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53 Cards in this Set
- Front
- Back
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What kind of insulin are these: Insulin lispro, insulin aspart, insulin glulisine
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Regular insulin
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What is the onset, peak, duration of regular insulin
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30-60 mins
1-2 hrs 4-5 hrs |
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Lente & NPH - what kind of insulin
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Intermediate insulin
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Onset, peak duration of intermediate insulin
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2-4 hrs
4-10 hrs 10-16 hrs |
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Ultralente, Insulin glargine, PZI, Insulin detemir - what kind of insulin
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Long acting insulin
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Onset, peak, duration of long acting insulin
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2-4 hr
No peak ~24 hr duration |
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First line medication for Type II DM
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Metformin
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MOA Metformin
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Inhibits glucose absorption from gut
Decreases glucose output by liver Increases glucose uptake in adipose tissue & sk. m. |
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When should you avoid/stop Metformin
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Stop - prior to IV contrast, re-start >48 hrs after
Avoid - Alcoholic, Severe CHF, Liver & renal failure |
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MOA Acarbose
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Alpha-glucosidase inhibitor
(inhibits GI tracts ability to degrade carbohydrates) Works to limit post-prandial hyperglycemia |
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Common SE Acarbose
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Flatulence
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MOA "glitazones"
(thiazolidinediones) |
Sensitize sk. m. & fat tissue to insulin
(increase # insulin R & glucose transporters) |
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What are the glitazones
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Rosiglitazone
Pioglitazone |
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SE glitazones
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Edema
Wt gain New onset HF Exacerbation of pre-existing CHF Hepatotoxic |
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Avoid glitazones in who?
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Liver dz
If on nitrates or insulin A/w increased risk myocardial ischemia |
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MOA "glitinides"
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Increase insulin release by beta-islet cells
(No decrease in effect if used long term) |
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MOA Sulfonylureas
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Promote insulin release from beta-islet cells
(Decreased effect after long term tx) |
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What are the sulfonylureas
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-1st generation -
Tolbutamide Chlorpropamide Tolazamide -2nd generation - Glimepiride Glyburide Glipizide |
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MOA Pramlintide
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Amylin analogue
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Who is pramlintide contraindicated in
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Pt hypoglycemic unaware
On alpha-glucosidase inhibitors Decreased GI motility HbA1C > 9% Compliance problems |
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What are the incretins? How do they work?
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GLP-1
GIP Release from GI cell after meal (increase insulin release, decrease gastric emptying, inhibit glucagon release) |
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What is exenatide? Use?
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GLP-1 analogue
Adjunct for DM type II |
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SE Exenatide
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GI distrubance
Increased risk pancreatitis Promotes wt loss |
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What is Liraglutide?
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GLP-1 analogue
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SE Liraglutide
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Medullary cell CA thyroid
(increased serum calcitonin) |
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Liraglutide is contraindicated in
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Personal or FMHx medullary thyroid CA or MEN Type II
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Exenatide is contraindicated in
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Renal failure
Conditions w/ decreased GI motility Type I DM |
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What is Sitagliptan? Use?
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DDP-4 inhibitor
(DDP-4 catalyzes destruction of incretins) Adj in Type II DM |
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SE Sitagliptan
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Pancreatitis
Increased risk of CA |
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What is Saxagliptan? SE?
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DDP-4 inhibitor
URI UTI Pharyngitis GI disturbance |
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MOA Niacin
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Decreased hepatic uptake of released FFA
Inhibits lipolysis in fat cells (Increase HDL, efficacy of resins, CM & VLDL clearance decrease LDL,TG) |
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SE Niacin
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SEVERE cutaneous flushing & pruritis
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Use Niacin
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Prophylactic
Adjunct (Never as monotherapy) |
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MOA Clofibrate, Fenofibrate, Gemfibrozil
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Increase lipoprotein lipase
(decrease CM & VLDL) Increase apoprotein R recognition sites (increase lipoprotein uptake by liver) |
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SE fibric acid agents
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Gallstones
Cardiac dysrhythmias Increase malignancy Risk of myopathy (rhabdomyolysis) |
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Use fibric acid agents
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DOC Hypertriglyceridemia
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MOA Cholestyramine, Colestipol, Colsevelam
(bile acid sequestrant) |
Binds CH in gut--> Increased hepatic CH synthesis --> increases hepatic LDL uptake
(LDL decreased, VLDL & TG increased) |
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Contraindication for bile acid sequestrant
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Hypertriglyceridemia
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What are the HMG CoA reductase inhibitors
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"statins"
Lovestatin Atorvastatin Fluvastatin Pravastatin Rosuvastatin Simvastatin |
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SE "statins"
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Hepatotoxic
Myopathy --> Rhabdo |
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Effect of "statins"
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Increased LDL uptake by liver --> decreased CH in blood
Reduce mevalonate levels (normally mevalonate upregulates ACE) |
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What are the H2 blockers
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Cimetidine
Ranitidine Nizatidine Famotidine |
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MOA H2 blockers
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Competitiively bind H2 R on parietal cells --> No histamine can act
(45 mins onset) |
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SE Cimetidine
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Anti-androgenic
(galactorrhea, gynecomastia, decreased sperm count) |
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MOA Misoprostol
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PGE2 analogue
(PG cytoprotective to stomach, increase mucus & bicarb, decrease HCl) |
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Misoprostol contraindication
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Pregnancy
(uterine contractions) |
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What are the PPI
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Omeprazole
Esomeprazole Lansoprazole Pantoprazole Rabeprazole |
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SE PPIs
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Increased gastric carcinoids
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Use of antimuscarinics in a/w peptic ulcers
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Zollinger-Ellison
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MOA Pirenzepine
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M1 R blocker
(affects the stomach w/o affecting heart, eye, salivary glands) |
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MOA Sucralfate
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Binds to positively charged grps of exposed mucosa --> forms gel over mucosa
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Why is sucralfate CI in taking H2 blocker, PPIs, Antacids
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Requires low pH for activation
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MOA and Use Bismuth
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Inhibits pepsin
Toxic to H.pylori |
