within stressful situations

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6
Q

What are the 4 types of insulin?

A
  1. rapid acting
  2. short acting
  3. Intermediate acting
  4. long acting
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7
Q

What is the indicator for use of insulin?

A
  • Type 1 DM
  • Type 2 DM - co-administered with oral hypoglycaemic agents in management of DM
  • Hyperglycaemia: in emergencies & stress, infection, surgery, during pregnancy, Treatment of hyperkalaemia
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8
Q

What caution/contra-indicators is there for someone who is on insulin?

A

in patients with liver or kidney disease, fever, infection, hyperthyroidism, GI upset, recent surgery. Interact with corticosteroids, beta blockers, ACE inhibitors and thiazide diuretics (beta blockers may mask symptoms of hypoglycaemia)

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9
Q

What are the pharacokinetics of insulin?

A

onset, peak action and duration varies due to type and properties of insulin being used. Metabolised and inactivated rapidly in most tissues of the body.

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10
Q

What are some adverse drug reactions of insulin?

A

Hypoglycaemia, Weight gain, Allergy-rare, injection site reactions

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11
Q

What patient education would you provide for someone on insulin?

A

lifestyle management through exercise, eating healthy diet, rotate injection sites (subcutaneous injection – stomach is ideal). Ability to recognise signs of hypoglycaemia e.g. blurred vision, confusion, dizziness, faintness, and headache, how to store insulin, how to administer insulin.

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12
Q

What are some monitoring requirements with insulin?

A

Monitor BGL levels (4-8 mmol/L), monitor BP, monitor blood for lipid levels, monitor kidney function, eye, and foot care. Instruct appropriate administration and storage

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13
Q

How does each form on insulin work eg. duration and onset?

A

Rapid acting = rapid onset & short duration of action
Short acting = quick onset & moderate duration of action
Intermediate acting = longer onset of action & longer duration
Long acting = longest onset of action & longest duration

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14
Q

What is the Basal dose regimen?

A

basal dose is given when there are low levels of insulin present between meals and overnight to “mop up” glucose that is still breaking down between meals. The body needs basal insulin to maintain a steady blood glucose level. Intermediate and longer acting insulins are used.

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15
Q

What is the bolus dose regimen?

A

bolus dose of insulin is given to cover sharp rise as a result of eating (meal-times) called ‘post prandial’ rise, approx. 90 -120 mins after eating. Bolus insulin provides you with extra insulin on top of your basal insulin. Rapid acting and shorter acting insulins are used.

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16
Q

What are some lifestyle managements/ monitoring with someone on insulin?

A

Risk of long term complications requires careful monitoring of:

  • Renal function
  • Vision
  • Peripheral circulation
  • Cardioprotective measures
    • Weight management
    • Health eating
    • Healthy activities
    • Cardiovascular risk assessment
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17
Q

What is used in the treatment of Type 2 diabetes?

A
  • Oral hypoglycaemic agents
  • Lifestyle changes: food, physical activity, and behavioural strategies
  • Oral monotherapy: one drug
  • Combination oral therapy: multiple drugs
  • Oral drug plus insulin
  • Insulin only
18
Q

What are Biguanides and give an example

A

Oral diabetic medication. For example, Metformin. Metformin is the only one used in NZ

19
Q

What is the indication of use for Biguanides (Metformin)?

A

Type 2 diabetes

20
Q

What is the MOA of Biguanides?

A

Increase glucose uptake & utilisation in skeletal muscle (reduces insulin resistance). Reduce glucose production in the liver (gluconeogenesis). Increase insulin sensitivity
Reduces low and very-low density lipoproteins

21
Q

what is the pharmacokinetics of Biguanides?

A

Metformin is well absorbed from small intestine, does not bind to plasma proteins, does not undergo hepatic biotransformation, excreted unchanged in urine.
Half life of Metformin is 1.5 - 4.5 hours, taken in three doses with meals

22
Q

What are some adverse drug reactions of Biguanides?

A

GI upset nausea, vomiting, anorexia, diarrhoea, abdominal discomfort, metallic taste. Rare but fatal—lactic acidosis

23
Q

What are some symptoms of Lactic Acidosis?

A

dizziness, sleepiness, chills, muscle pain, weakness, diarrhoea, low BP, decreased HR, dyspnoea

24
Q

What are some contraindications of Biguanides?

A
  • Patient with severe renal or hepatic impairment
  • History of lactic acidosis, HF, recent MI, chronic lung disease.
    -Elderly and those taking alcohol
25
Q

What patient education would you give to someone on Biguanides (Metformin)?

A
  • Not recommended for use in pregnancy or during lactation
  • Take with food or at the end of the meal
  • Start on low dose to minimise GI effects
  • Avoid alcohol
  • Healthy diet & exercise
  • Regular checks of HbA1C
  • Stop taking if experiencing vomiting and diarrhoea
  • Stop taking prior to surgery to reduce Lactic Acidosis
26
Q

Why would Sodium glucose co-transported-2 inhibitors be used?

A

This group of oral hypoglycaemics are considered the second line treatment or used when metformin is contraindicated

27
Q

Give an example of a Sodium Glucose co-transported-2 inhibitor

A

Empaglaflozin

28
Q

What is the indicator of use for a sodium glucose co-transported-2 inhibitor?

A

treatment of type II diabetes in persons with high risk of CVD or renal complications, including all Māori & Pacific peoples

29
Q

What is the MOA for sodium glucose co-transported-2 inhibitor?

A

Acts on the sodium glucose co-transporters in the renal tubules to inhibit reabsorption of glucose (increases excretion of glucose)

30
Q

What are some contraindications of using a sodium glucose co-transported-2 inhibitor?

A

T1DM- High risk of ketoacidosis. Caution in older persons due to decreased renal and hepatic function

Avoid in persons with:
- Hypersensitivity,
- Severe renal or hepatic impairment,
- Ketoacidosis or diabetic coma,
- Undergoing surgery
- Pregnancy & lactation

31
Q

What are some adverse drug reactions of a sodium glucose co-transported-2 inhibitor?

A
  • Urinary tract infection
  • Hypoglycaemia
  • Increased urination and increased thirst
  • Constipation
  • Puritis
32
Q

What patient education would you provide for someone taking a sodium glucose co-transported-2 inhibitor?

A
  • Take with or without food at the same time each day
  • Seek immediate medical attention if symptoms of diabetic ketoacidosis occur
  • Keep your genitals clean to decrease risk of thrush
  • Stop the medication if feeling unwell
  • Avoid a keto diet
  • Healthy diet and exercise
33
Q

What is the risk for diabetic patients who drink alcohol?

A
  • Increased the risk of lactic acidosis for patient taking metformin
  • Hypoglycaemia
34
Q

Which groups of patients should not take metformin and why?

A
  • Patient with severe renal or hepatic impairment
  • History of lactic acidosis
  • Elderly and those taking alcohol
  • HF, recent MI, chronic lung disease, severe burn/infection, dehydration, DKA, recently had major surgery or trauma (those conditions predispose to increase lactate production which could lead to lactic acidosis)
35
Q

Why does Metformin NOT cause hypoglycemia?

A

Metformin rarely produces hypoglycemia (low blood sugar levels) because it does not change how much insulin is secreted by the pancreas and does not cause high insulin levels. No effect on the BETA Cells

36
Q

Why would metformin be selected for treatment of diabetic patients who are overweight?

A

Because Metformin does not cause weight gain

37
Q

What factors determine which oral hypoglycaemic agent is selected?

A

Patient age, co-morbidities, duration of diabetes, history of hypoglycaemia and overall health status

38
Q

What are the risks for persons with diabetes who are also taking beta blockers?

A

In insulin-dependent diabetics, beta-blockers can prolong, enhance, or alter the symptoms of hypoglycaemia, while hyperglycaemia appears to be the major risk in noninsulin-dependent diabetics, beta-blockers can potentially increase blood glucose concentrations and antagonize the action of oral hypoglycaemic drugs.

39
Q

What is the threshold of diagnosis of type 2 diabetes?

A

HbA1c above 50 mmol/mol
HbA1c 41-49 mmol/mol is classified pre-diabetes

40
Q

When administering a sulphonylurea oral hypoglycaemic drug, when should someone take it?

A

Administer one hour prior to meals.

BNPH700 (8 decks)

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