Glycemics Flashcards Preview

PHM > Glycemics > Flashcards

Flashcards in Glycemics Deck (19)
Loading flashcards...
1

SULFONYLUREAS

Example
Indications
Mechanism of action
Side Effects
Contraindication/considerations

E- 2nd Gen- glyburide, glipizide, glimeperide [IDES]

I- DM2, fasting and postprandial

M- enhance insulin secretion by blocking ATP-sensitive K+ channels in cell membranes of pancreatic cells [pancreas] / Hepatic metabolize (CYP 450 2C9), renal excretion

S- hypoglycemia & weight gain; avoid alcohol

C- elderly patients (renal/hepatic) - lower dose
-*only tolbutamide requires dosage adjust
- inability to stimulate insulin release at extremely high glucose levels

2

NONSULFONYLRUEA SECRATGOGUES

Example
Indications
Mechanism of action
Side Effects
Contraindication/considerations

E- glinides / meglitinides

I- DM 2, reduce post meal glucose levels

M- very similar to sulfonylureas, but shorter onset and duration; 15 minutes before meal

S- hypoglycemia

3

BIGUANIDES

Example
Indications
Mechanism of action
Side Effects
Contraindication/considerations

E- metformin; 500mg BID

I- DM 2, fasting and postprandial

M- decrease hepatic glucose production and increase insulin sensitivity in both hepatic and peripheral muscle tissue

S-GI (appetite, nausea, and diarrhea), b12 absorption

C- eGFR < 30; hold 24 hours before surgery; radiographic procedure; lactic acidosis

FIRST LINE therapy

4

THIAZOLIDINEDIONES (TZDs)
[great for cardio / fat but risky s/e]

Example
Indications
Mechanism of action
Side Effects
Contraindication/considerations

E- pioglitazone, rosiglitazone (-litazones)
-- 15-30mg/day, increase up to 45 after 12 weeks (how long it takes to effect)

I- DM 2, Fasting and postprandial

M- increase insulin sensitivity by stimulating PPAR-Y

S- onset delayed several weeks (12 weeks); fluid retention and edema; weight gain, fractures, bladder CA

C- Heart Failure; piggy better for heart, rosi bad; monitor liver enzymes

5

ALPHA-GLUCOSIDASE INHIBITORS

Example
Indications
Mechanism of action
Side Effects
Contraindication/considerations

E- Acarbose; miglitol
--25mg TID w/ meals; advance 4-8 week intervals up to 100mg TID

I- DM 2, postprandial

M- small intestine, delay absorption; post prandial

S- GI -- farts, abd discomfort, diarrhea

C- intestinal disease; high serum creatinine (> 2mg/dL)

6

DPP-4 INHIBITORS

Example
Indications
Mechanism of action
Side Effects
Contraindication/considerations

E- [GLIPTINS] sitagliptin, saxagliptin, linagliptin etc.

I- DM2; primarily post prandial
[GI TRACT]
M- w/ diet and exercise; inhibit DPP-4, which breaks down GLP-1 - more endogenous GLP-1 when eating

S-headache and nasopharyngitis (NOT Hypogly - indirect); pancreatitis

C- once daily med, reduce w/ renal impair

7

SGLT2 INHIBITORS

Example
Indications
Mechanism of action
Side Effects
Contraindication/considerations

E- (-glifozin); canagliflozin, dapagliflozin, empagliflozin

I- DM 2 [KIDNEY], fasting and postprandial

M-inhibition of SGLT2 in proximal tubules, reducing reabsorption of filtered glucose and lowers renal threshold for glucose which together cause increased urinary excretion of glucose and decreased plasma glucose

S- amputation? UTI and genital mycotic infxn; hypotension from osmotic diuresis; fractures and bladder CA; hyperkalemia, DKA**

C- good for cardiovascular; *monitor fluid volume status; ketoacidosis assessment

8

CENTRAL ACTING DOPAMINE ANTAGONIST

Example
Indications
Mechanism of action
Side Effects
Contraindication/considerations

E- Bromocriptine

I- DM 2, hypothalamus, Postprandial

M- improves insulin sensitivity

S- rhinitis, dizziness, asthenia, H/a, sinusitis, constipation, nausea

C- take 2 hours after waking in AM w/ food
contra- syncopal migraine and nursing women
CyP 34A inhibitor *** (fungals and HIV Meds - dont take; decrease for moderate)

9

BILE ACID SEQUESTRANTS

Example
Indications
Mechanism of action
Side Effects
Contraindication/considerations

E- Colesevelam (adjunctive), 1.875g BID

I- DM 2, fasting

M- binds bile acid in intestine

S- constipation and dyspepsia; fat soluble malabsorption

C- Drug-drug interactions r/t absorption (levo, glyburide, contraceptive, phenytoin, warfarin, digoxin; separate 4 hours from pills

10

INSULIN
Regular (short-acting)

Type
Onset
Peak
Duration
Administration

"Bolus"; Regular (humulin, Novolin)

Onset - 30 minutes

Peak- 2-3 hours

Duration- 3-6 hours

Administration - IV or SQ

11

INSULIN
Regular (short-acting)

Type
Onset
Peak
Duration
Administration

"Bolus", Lispro, Aspart, Glulisin

Onset - 15-30 mins

Peak- ~1-3 hours

Duration - 3-4 hours

Administration- IV, SQ, (INH?)

12

INSULIN
Intermediate Acting

Type
Onset
Peak
Duration
Administration

"BASAL", NPH

Onset - 2-4 hours

Peak- 4-6

Duration 8-12

Administration - SQ

13

INSULIN
Long-Acting

Type
Onset
Peak
Duration
Administration

"BASAL", Glargine, Detemir, Degludec

Onset- 4-5 hours, no peak, 22-42 hours (Degludec longest)

SQ

14

Combination Therapy

NPH and Regular
NPH and lispro
NPH and humalog

15

Insulin Pump Rules

Required dose vs correction

REQUIRED
500 Rule (rapid-acting)
450 Rule (regular insulin)
--> divide 500 by daily dose of insulin
______
CORRECTION
1800 rapid, 1500 regular
--> 1800 by total daily insulin

16

GLP-1 Agonist

Exnatide, Liraglutide, Abligutide, Dulaglutide, Lixisenatide

-Stimulates insulin release
-Delays gastric emptying
-Suppression of postpradial glucagon release

Weight Loss, RENAL adjust for exenatide and lixisenatide (CrCl <15 and 30); others = no adjust

S/E: Acute pancreatitis, GI Side effects

17

pramlintide

Synthetic Amylin
slows gastric emptying

S/e: hypoglycemia, n/v, delay of oral meds

18

EFFICIENCY
High
Low

HIGH--> biguanide, Sulfonyl, GLP-1 Agonist, TZD

Low --> Dopamine agonist, pramlintie, bile acid

19

*Goals for Glycemic Control*

1) A1C
2) Fasting Glucose
3) Peak postprandial glucose (1-2 hrs after meal)
4) BP

1) <6.5-7.0%
2) 80-130
3) <180
4) 130/80