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29 Cards in this Set
- Front
- Back
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A person with type 2 diabetes mellitus has elevated blood glucose levels because...
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-Pancreas does not make enough insulin to control blood glucose
-Liver releases glucagon inappropriately -Muscle cells don't easily take in glucose |
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Pharmacology (alpha-Glucosidase)
-acarbose (Precose) -miglitol (Glyset) |
-Oral Agent for Type 2 DM
-Class: alpha-Glucosidase Inhibitors -Action: Blocks conversion of CHO to glucose in the gut -Take with 1st bite of each meal (skip med if you skip meal) -Does not cause weight gain -Side effects: Gas, bloating, diarrhea -Who should not take: Patients with IBD, other intestinal diseases or obstructions -Does not cause hypoglycemia if used alone -If hypoglycemia when used with other diabetes meds give pure glucose tablets or gel or fruit juice as this med delays breakdown of many other CHO |
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Pharmacology (Biguanides)
-metformin (Glucophage) -metformin, long-lasting (Glucophage XR, Glumetza, others) -metformin, liquid (Riomet) |
-Oral agent for type 2 DM
-Class: Biguanides -Action: Increases tissue response to insulin -Take with meals to minimize side effects (nausea, diarrhea, loss of appetite x a few weeks but usually subside) -Lactic acidosis rare but serious side effect -Does not cause weight gain and may improve cholesterol levels -Does not cause hypoglycemia when used alone -May not be a good choice for patients with kidney problems, severe respiratory problems, 80+ years old, taking med for heart failure, hx of liver disease, drink alcohol excessively (binge drinking), or hospitalized -Any medical testing, radiology, surgical procedures requiring fasting or iodinated dye, must inform medical personnel patient is taking this med |
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Pharmacology (DPP-4 Inhibitors)
-sitagliptin (Januvia) |
-Oral agent for type 2 DM
-Class: DPP-4 Inhibitors) -Action: Will produce insulin in response to elevated glucose levels, slows gastric emptying, inhibits release of PP glucagon -Does not cause weight gain -occasionally stomach discomfor, diarrhea -If kidney problems MD may Rx lower doses -MD may do blood tests from time to time to see how well kidneys are functioning |
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Pharmacology (Meglitinides)
-nateglinide (Starlix) -repaglinide (Prandin) |
-Oral agent for type 2 DM
-Class: Meglitinides -Action: Increases beta cells' production of insulin -Can cause hypoglycemia but risk is lower than with sulfonylureas -Take at start of meals -Skip dose if meal is skipped |
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Pharmacology (Sulfonylureas)
-glimepiride (Amaryl) -glipizide (Glucotrol) -glipizide, long-acting (Glucotrol XL) -glyburide (DiaBeta, Micronase) -glyburide, micronized (Glynase Pres Tab) -chlorpropamide* (Diabinese) -tolazamide* (generic only) -tolbutamide* (generic only) |
-Oral agent for type 2 DM
-Class: Sulfonylureas -Action: Helps body to secrete insulin -Those followed by * are older sulfonylureas which tend to cause more hypoglycemia and are seldom used today |
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Pharmacology (Sulfonylureas)
-glimepiride (Amaryl) |
-Oral agent for type 2 DM
-Class: Sulfonylureas -Action: Helps body to secrete insulin -Probably safe in patients with kidney disease but elderly should be started on lower-than-usual dose |
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Pharmacology (Sulfonylureas)
-glipizide (Glucotrol) |
-Oral agent for type 2 DM
-Class: Sulfonylureas -Action: Helps body to secrete insulin -Most effective when taken with meal -May be more effective when taken 30 minutes before meals |
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Pharmacology (Sulfonylureas)
-glipizide, long-acting (Glucotrol XL) |
-Oral agent for type 2 DM
-Class: Sulfonylureas -Action: Helps body to secrete insulin -Should be taken with meals |
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Pharmacology (Sulfonylureas)
-glyburide (DiaBeta, Micronase) |
-Oral agent for type 2 DM
-Class: Sulfonylureas -Action: Helps body to secrete insulin -Effects may last entire day -May not be suitable for patients with kidney disease |
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Pharmacology (Sulfonylureas)
-glyburide, micronized (Glynase Pres Tab) |
-Oral agent for type 2 DM
-Class: Sulfonylureas -Action: Helps body to secrete insulin -More readily absorbed than regular glyburide so strengths of tablets are different |
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Pharmacology (Sulfonylureas)
-chlorpropamide* (Diabinese) |
-Oral agent for type 2 DM
-Class: Sulfonylureas -Action: Helps body to secrete insulin -Longest-acting drug in this class so has higher potential to cause low blood glucose -Not recommended for elderly or patients with kidney disease -May cause low blood sodium levels, jaundice, possibly skin rashes -*older, seldom used today |
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Pharmacology (Sulfonylureas)
-tolazamide* (generic only) |
-Oral agent for type 2 DM
-Class: Sulfonylureas -Action: Helps body to secrete insulin -Patients with kidney disease may need smaller doses -*older, used infrequently today |
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Pharmacology (Sulfonylureas)
-tolbutamide* (generic only) |
-Oral agent for type 2 DM
-Class: Sulfonylureas -Action: Helps body to secrete insulin -An older agent, used infrequently for dibetes |
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Pharmacology (Thiazolidinediones, TZDs)
-pioglitazone (Actos) -rosiglitazone (Avandia) |
-Oral agent for type 2 DM
-Class: Thiazolidinediones, TZDs -Action: Improves insulin sensitivity of tissues with decreased risk of hypoglycemia -Typically takes 4-6 weeks to see effect on blood glucose -Side effects: Weight gain, fluid retention, heart failure. -MD should perform liver function prior to starting these meds and periodically throughout tx. -May cause women who are not ovulating who have not gone through menopause to start ovulating again, enabling them to conceive -OCPs may be less effective when taking these meds -Avandia carries potential increased risk of MI |
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Pharmacology (Combination Pills)
-metformin + glyburide (Glucovance) -metformin + rosiglitazone (Avandamet) -metformin + glipizide (Metaglip) -metformin + pioglitazone (Actoplus Met) -metformin + sitagliptin (Janumet) -pioglitazone + glimepiride (Duetact) -rosiglitazone + glimepiride (Avandaryl) |
-Oral agent for type 2 DM
-Class: Combination Pills -Action: As for each individual med -Side effects: As for each individual med -Make sure no liver problems -Women can begin ovulating again -OCPs less effective |
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Insulin
Most widely used insulins in this country are... |
-Human insulin analogs
-Recombinant DNA human insulins -Through genetic engineering sterile bacteria or yeast are transformed into "little factories" that produce synthetic human insulin |
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Insulin
The 3 main characteristics of insulin are... |
-Onset: Length of time before insulin reaches bloodstream and begins lowering blood glucose
-Peak time: Time during which insulin is at its maximum strength in terms of lowering blood glucose levels, when hypoglycemia is most likely to occur -Duration: How long insulin continues to lower blood glucose |
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Insulin
Types of insulin are... |
-Rapid-acting
-Regular -Intermediate-acting -Long-acting -Mixtures |
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Insulin (Rapid-acting)
-insulin glulisine (Apidra*), clear -insulin lispro (Humalog*), clear -insulin aspart (NovoLog*), clear |
-*Denotes availability in prefilled, disposable pens or cartridges for reusable pens
-All are analog |
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Insulin (Regular)
-regular (Humulin R), clear -regular (Novolin R*, ReliOn), clear |
-*Denotes availability in prefilled, disposable pens or cartridges for reusable pens
-All are human |
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Insulin (Intermediate-acting)
-NPH (Humulin N*), cloudy -NPH (Humulin N*, ReliOn), cloudy |
-*Denotes availability in prefilled, disposable pens or cartridges for reusable pens
-All are human |
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Insulin (Long-acting)
-insulin detemir (Levemir*), clear -insulin glargine (Lantus*), clear |
-*Denotes availability in prefilled, disposable pens or cartridges for reusable pens
-Never mix these -All are analog |
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Insulin (Mixtures)
-70% NPH/30% regular (Humulin 70/30*) -70% NPH/30% regular (Novolin 70/30*, ReliOn) -50% lispro protamine, 50% insulin lispro (Humalog Mix 50/50*) -75% lispro protamine (NPL)/25% lispro (Humalog Mix 75/25*) -70% aspart protamine/30% aspart (NovoLog Mix 70/30*) |
-*Denotes availability in prefilled, disposable pens or cartridges for reusable pens
-All are cloudy -NPH/regular is human -lispro, aspart are analog |
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Human & Analog Insulin
Time of Action: -lispro -aspart -glulisine |
-Onset: Less than 15 minutes
-Peak: 1-2 hours -Duration: 3-4 hours |
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Human & Analog Insulin
Time of Action: -regular |
-Onset: 30 minutes-1 hour
-Peak: 2-3 hours -Duration: 3-6 hours |
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Human & Analog Insulin
Time of Action: -detemir |
-Onset: 1-2 hours
-Peak: Relatively flat -Duration: Up to 24 |
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Human & Analog Insulin
Time of Action: -glargine |
-Onset: 1-2 hours
-Peak: No pronounced peak -Duration: 24 |
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Human & Analog Insulin
Time of Action: -NPH (70/30) |
-Onset: 2-4 hours
-Peak: 4-10 hours -Duration: 10-16 hours |
