Endocrine Flashcards
(18 cards)
Diabetes Plasma conc> Fasting> 2 hr post load glucose> A1c >
200
126
200
6.5
Goals of treatment diabetes A1c Preprandial plasma glucose Peak postprandial plasma glucose bp lipids ldl triglycerides hdl
evaluate pt every
a1c- 7
preprandial- 90-130
post- 50
every 3 months
Insulin
MOA
15 gm CHO raises BG
1 unit bolus insulin lowers glucose
Initial Dose insulin=
basal vs. bolus
moa- increase storage of glucose as glycogen
15 gm cho raises bg around 50
1 unit insulin lowers 20-60
.2-.6 units/kg/day
50/50
Rapid acting
Short-acting
Intermediate
Long
Humalog, Novolog (onset 5 mins, peak 1 hr, lasts 4-5)
Regular (humulin r/novolin r) around meal time 30-45 mins before peaks 3-4 hours lasts 4-10
NPH (humulin n/novolin n) similar to above, more challenging to dose
Glargine Detemir onset 2-4 hours duration 24 hours no peak
Insulin dosing
50 gm person
Insulin drug interactions
.5 times 50= 25 units a day
- 5 basal
- 5 bolus (4 each meal)
interactions- beta blockers (increase insulin resistance, masks hypoglycemic symptoms)
Insulin
Pregnancy
Hypo/hyper thyroid
pregnancy- only human insulin (rapid/short acting only)
aspart- b, glargline glulisine- c
hypo- requires less insulin
hyper- requires more insulin
type 2
lean
obese
high risk hypo
postprandial hyper
lean- sulfonylurea
obese- metformin
high risk hypo- metformin or pioglitazone
postprandial- alpha-glucosidase inhibitor
oral diabetics
baseline monitoring every ___ months then every __
ADRs
every 3 then every 6
ADRs- GI, hypoglycemia (except metform and pioglitazone)
Sulfonylureas
examples
MOA
Precautions/considerations
ADRs
Glipizide, glyburide, glimepride
MOA- stimulate insulin release from beta
CYP cross senstivity with sulfonamides or thiazides Avoid in pregnant- category C Caution with older adults Used in pediatric 10-18 unlableded
Adr- hypoglycemia, GI, derm rashes, leukopenia, thrombocytopenia, weight gain
Sulfolylureas continued
avoid _____ in elderly use _____
If renal impairment
avoid chlorpropamide and glyburide in elderly use glipizide
use glipizide, tolbutamide, or glyburide
Biguanides
MOA
Excreted
Precautions
ADR
Metformin -decrease glucose production, decrease absoprtion, improve insulin sensitvity increase glucose uptake
by kidneys- contraindicated in serum cr>1.5
Precautions- Renal, hepatic Metabolic acidosis withhold 48 hours if iodine b12 def. Pregnancy B Not recommended children
Metformin
ADR
If not responding….
GI resolves in 2 weeks, report diarrhea >2
not responding…after 4 weeks can add sulf. before maxing
alpha-glucosidase inhibitors
examples
acarbose, miglitol
alpha-glucosidase inhibitors
examples
MOA
not used for
Precautions
ADR
acarbose, miglitol
inhibit absorption of CHO
Not monotherapy
GI (ibd)
Renal
Pregnancy, Pediatric not used
GI, NO HYPOGLYCEMIA
Thiazolidinediones
Examples
MOA
Considerations
Precautions
Pregnancy/children
Pioglitazone
Rosiglitazone
Improve target cell response to insulin, increase utilization of insulin
CYP- many interactions (OC, corticosteroids)
Liver disease, fluid retention, rosi- heart attack
Pregnancy C, not recommended
Meglitinides
Examples
MOA
Precautions/contraindications
Pregnancy, children?
ADRS
nateglinide repaglinide (prandin)
increase insulin release (time in plasma
DP4 inhibitors (dipeptidyl peptidase 4 inhibitors) examples
MOA
Used for
Promotes
Precautions/contraindications
Pregnancy.children?
sitagliptin, saxaglipin, linagliptin
increase secretion of insulin suppress release of glucagon
pre/postprandial
weight loss
Renal, interact with ACEinhibitors (risk angioedema) pregnancy B (not approved for children) well tolerated in elderly
Glucagon like peptide 1 agonists
examples
MOA
Precautions
used in
exenatide, liraglutide
promotes insulin release in presence of elevated glucose
acute pancreatitis
GI
Drug interaction with warfarin (increased inr)
Pregnancy C
combination
