Module 10 Pharmacology - Diabetes Management Flashcards
(35 cards)
insulin aspart (rapid acting)
Onset: <15 min
Peak: 1-2 hr
Duration: 3-4 hr
- Therapeutic and pharmacologic class (2,1)
- Indications (1)
- Contraindications (2)
- Mechanism of action (4)
- Common and life-threatening side effects (0,2)
- Assessment and safety (2)
Trade Names: NovoLog
Ther. Class.: antidiabetic, hormone
Pharm. Class.: pancreatic
Indications:
-Control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus
Contraindications:
- Hypoglycemia
- Allergy/hypersensitivity to drug
Mechanism of Action:
- Stimulates glucose uptake
- Inhibits hepatic glucose production
- Inhibits lipolysis and proteolysis
- Enhances protein synthesis
Therapeutic Effect:
-Controls hyperglycemia in diabetic patients
Route: SQ
Most Common Side Effects:
-None listed
Life-threatening Adverse Reactions:
Endo: HYPOGLYCEMIA
Misc: ANAPHYLAXIS
Safety/Monitoring:
- Check blood glucose before administering
- Assess for symptoms of hypoglycemia
Interactions:
Metabolism and Excretion:
-Liver, spleen, kidney, and muscle
Evaluation/Desired Outcomes:
-Control of blood glucose levels without hyper or hypoglycemia
Patient Education:
- Emphasize importance of compliance with nutritional and exercise regimens
- Emphasize importance of carrying source of quick glucose (candy, gel, etc.)
- Instruct patient on signs of hyper and hypoglycemia and what to do if they occur
insulin lispro (rapid acting)
Onset: <15 min
Peak: 1-2 hr
Duration: 3-4 hr
- Therapeutic and pharmacologic class (2,1)
- Indications (1)
- Contraindications (2)
- Mechanism of action (4)
- Common and life-threatening side effects (0,2)
- Assessment and safety (2)
Trade Names: Humalog
Ther. Class.: antidiabetic, hormone
Pharm. Class.: pancreatic
Indications:
-Control of hyperglycemia in patients with type 1 and type 2 diabetes mellitus
Contraindications:
- Hypoglycemia
- Allergy/hypersensitivity to drug
Mechanism of Action:
- Stimulates glucose uptake
- Inhibits hepatic glucose production
- Inhibits lipolysis and proteolysis
- Enhances protein synthesis
Therapeutic Effect:
-Control of hyperglycemia in diabetic patients
Route: SQ
Most Common Side Effects:
-None listed
Life-threatening Adverse Reactions:
Endo: HYPOGLYCEMIA
Misc: ANAPHYLAXIS
Safety/Monitoring:
- Check blood glucose before administering
- Assess for symptoms of hypoglycemia
Interactions:
Metabolism and Excretion:
-Liver, spleen, kidney, and muscle
Evaluation/Desired Outcomes:
-Control of blood glucose without hyper or hypoglycemia
Patient Education:
- Emphasize importance of compliance with nutritional and exercise regimens
- Emphasize importance of carrying source of quick glucose (candy, gel, etc.)
- Instruct patient on signs of hyper and hypoglycemia and what to do if they occur
insulin glulisine (rapid acting) (glu-LI-seen)
Onset: <15 min
Peak: 1-2 hr
Duration: 3-4 hr
- Therapeutic and pharmacologic class (2,1)
- Indications (1)
- Contraindications (2)
- Mechanism of action (4)
- Common and life-threatening side effects (0,2)
- Assessment and safety (2)
Trade Names: Apidra
Ther. Class.: antidiabetic, hormone
Pharm. Class.: pancreatic
Indications:
-Control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus
Contraindications:
- Hypoglycemia
- Allergy/hypersensitivity to drug
Mechanism of Action:
- Stimulates glucose uptake
- Inhibits hepatic glucose production
- Inhibits lipolysis and proteolysis
- Enhances protein synthesis
Therapeutic Effect:
-Controls hyperglycemia in diabetic patients
Route: SQ
Most Common Side Effects:
-None listed
Life-threatening Adverse Reactions:
Endo: HYPOGLYCEMIA
Misc: ANAPHYLAXIS
Safety/Monitoring:
- Check blood glucose before administering
- Assess for symptoms of hypoglycemia
Interactions:
Metabolism and Excretion:
-Liver, spleen, kidney, and muscle
Evaluation/Desired Outcomes:
-Control of blood glucose levels without hyper or hypoglycemia
Patient Education:
- Emphasize importance of compliance with nutritional and exercise regimens
- Emphasize importance of carrying source of quick glucose (candy, gel, etc.)
- Instruct patient on signs of hyper and hypoglycemia and what to do if they occur
insulin, human inhalation (rapid acting)
Onset: <30 min
Peak: 30-60 min
Duration: 2.5 hr
- Therapeutic and pharmacologic class (1,1)
- Indications (1)
- Contraindications (4)
- Mechanism of action (4)
- Common and life-threatening side effects (1,3)
- Assessment and safety (2)
Trade Names: Afrezza
Ther. Class.: antidiabetic
Pharm. Class.: hormone
Indications:
-Control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus
Contraindications:
- Hypoglycemia
- Allergy/hypersensitivity to drug
- Smokers, or those who recently quit
- Asthma, COPD, or lung cancer patients
Mechanism of Action:
- Stimulates glucose uptake
- Inhibits hepatic glucose production
- Inhibits lipolysis and proteolysis
- Enhances protein synthesis
Therapeutic Effect:
-Controls hyperglycemia in diabetic patients
Route: Inhalation
Most Common Side Effects:
Resp: cough
Life-threatening Adverse Reactions:
Resp: BRONCHOSPASM
Endo: HYPOGLYCEMIA
Misc: ANAPHYLAXIS
Safety/Monitoring:
- Check blood glucose before administering
- Assess for symptoms of hypoglycemia
Interactions:
Metabolism and Excretion:
-Liver, spleen, kidney, and muscle
Evaluation/Desired Outcomes:
-Control of blood glucose levels without hyper or hypoglycemia
Patient Education:
- Emphasize importance of compliance with nutritional and exercise regimens
- Emphasize importance of carrying source of quick glucose (candy, gel, etc.)
- Instruct patient on signs of hyper and hypoglycemia and what to do if they occur
insulin, regular (slow acting, short duration)
SQ onset: 30-60 min
SQ peak: 2-4 hr
SQ duration: 5-7 hr
- Therapeutic and pharmacologic class (2,1)
- Indications (1)
- Contraindications (2)
- Mechanism of action (4)
- Common and life-threatening side effects (0,2)
- Assessment and safety (2)
Trade Names: HumuLIN R, NovoLIN R
Ther. Class.: antidiabetic, hormone
Pharm. Class.: pancreatic
Indications:
-Control of hyperglycemia in patients with diabetes mellitus type 1 or 2
Contraindications:
- Hypoglycemia
- Allergy/hypersensitivity to a particular type of insulin, preservatives, or other additives
Mechanism of Action:
- Stimulates glucose uptake
- Inhibits hepatic glucose production
- Inhibits lipolysis and proteolysis
- Enhances protein synthesis
Therapeutic Effect:
-Control of hyperglycemia in diabetic patients
Route: SQ, IV
Most Common Side Effects:
-None listed
Life-threatening Adverse Reactions:
Endo: HYPOGLYCEMIA
Misc: ANAPHYLAXIS
Safety/Monitoring:
- Check blood glucose before administering
- Assess for symptoms of hypoglycemia
Interactions:
Metabolism and Excretion:
-Liver, spleen, kidney, and muscle
Evaluation/Desired Outcomes:
-Control of blood glucose levels without hyper or hypoglycemia
Patient Education:
- Emphasize importance of compliance with nutritional and exercise regimens
- Emphasize importance of carrying source of quick glucose (candy, gel, etc.)
- Instruct patient on signs of hyper and hypoglycemia and what to do if they occur
NPH insulin (neutral protamine hagedorn)
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insulin detemir
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insulin glargine
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insulin degludec
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metformin
PO onset: ?
PO peak: ?
PO duration: 12 hrs
XR onset: ?
XR peak: 4-8 hrs
XR duration: 24 hrs
- Therapeutic and pharmacologic class (1,1)
- Indications (1)
- Contraindications (5)
- Mechanism of action (3)
- Common and life-threatening side effects (4,1)
- Assessment and safety (1)
Trade Names: Glucophage
Ther. Class.: antidiabetic
Pharm. Class.: biguanide
Indications:
-Management of type 2 diabetes mellitus
Contraindications:
- Metabolic acidosis
- HF
- Renal dysfunction
- Dehydration
- Hypersensitivity
Mechanism of Action:
- Decrease hepatic glucose production
- Decrease intestinal glucose absorption
- Increase sensitivity to insulin
Therapeutic Effect:
-Maintenance of blood glucose
Route: PO, XR
Most Common Side Effects:
GI: bloating, N/V/D
Life-threatening Adverse Reactions:
F and E: LACTIC ACIDOSIS
Safety/Monitoring:
-If patient with well controlled diabetes becomes ill, assess for DKA or metabolic acidosis; stop metformin and treat acidosis if present
Interactions:
Metabolism and Excretion:
-Eliminated almost entirely unchanged by kidneys
Evaluation/Desired Outcomes:
-Full effect of therapy may take 2 weeks to occur
Patient Education:
-Explain risk of lactic acidosis and potential need to discontinue therapy (symptoms include: chills, diarrhea, dizziness, low BP, muscle pain, sleepiness, weakness, slow HR or dyspnea)
glimepiride
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glyburide
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glipizide
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rosiglitazone
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pioglitazone
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acarbose
Onset: ?
Peak: 1 hr
Duration: ?
- Therapeutic and pharmacologic class (2)
- Indications (1)
- Contraindications (3)
- Mechanism of action (2)
- Common and life-threatening side effects (3,0)
- Assessment and safety (1)
Trade Names: Precose
Ther. Class.: antidiabetic
Pharm. Class.: alpha glucosidase inhibitor
Indications:
-Management of type 2 diabetes in conjunction with diet (may be used with insulin or other hypoglycemic agents)
Contraindications:
- DKA
- Cirrhosis
- Serum creatinine greater than 2 mg/dL
Mechanism of Action:
- Lowers blood glucose by inhibiting enzyme in the GI tract
- Delays and reduces absorption of glucose
Therapeutic Effect:
-Lower blood glucose in diabetic patients, especially after meals
Route: PO
Most Common Side Effects:
GI: abdominal pain, diarrhea, flatulence
Life-threatening Adverse Reactions:
-None listed
Safety/Monitoring:
-Monitor for signs and symptoms of hypoglycemia
Interactions:
Metabolism and Excretion:
-Excreted by kidneys
Evaluation/Desired Outcomes:
-Control of blood sugar without hypo/hyperglycemic episodes
Patient Education:
- Instruct patina to take drug at same time each day, with the first bite of each meal
- If dose is skipped, do not double dose next meal
- Standard diabetes education
miglitol
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repaglinide
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nateglinide
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sitagliptin
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saxagliptin
Onset: ?
Peak: 2 hrs
Duration: 24 hrs
- Therapeutic and pharmacologic class (1,1)
- Indications (1)
- Contraindications (3)
- Mechanism of action (1)
- Common and life-threatening side effects (0,4)
- Assessment and safety (2)
Trade Names: Onglyza
Ther. Class.: antidiabetic
Pharm. Class.: DDP-4 inhibitor (dipeptidyl peptidase)
Indications:
-Improve glycemic control in type 2 diabetes mellitus patients
Contraindications:
- Type 1 diabetes
- DKA
- Hypersensitivity
Mechanism of Action:
-Slows inactivation of incretin hormones, thereby increasing its concentration, resulting in reduced fasting and postprandial glucose
Therapeutic Effect:
-Improved control of blood sugar
Route: PO
Most Common Side Effects:
-None listed
Life-threatening Adverse Reactions:
GI: PANCREATITIS
Misc: ANAPHYLAXIS, ANGIOEDEMA, EXFOLIATIVE SKIN DISORDERS
Safety/Monitoring:
- Monitor for signs of pancreatitis (N/V, anorexia, severe abdominal pain)
- Monitor for hypoglycemic reactions
Interactions:
Metabolism and Excretion:
- Metabolized by liver
- 60% excreted by kidneys
- 22% excreted by feces/bile
Evaluation/Desired Outcomes:
-Improved Hgb A1C, fasting plasma glucose, and 2 hr postprandial glucose
Patient Education:
-Advise patient to notify health care professional if swelling of hands, feet, ankles; hives; or swelling of the face and throat occurs
linagliptin
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glyburide and metformin
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sitagliptin and metformin
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