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Week 9 Notes Flashcards

1
Q

What is endogenous insulin?

A

Insulin made in the body.

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2
Q

Why do all type 1 diabetes patients require insulin therapy?

A

Their pancreas is not producing any or enough insulin.

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3
Q

What happens to beta cell function over time in type 2 diabetes?

A

Beta cell function decreases, leading to inadequate insulin production.

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4
Q

True or False: A type 1 diabetic patient may not need insulin if they have a pancreas transplant.

A

True.

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5
Q

What are some serious complications of delaying insulin therapy in type 2 diabetes?

A
  • Vision loss
  • Limb loss
  • Peripheral vascular disease
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6
Q

What is one use of insulin therapy aside from diabetes management?

A

Treatment of hyperkalemia.

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7
Q

What does basal insulin therapy maintain?

A

Normal blood glucose levels during fasting.

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8
Q

What does bolus insulin therapy cover?

A

Food intake to decrease post-meal blood glucose elevation.

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9
Q

List the types of insulin available.

A
  • Rapid-acting
  • Short-acting
  • Intermediate-acting
  • Long-acting
  • Ultra long-acting
  • Inhaled insulin
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10
Q

What is the onset of action for rapid-acting insulin?

A

Within 15 minutes.

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11
Q

What are the three types of rapid-acting insulin analogues?

A
  • Insulin lispro
  • Insulin aspart
  • Insulin glulisine
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12
Q

What is the onset of action for short-acting insulin?

A

30 minutes.

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13
Q

What is the clinically relevant peak of action for short-acting insulin?

A

1 to 2 hours.

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14
Q

What type of insulin is NPH?

A

Intermediate-acting insulin.

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15
Q

What is a key characteristic of insulin glargine?

A

It does not have a pronounced peak of action.

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16
Q

What is the duration of action for ultra long-acting insulin degludec?

A

Up to 42 hours.

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17
Q

What is the onset of action for inhaled insulin?

A

Very rapid.

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18
Q

What is a major adverse effect of insulin therapy?

A

Hypoglycemia.

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19
Q

What can precipitate hypoglycemia in insulin therapy?

A
  • Too much insulin
  • Insufficient food
  • Excessive exercise
  • Drug interactions
  • Alcohol
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20
Q

What condition can occur due to inadequate insulin in type 1 diabetes?

A

Diabetic ketoacidosis.

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21
Q

What should be avoided when prescribing inhaled insulin?

A

Patients with chronic lung disease.

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22
Q

What should you do if a patient has experienced a hypersensitivity reaction to insulin?

A

Do not administer the insulin.

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23
Q

In pregnancy, which type of insulin is recommended?

A

Human insulin.

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24
Q

What lifestyle modifications can improve glycemic control in diabetes?

A
  • Regular aerobic and strength training exercises
  • Proper diet avoiding simple carbohydrates
  • Maintenance of lean body weight
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25
What is the drug in the biguanides class available in the United States?
Metformin
26
What is metformin considered for type 2 diabetes mellitus?
First-line therapy
27
What are some actions of metformin?
* Improves insulin sensitivity * Prevents liver from forming glucose * Decreases absorption of glucose by intestines * Can cause weight loss or be weight neutral
28
What are some adverse effects of metformin?
* Gastrointestinal side effects (bloating, nausea, diarrhea) * Vitamin B12 deficiency * Headache * Lactic acidosis (rare) * Hypoglycemia (rare)
29
What is a serious adverse effect of metformin?
Lactic acidosis
30
What should be monitored in patients taking metformin?
Vitamin B12 levels
31
What are some contraindications for metformin use?
* Severe renal dysfunction * Acute or chronic metabolic acidosis * Severe liver dysfunction * Use of IV contrast
32
What class of drugs are glyburide and glipizide part of?
Sulfonylureas
33
What is the primary action of sulfonylureas?
Increase insulin release from the pancreas
34
What is a major risk associated with sulfonylureas?
Hypoglycemia
35
What are some adverse effects of sulfonylureas?
* Gastrointestinal upset * Weight gain * Disulfiram-like reaction with alcohol * Blood cell dyscrasias
36
What should patients be educated about when using diabetes medications?
Signs and symptoms of hypo and hyperglycemia
37
What are thiazolidinediones used for?
Type 2 diabetes mellitus
38
What are the main drugs in the thiazolidinediones class?
* Pioglitazone * Rosiglitazone
39
What action do thiazolidinediones have on insulin?
Decrease insulin resistance
40
What are some adverse effects of thiazolidinediones?
* Weight gain * Edema * Heart failure * Elevated liver function tests
41
What should patients monitor while on thiazolidinediones?
Weight and edema
42
What are contraindications for thiazolidinediones?
* History of hypersensitivity * Class III or IV heart failure * Acute coronary syndrome * Hepatic dysfunction
43
What are the drugs in the alpha-glucosidase inhibitors class?
* Acarbose * Miglitol
44
What is the primary action of alpha-glucosidase inhibitors?
Delay carbohydrate digestion in the small intestine
45
What are some adverse effects of alpha-glucosidase inhibitors?
* Bloating * Gas * Diarrhea * Abdominal pain
46
What should patients take alpha-glucosidase inhibitors with?
The first bite of a meal
47
What is the primary action of meglitinides?
Increase insulin secretion from beta cells
48
What are the drugs in the meglitinides class?
* Nateglinide * Repaglinide
49
Are meglitinides used as monotherapy or in combination?
Usually in combination
50
What class of drugs do nateglinide and repaglinide belong to?
Insulin secretagogues
51
How do insulin secretagogues like nateglinide and repaglinide function?
They cause more insulin to be secreted by the beta cells of the pancreas
52
What happens to insulin secretagogues if beta cell function is lost?
They will not work
53
What is the timing of administration for nateglinide?
1 to 30 minutes prior to meals
54
What is the timing of administration for repaglinide?
30 minutes before meals
55
What are some adverse effects of insulin secretagogues?
Hypoglycemia
56
What should be considered when using meglitinides in patients with severe hepatic impairment?
Cautious use and possible dose adjustment
57
What is a contraindication for using repaglinide?
History of myocardial ischemia
58
In which conditions should SGLT2 inhibitors be cautiously used?
Severe hepatic impairment and severe renal impairment
59
What is a key action of SGLT2 inhibitors?
Inhibit the reabsorption of glucose in the kidney proximal tubule
60
What are some adverse effects associated with SGLT2 inhibitors?
* Genital fungal infections * Urinary tract infections * Diabetic ketoacidosis * Bone loss and fractures
61
What black box warning is associated with canagliflozin?
Risk of amputation
62
What condition should SGLT2 inhibitors not be used to treat?
Diabetic ketoacidosis
63
What are amylin agonists used for?
Type 1 and type 2 diabetes as second-line therapy
64
What is the drug in the class of amylin agonists?
Pramlintide
65
What are the effects of amylin agonists?
* Slow down gastric emptying * Decrease glucagon secretion * Help with weight loss
66
What is a significant adverse effect of amylin agonists when used with insulin?
Severe hypoglycemia
67
What is the mechanism of action of DPP-4 inhibitors?
Slow down the breakdown of GLP-1
68
What does GLP-1 do in the body?
* Increases glucose-dependent insulin secretion * Suppresses glucagon secretion * Slows gastric emptying
69
What are some adverse effects of DPP-4 inhibitors?
* Renal dysfunction * Bullous pemphigoid * Stevens-Johnson syndrome
70
What should be monitored when using DPP-4 inhibitors?
Renal function
71
What are GLP-1 receptor agonists used for?
Type 2 diabetes as monotherapy or combination therapy
72
What are some gastrointestinal side effects of GLP-1 receptor agonists?
* Nausea * Vomiting * Diarrhea
73
What serious adverse effect is associated with GLP-1 receptor agonists?
Pancreatitis
74
What is tirzepatide?
A dual acting GLP-1 and GIP receptor agonist
75
What should not be used in combination with GLP-1 receptor agonists?
DPP-4 inhibitors
76
What is the importance of titration in administering GLP-1 receptor agonists?
Helps to avoid gastrointestinal side effects
77
What is a contraindication for using GLP-1 receptor agonists?
History of pancreatitis
78
What should be avoided when prescribing amylin agonists?
Gastroparesis
79
What should not be used together with DPP-4 inhibitors due to lack of evidence for improved glycemic control?
These medications ## Footnote DPP-4 inhibitors have no proven benefit when combined with certain other medications.
80
What type of insulin can be used with medications mentioned in the text?
Basal insulin ## Footnote The combination depends on the clinical situation of the patient.
81
What is tirzepatide classified as?
A dual acting GLP-1 and GIP receptor agonist ## Footnote Tirzepatide acts on both GLP-1 and GIP receptors.
82
What are the actions of tirzepatide similar to?
GLP-1 receptor agonists used alone ## Footnote The effects and adverse effects mirror those of GLP-1 agonists.
83
What must be present for tirzepatide and GLP-1 to work?
Glucose ## Footnote Both drugs are incretin hormones that require glucose for action.
84
True or False: Both tirzepatide and GLP-1 receptor agonists can work without glucose.
False ## Footnote Their efficacy is dependent on the presence of glucose.
85
What condition is relevant to the pathophysiology discussed in the text?
Type 2 diabetes ## Footnote Understanding the pathophysiology of type 2 diabetes is crucial for the use of these drugs.

PHARM (14 decks)

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