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Clinical Medicine Lecture - Professor Kramer > DM TII medications > Flashcards

DM TII medications Flashcards

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1
Q

Biguanides example ?

A

Metformin

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2
Q

Metformin MOA ?

A

Reduces hepatic glucose production

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3
Q

Metformin promotes ?

A

Promotes weight loss and reduces triglycerides

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4
Q

Metformin SE ?

A

Commonly causes dyspepsia, kidney injury, B12 deficiency

tough for kidney to remove - issues

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5
Q

Metformin avoid if ?

A

Avoid if creatinine >1.4

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6
Q

Sulfonylureas examples ?

A

Glyburide,

glipizide,

glimepiride

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7
Q

Sulfonylureas potentiate ?

A

insulin secretion - helps push out insulin from beta cell

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8
Q

Sulfonylureas SE ?

A

Commonly cause weight gain and hypoglycemia

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9
Q

Thiazolidinediones (TZDs)

examples ?

A

Pioglitazone,

rosiglitazone

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10
Q

Thiazolidinediones (TZDs)

sensitize ?

A

Sensitize peripheral tissues to insulin

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11
Q

Thiazolidinediones (TZDs)

avoid if ?

A

Avoid if CHF NYHA III-IV or liver disease

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12
Q

Thiazolidinediones (TZDs)

increase risk of ?

A

Increased risk of bladder cancer, fractures

increase risk of sudden cardiac death - fallen to the way side

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13
Q

A-Glucosidase inhibitors

examples ?

A

Acarbose

miglitol

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14
Q

A-Glucosidase inhibitors

delays what ?

A

absorption of carbohydrates by blocking a-glucosidase enzyme at intestine

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15
Q

A-Glucosidase inhibitors

commonly causes what ?

A

GI SE

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16
Q

A-Glucosidase inhibitors

duration ?

A

4 hrs

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17
Q

Glucagon like peptide 1 (GLP1) receptor agonists examples ?

A

Exenatide (Byetta), liraglutide

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18
Q

Glucagon like peptide 1 (GLP1) receptor agonists slows what ?

A

Slows gastric emptying,

stimulates insulin response to glucose,

reduces glucagon release after meals

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19
Q

Glucagon like peptide 1 (GLP1) receptor agonists route ?

A

Injected

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20
Q

Glucagon like peptide 1 (GLP1) receptor agonists commonly causes ?

A

nausea, pancreatitis, weight loss, thyroid cancer

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21
Q

Glucagon like peptide 1 (GLP1) receptor agonists contraindicated in ?

A

gastroparesis

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22
Q

Dipeptidyl peptidase (DPPs) examples ?

A

Saxagliptin,

sitagliptin,
vildagliptin,
linagliptin

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23
Q

Dipeptidyl peptidase (DPPs) inhibit ?

A

DPP4 activity

Prolong action of GLP1, stimulate insulin secretion, suppress release of glucagon

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24
Q

Dipeptidyl peptidase (DPPs) dosage ?

A

Dosed once daily oral

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25
Dipeptidyl peptidase (DPPs) can causes ? but it is limited.
pancreatitis angioedema
26
Dipeptidyl peptidase (DPPs) does NOT cause ?
hypoglycemia
27
Amylin synthetic | example ?
Pramlintide
28
Amylin synthetic | produced by ?
pancreatic B-cel
29
Amylin synthetic | delays ?
gastric emptying
30
Amylin synthetic | surpresses ?
glucagon
31
Amylin synthetic | decreases ?
appetite
32
Amylin synthetic | route ?
Injected
33
Amylin synthetic | only approved for patients on ?
insulin therapy
34
Bile acid sequestrants | examples ?
Colesevelam
35
Bile acid sequestrants | also treats ?
hypercholesterolemia
36
Bile acid sequestrants | bind to ?
intestinal bile acids and glucose
37
Bile acid sequestrants | does NOT cause ?
hypoglycemia
38
Bile acid sequestrants | contraindicated ?
very high triglyceride levels
39
Bile acid sequestrants | interfere with absorption of ?
nutrients and medications
40
Dopamine 2 agonist | examples ?
Bromocriptine
41
Dopamine 2 agonist improves ?
insulin sensitivity
42
Dopamine 2 agonist does NOT cause ?
hypoglycemia
43
Dopamine 2 agonist contraindicated ?
with ergot medications (migraine)
44
Insulin add if ?
fail other treatment
45
___ of all DM II take insulin in addition to other hypoglycemics or alone
33%
46
Hypoglycemia tx: if not altered ?
Food OR | Oral glucose
47
Hypoglycemia tx: if AMS ?
IV/IM/SQ Glucose Hydrocortisone
48
Hypoglycemia tx: if sulfonylurea OD ?
IV/IM/SQ Glucose Octreotide - somatostatin so it stops the process esophageal varies
49
Hypoglycemia patient education ?
Proper medication use Proper feeding
50
Hypoglycemia pharmacology ?
Glucose oral or IV (1g/kg dextrose in 50% solution) Glucagon 1mg IM or SC if no IV access 10% dextrose solution may be required to maintain level above 100mg/dl Hypoglycemia refractory to glucose may require hydrocortisone 100mg IV or glucagon 1mg IV Octreotide has been used in preventing recurrent sulfonylurea-induced hypoglycemia
51
Diabetes mellitus type I tx ?
Lifestyle measures Insulin Regular monitoring
52
DMTI tx: rapid insulin example ?
Lispro Aspart Glulisine
53
DMTI tx: regular insulin example ?
Regular
54
DMTI tx: longer acting insulin example ?
Neutral protamine Hagedorn (NPH)
55
DMTI tx: basal insulin examples ?
Glargine Detemir
56
Rapid insulin peak ?
60-90 min
57
Rapid insulin duration ?
4-5 hours
58
Rapid insulin notes ?
Take 20 minutes before meal
59
Regular insulin peak ?
2-4 hours
60
Regular insulin duration ?
5-8 hours
61
Regular insulin notes ?
Take 30 minutes before meal
62
Longer acting insulin peak ?
5-8 hours
63
Longer acting insulin duration ?
12-24 hours
64
Longer acting insulin notes ?
Usually twice daily
65
Basal insulin peak ?
No peak - so helps maintain G levels
66
Basal insulin duration ?
12-24 hours
67
Basal insulin notes ?
Usually once daily (detemir may be twice) **basal important cause it is better to stay constantly high rather than be up and down
68
``` Analog insulins ( synthetic) examples ? ```
Rapid | Basal
69
Human insulin less antibody response than animal | examples ?
regular NPH
70
Diabetes mellitus type I surgery or procedure ?
Insulin pump Pancreas transplant
71
Insulin pump notes ?
Basal rate AND/OR Bolus before meal calculations
72
Pancreas transplant | notes ?
Research indicates graft success 78% at 1 year and 54% at 5 years Currently only indicated is severe uncontrolled cases
73
Diabetes mellitus type I Lifestyle measures ?
``` Diet -Individualized -Must consider activity and ideal body weight -Carbohydrate training 1 unit of short acting insulin per 10-15g carbohydrate -Recommend Complex carbohydrates (vs simple) Low fat High fiber Consider using artificial sweeteners ``` Moderate exercise Meticulous hygiene
74
Diabetes ketoacidosis typical patient TX ?
Normal saline IV - most important!!!!!!!!!!!!!!!!!!!!!!!!! Insulin IV - Bolus then - Infusion Monitor and correct electrolytes Treat underlying cause, MI, PNA, UTI
75
Diabetes ketoacidosis Isotonic fluid ?
Average has body water deficit of 5-10 Liters Stop vomiting with antiemetic ( zofran, phenergran, reglan ( gastropuresis)
76
Diabetes ketoacidosis Insulin ?
Bolus IV/ SQ (sliding scale) THEN Continuous IV infusion 0.1 mg/kg/hr. -(regular insulin avg half life is 5mins) Shut off ketosis and resume glucose utilization Double rate each hour if no response. (insulin resistance)
77
Diabetes ketoacidosis extra Tx ?
Potassium Sodium Magnesium Bicarbonte
78
Diabetes ketoacidosis disposition ?
ICU admission
79
Diabetes ketoacidosis monitoring ?
Glucose, anion gap, potassium and bicarbonate levels hourly until recovery well established. Cerebral edema occurs predominantly in children Develops 4-12 hours into treatment and manifests as deterioration of neurologic function Associated with rehydration rates exceeding 50ml/kg in the first 4 hours of treatment If exceeded and suspected, give mannitol 1g/kg and confirm on CT scan

Clinical Medicine Lecture - Professor Kramer (28 decks)

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