Meds for DM Flashcards by Samantha Scheetz

What are the exocrine cells of the pancreas

acini

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what are the endocrine cells are the pancreas

islets of langerhans

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alpha cells in the islets secrete _______

glucagon

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beta cells in the islets secrete ________

insulin

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delta cell in the islets secrete _________

somatostatin

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what is an anabolic hormone that builds energy stores and lowers blood sugar

insulin

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what is a catabolic hormone that breaks down energy stores and raises blood sugar

glucagon

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what is usable energy

glucose

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what is stored energy (lots of glucose together)

glycogen

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blood sugar goal is _________

70mg/gl-120mg/dl

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what is hyperglycemia with variable degree of insulin resistence/deficiency

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what type is DM is absolute insulin deficiency due to beta cell destruction and is autoimmune

type 1

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what type of DM is insulin resistance and is 90% with obesity risk factor and genetic disposition

type 2

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what type of DM occurs during pregnancy and makes you more likely to develop type 2 later

gestational

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Dx for DM

fasting glucose: __
hemoglobin A1c ______
sx of DM and random glucose is______
plasma gluose of OGTT _____

> 126

> 6.5%

> 200

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fasting glucose and hemoglobin a1c needed to be tested on _____ occasions

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typical treatment sugar goals

fasting ________

HgA1c __________

post prandial ______

80-130

<6.5%

<180

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what bacteria is used to make insulin

e coli
s cerevisiae

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how in insulin administered

subq injection/pump

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what are the 4 rapid acting insulins

aspart (novolog)
lispro (humalog)
Glulisine (apidra)

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Administer rapid insulin when

with each meal

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short acting insulin meds

Humulin R
Lovolin R

“LIN”

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administer short acting insulin when

30 min before meal

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intermediate acting insulin meds (and what is it comboed with)

Humulin N
Novolin N

—- with protamine to make it longer lasting

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when do you administer intermediate insulin

usually BID

long acting insulin meds

glargine (lantus/tuojeo) Detemir (levemir) degludec (tresiba)

long lasting insulin when

usually qHS

combo insulin is combo of intermediate and short/long acting

humalog 50/50 humalog 75/25 lumulin 70/30 novolin 70/30 novolog 70/30

combo insulin when administered

BID

avoid injecting what temp insulin

cold

SE of insulin

hypoglycemia

Tx for hypoglycemia

glucagon IM carbs

meds that decrease hypoglycemic effects (6)

corticosteroids loop diuretics thiazide diuretics thyroid medication sympathomimetics antiretrovirals

Meds that increase hypoglycemic effects

beta blockers alc lithium sulfonylureas salicylates MAOIs

type 1 must be treated with ________________ 2

beta bolus pump

type 2 DM can be treated with (3)

oral meds GLP-1 agonst insulin

what type 2 med class is the first line and decreases gluconeogenesis, increases peripheral glucose utilization, and decrease insulin resistance, while slowing GI uptake of sugars

biguanides

what med is in the class biguanide

metformin (glucophage)

90% of metformin is secreted in the urine because it is not __________

metabolized

Benefits of biguanides (3)

weightloss improves lipid profile decreased macrovascular risk

SE of biguanides (3)

dose related diarrhea lactic acidosis less b12 absorption

what is biguanides contraindicated for

GFR <30 liver disease CHF

what is the effect called when oral glucose produces more insulin secretion then when equal IV glucose is given

incretin effect

What is secrete by L cells in the small intestine in repsonse to oral glucose intake

GLP-1

GLP-1 stimulates beta cells to secrete insulin that is _______________

glucose dependent

What enzyme breaks down GLP-1

dipeptidyl peptidase-4

what GLP-1 short acting daily injections meds (2)

exenatide (byetta) liraglutide (victoza) TIDES

What are long acting 1 week GLP-1 injections (3)

albiglutide (tanzeum) dulaglutide (trulicity) semaglutide (ozempic) TIDES

what is the only oral GLP1

semiglutide (rybelsus)

How are most GLP-1 administered

subQ injections

what are GLP-1s indicated for

ASCVD stroke/tia chronic kidney disease

benefits of GLP-1

weightloss, lipid blood pressure reduction decrease CV risk decrease neuropathy

SE of GLP-1 (4)

N/V/D pancreatitis delayed gastric emptying injection site rxn

GLP1 are contraindicated in what groups

hx of pancreatitis severe renal impairment gastroparesis

what med is a GLP-1/GIP agonist

tirzepatide (Monjaro)

GIP is produced in what cells of the small intestine

k cells

GIPs have less effect on gastric ________ but are best for _______

emptying weightloss

T/F there is no data that GIPs reduce ASCVD risk

SE of GIPs

gallbladder disease pancreatitis AKI

GIPs are contraindicated in people with family Hx of ________

medullary thyroid cancer

What meds are DPP-2 inhibitors (3)

sitagliptin (januvia) saxagliptin (onglyza) linagliptin (tradjenta) -AGLIPTIN

What is the mechanism of action of DPP inhibitors

stops DPP from breaking down GLP-1

DPPs allows GLP-1 to stimulate beta cells in a glucose ____________ manner

dependent

DPPs are absorbed _____ and food does not effect it

orally

what DPP undergoes enterohepatic excretion

linagliptin

DPPs are weight ________

neutral

SE of DPP

pancreatitis, URI, joint painw

which DPP puts you at increased risk of CHF

saxagliptin (onglyza)

what are SGLT2 inhibitor meds (3) (sodium glucose cotransporter)

dapagliflozin (Forxiga) Canagliflozin (invokana) empagliflozin (jardiance) -----GLIFLOZIN

SGLT2 id expressed in the _________ and mediated reasorption of 90% of the filtered glucose

proximal tubule

SGLT inhibitor meds inhibit SGLT which promotes renal excretion of ____________

glucose

SGLT meds decrease reabsorption of what

sodium

how and when are SGLT administered

oral before first meal

SGLTs are indicated for what conditions

HF CKD ASCVD

Which SGLT is associated with lower CV risk and decrease risk of hospitalizations for HF

empagliflozin

SE of SGLT

genitourinary infections DKA AKI

how long before surgery or sports do you stop SGLT

72 hrs

What two things in diet should be avoided on SGLT

very low carb alcohol

what medications are sulfonylureas

glipizide (glucotrol) glyburide (Diabeta/Micronase) glimepiride (amaryl) IDES

sulfonylureas stimulate the beta cells in the pancreas to secrete more insulin making it glucose __________

independent

sulfonylureas require beta cell ________

function

sulfonyureas are given when

30 mins before meal

benefits of sulfonyureas

cost and effectiveness

SE of sulfonyreas

hypoglycemia photosensitivity macrovascular risk increased LFTs

sulfonylureas are contraindicated in what two populations

renal or hepatic failure

use what med for known/risk of ASCVD

GLP1 or SGLT2

use what med for HF

SGLT2

use what med to slow progression of CKD

SGLT2 or GLP1

use what med is stroke or TIA

GLP1/TZD

use what med for nonalcoholic steatohepatitis

TZD

Meds for DM Flashcards

(90 cards)