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Flashcards in Endocrine Deck (18):
1

Diabetes
Plasma conc>
Fasting>
2 hr post load glucose>
A1c >

200
126
200
6.5

2

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

3

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

4

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

5

Insulin dosing

50 gm person

Insulin drug interactions

.5 times 50= 25 units a day

12.5 basal
12.5 bolus (4 each meal)

interactions- beta blockers (increase insulin resistance, masks hypoglycemic symptoms)

6

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

7

type 2

lean

obese

high risk hypo

postprandial hyper

lean- sulfonylurea

obese- metformin

high risk hypo- metformin or pioglitazone

postprandial- alpha-glucosidase inhibitor

8

oral diabetics

baseline monitoring every ___ months then every __

ADRs

every 3 then every 6

ADRs- GI, hypoglycemia (except metform and pioglitazone)

9

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

10

Sulfolylureas continued

avoid _____ in elderly use _____

If renal impairment

avoid chlorpropamide and glyburide in elderly use glipizide

use glipizide, tolbutamide, or glyburide

11

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

12

Metformin

ADR

If not responding....

GI resolves in 2 weeks, report diarrhea >2

not responding...after 4 weeks can add sulf. before maxing

13

alpha-glucosidase inhibitors

examples

acarbose, miglitol

14

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

15

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

16

Meglitinides
Examples

MOA

Precautions/contraindications
Pregnancy, children?

ADRS

nateglinide repaglinide (prandin)

increase insulin release (time in plasma

17

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

18

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