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35 Cards in this Set

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What value is the criical point for diagnosins diabettes and why
126 mg/dl

Increase in the incidence retinopathy first detected at this level
Ethanol effect on insulin sensitivity
Increases insulin sensitivity
What drug class decreases insulin sensitivity
Thiazides
Beta blockers
Metabolic syndrome
Type 2 Diabetes, Hypercholesterolemia, hypertenison
Distinguising diabetic come from insulin coma
Give glucose first, insulin coma will respond, diabetic coma won't (but no harm done)
Type 1 effect on muscles
Atrophy

Insulin required for amino acid uptake and suppression of proteolysis
Half life of circulating insulin
8 minutes
Half life of long acting insulins
Same as regular. They are longer acting because they are more slowly absorbed SC.
Exubera
Inhalable insulin
CI Exubera
Asthma, smokers, lung problems
SE of insulin
Temporary visual disturbance dud to decreasing osmolarity
Localized fat accumulation at injection site
Oral Hypoglycemic agents
Sulfonylureas
Meglitinides

Promote insulin release (for type 2's)
Sulfonylureas (amide's)
Increase cytosolic Ca to stim Insulin release)

ALSO increase insulin sensitivity

Taken orally, last 3-48 hrs
Tolbutamide
Shortest Half life Sulfonyurea
Notable about acetohexamide
It's metabolite is more active than the nonmetabolized drug itsel.
Chlorpropamide
Longest half life of sulfonylureas

Fluid retention by stimulating ADH
SE of sulfonylureas
Weight gain
Hypoglycemia
GI, allergic, derm, transient leukemia
Disulfram-like with alcohol
Meglitinides
Repaglinide
Nateglinide

Same effects as sulfonylureas, must be take right before meal.

Rapid on, Rapid Off
Repaglinide
Meglitinide

Do not give with Gemfibrizol
Avoid in pregnancy
Diabetic drug not to be taken with Gemfibrizol
Repaglinide
Exenatide (byetta)
From gila monster

Give 1 hour before eating, not after

Enhances insulin secretion
MOA of exenatide
Enhance insuling
decrease glucagon
Slow gastric emptying
Decrease food intake

For Type 2 only
Antihyperglycemic Agents
Metformin
Thaizolidinedione
Symlin

Help lower sugar levels but do not stimulate insulin
Metformin
Decrease glucose output, inhibits absorption and increase muscle uptake.

No weight gain, good 1st choice drug

Oral, 2-4 hours, urinary excretion
SE of Metformin
GI distress (from inhibition absorption)
Lactic acidosis in elderly or renal failure. Check renal labs. Avoid alcohol
Thiazolidineodiones
Rosiglitazone
Piolitazone

Increase insulin sensitivity in peripheral target tissue. Lower levels of insulin necessary, so are beta cell protective
Rosiglitazone for type 1 diabetics
must be used with insulin treatment
SE of Thiazolidineodiones
Weight gain
Fluid retention

Monitor liver enzymes
Monitor this before and periodically after prescribing thiazolidineodiones
Liver enzymes
alpha glucoside inhibitors
Acarose and miglitol

Prevent generation of monosaccharides, so absorption of surgar and reduce peak levels

Only one that doesn't cause hypoglycemia
SE of acarbose adn miglitol
GI symtoms for absorption inhibition
Symlin
Amylin homolog

SQ injection that dealys gastic emptying, prevents rise in glucagon, promotes satiety
Caution on symlin and insulin
Do not draw in samy syringe
CI to symlin
Gastroparesis
Cholpropamide and vasopressin
Chlorpropamide STIMULATES vasopressin

It is the only sulonylurea that does this