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19 Cards in this Set
- Front
- Back
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Symptoms of hyperglycemia?
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thirst
agitation fatigue |
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Symptoms of hypoglycemia?
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Simple Sugars Always Problem - SSAP
Shaking/seizures Sweating Anxiety Paliptation |
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Drugs that induce Hyperglycemia?
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NOT SPPICCED
Nicitinic acid Oral contraceptives Thyroid products Sympathomimetics Phenozanthines Phenytoin Isoniazide CCB Corticosteroids Estrongen producst Diuretics |
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Drugs that cause hypoglycemia
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ethanol
BBlockers salicylates |
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Metformin
MOA Dose BBW ADR Renal precautions |
Glucophage
MOA increases insulin sensitivity decreases GI absorption of sugar decreases the hepatic production of glucose from glucagon Dose - No specified dosing reg; start LOW and go SLOW - usually need > 1500 mg/d to be therapeutic MAX IR 2550 mg/d MAX ER 2000 mg/d BBW Lactic acidosis alcohol may potentiate problem SSx Lactic acidosis: anorexia, N/V, abdominal pain, thrist, altered level conc., hyperpnea ADR diarrhea, GI problems, nausea Renal Contraindications d/c in males CrCl < 1.5 d/c in femals CrCl < 1.4 |
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Riomet
MOA/Class Dose Special precautions |
metformin oral solution
MOA/Class - biguanide Dose max 2550 mg/d child (10-16) max 2000mg/d Special precautions must be held for 48 hrs after certain diagnostic test requiring the use of iodine. eg. angiograms & pyelogreams |
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List first gen sulfonylureas
Advatage 2nd gen has over 1st gen sulfonylureas are these drugs highly protein bound? MOA Chlorpropamide t1/2 |
Tolbutamide - Ordinase
Acetahexamide - Dymelor Torzolamide - Tolinase Chlorpropamide - Diabinese 2nd gen advantage less side effects sulfs are highly protein bound Diabinese (chlorpropamide) MOA increase insulin secreation from pancrease |
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List 2nd generation sulfonylureas
advantages over 1st gen What is important to remember about glipizide? any worries about a disulfram rxn? |
Damn Glucose Goes Away
Diabeta - glyburide Glynase - micronized glyburide Glucotrol - glipizide Amaryl - glimepiride glipizide must be given on an empty stomach - all other sulfonylureas can be given with food disulfram rxn almost negligable MOA secregouge |
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List the Meglitinides
MOA when are they taken? often used in conjunction with? |
Repaglinide - Prandin
Nateglinide - Starlix MOA - stimulates release of insulin from the pancreas. Fast acting, short duration, concentrating its effect around meal time. SKIP THE MEAL, SKIP THE DOSE taken before meals often used in conjunction with metformin or TZD |
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List the Thiazolidinediones
MOA BBW Metabolizm ADR |
Rosiglitazone - Avandia
Pioglitazone - Actos MOA improves insulin sensitivity - insulin secreation remains unchanged suppresses hepatic glucose production **They depend on presence of insulin for their MOA BBW CHF Metabolized by liver Don't start if ALT > 2.5x ULN DC if ALT > 3x ULN ADR increase rxk for gallstone formation by enhancing gallbladder stasis |
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List the combotherapies
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Always Meet Girls And Just Pretend, oK?
Avandamet - rosiglitazone/metformin Metaglip - metformin/glipizide Glucovance - Metformin/glyburide Avadaryl - rosiglitazone/glimeperide Janumet - sitagliptin/metformin Prandimet - repaglinide/metformin Kombiglyze - saxagliptin/metformin |
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Exenatide
MOA Dose/Adminstration Side effect |
Byetta
MOA Incretin Memetic GLP-1 receptor agonist that promotes insulin release from beta bells in the presence of elevated glucose concentrations moderates glucagon secretion, decreased glucose output during periods of hyperglycemia delays stomach emptying Dose/Administration SC BID, up to 60 minutes before the morning and evening meals SE nausea *Risk of pancreatitis and hypoglycemia |
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liraglutide
MOA Dose Patient Counseling Side Effects |
MOA
incretin memetic GLP-1 receptor agonist Dose - w/ or w/out meals start 0.6mg/day for one week to reduce GI symptoms during titration (not therapeutic dose) after one week increase dose to 1.2-1.8 mg/day Patient Counseling instruct patient about warning signs of pancreatitis Side effects N, HA, diarrhea NOT FIRST LINE!!!! |
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Sitagliptin
MOA Indication Dose excretion Side effects |
Januvia
MOA INHIBITION OF DPP-4 enzyme activity for 24 hr period reduced hepatic glucose production DPP-4 is believed to be responisble for the breakdown of incretin hormones. By inhibiting this breakdown, we enhance the activity of the incretin hormones GLP1, GIP Indication monotheratpy and conjuctive therapy for DM 2 Dose 100mg daily w/wo food Excreation - 90% by kidneys - reduce for decreased renal fnx Side effects: very few, 5% get nasopharyngitis |
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Diabetic Ketoacidosis, explain.
SSx: Treatment Mortality rate |
DKA - caused by grossly deficient insulin availability causing a transitition from glucose to lipid oxidation and metabolism. Often caused by a lapse in insulin treatment, acute infection, trauma, infarct. Ketostix greatly understimates amt of ketones with KDA because it doesnt measure on of the metabolites with DKA
SSx: Hyperglycemia > ~ 600mg/dL Lethargic, glucose spill in urine (tastes sweet) osmotic diuresis dehydration hypotensive vomiting KUSSMAUL RESPIRATION - deep, rapid respiration pattern) Treatment Insulin fluids electrolytes heart monitor ~10% mortality rate because average patient is 5 L short of fluids and as you put in fluids, glucose and potassium go down; WATCH OUT FOR HYPOKALEMIA Treatment |
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Diabetic wound healing: explain treatment.
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Phenytoin is a well known Hydantoin derivative anticonvulsant, topical preparations ahve been widely used in the healing of various types of skin ulcers and large abscess cavities
Example Phenytoin combined with Misoprostal, ketoprofen and lidocaine |
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Oral alfa-glucosidase inhibitors, list.
MOA Dose/administration Side effects |
acarbose - precose
miglitol - glyset MOA works at the brush boarder of small intestines to inhibit breakdown of large saccharides to glucose Dose/administration -take with first bite of meals start 25mg tid cf side effects gas, diarrhea; avoid carbohydrates for first 4-6 hours when used as monotherapy should not cause hypoglycemia |
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Insulin for DM 1
usual daily dose? Usual ratio of NPH to Regular? |
Usual daily dose
0.7-2.5 u/kg/d 7am - 2/3 dose of daily total 6pm - 1/3 dose of daily total ratio of NPH to regular 2:1; sometimes 1:1 |
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Pramlintide
MOA Indication Dose BBW |
Symlin
MOA amylinomimetic agent -modulation of gastric emptying -prevention of the postprandial rise in plasma glucagon -satiety (feeling full) leading to decreased caloric intake and potential weight loss Indication co-administered with insulin therapy DM 1 & 2 Dose DM 1 - 15-60mcg DM 2 - 60-120mcg *SQ inj. in thigh or abdomen; NO ARMS BBW - risk of hypoglycemia |
