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19 Cards in this Set
- Front
- Back
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Aspart
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Rapid Acting Insulin
Mechanism:*Rapid acting Insulin --> mimic prandial release of insulin Adverse Reaction:*Hypoglycemia *Autonomic hyperactivity when glucose <60-80 mg/dl Clinical Use:*All type 1 DM patients *Type 2 DM patients not controlled by diet and oral hypoglycemic *Post-pancreatectomy diabetes *Gestational diabetes *DKA *Nonketoacidtotic hyperglycemic coma *not used alone *used with longer-acting insulin to assure proper glucose control. |
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Lispro
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Rapid Acting Insulin
Mechanism:*Rapid acting Insulin --> mimic prandial release of insulin Adverse Reaction:*Hypoglycemia *Autonomic hyperactivity when glucose <60-80 mg/dl Clinical Use:*All type 1 DM patients *Type 2 DM patients not controlled by diet and oral hypoglycemic *Post-pancreatectomy diabetes *Gestational diabetes *DKA *Nonketoacidtotic hyperglycemic coma *not used alone *used with longer-acting insulin to assure proper glucose control. |
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Regular Insulin
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Mechanism:*Binds insulin receptor --> activates tyrosine kinase --> phosphorylation of docking proteins and insulin receptor substrate 1-6 (IRS 1-6) --> IRS 1-6 bind other kinases to have cellular effects
*Rapidly lowers blood sugar Adverse Reaction:*Hypoglycemia *Autonomic hyperactivity when glucose <60-80 mg/dl Clinical Use:*Safe in pregnancy *All type 1 DM patients *Type 2 DM patients not controlled by diet and oral hypoglycemic *Post-pancreatectomy diabetes *Gestational diabetes *DKA *Nonketoacidtotic hyperglycemic coma |
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Neutral Protamine Hagedron (NPH) Isophane
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Intermediate Acting Insulin
Mechanism:*Delayed absorption of insulin due to protamine --> extends action Adverse Reaction:*Hypoglycemia *Autonomic hyperactivity when glucose <60-80 mg/dl Clinical Use:*All type 1 DM patients *Type 2 DM patients not controlled by diet and oral hypoglycemic *Post-pancreatectomy diabetes *Gestational diabetes *Not for ketoacidosis or emergency hyperglycemia *used with regular insulin |
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Glargine
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Long Acting Insulin
Mechanism:*Precipitation at injection site --> extends its action Adverse Reaction:*Hypoglycemia *Autonomic hyperactivity when glucose <60-80 mg/dl Clinical Use:*All type 1 DM patients *Type 2 DM patients not controlled by diet and oral hypoglycemic *Post-pancreatectomy diabetes *Gestational diabetes *DKA *Nonketoacidtotic hyperglycemic coma |
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Dethomir
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Long Acting Insulin
Mechanism:*associates with tissue-bound albumin at injection site --> extends its action Adverse Reaction:*Hypoglycemia *Autonomic hyperactivity when glucose <60-80 mg/dl Clinical Use:*All type 1 DM patients *Type 2 DM patients not controlled by diet and oral hypoglycemic *Post-pancreatectomy diabetes *Gestational diabetes *DKA *Nonketoacidtotic hyperglycemic coma |
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Chlorpropamide
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1st Generation Sulfanylurea
Mechanism:*↑insulin release from pancreatic B-cell. *Binds to sulfonylurea receptor --> inhibits ATP-sensitive K+ channel --> ↓ efflux of K+ --> depolarization --> open voltage-gated Ca channel --> ↑Ca influx --> release of preformed insulin Adverse Reaction:*Hypoglycemia *Weight gain *potentiate ADH effects *alcohol induced flushing Clinical Use:*Hyperglycemia control in type 2 diabetics who cannot control with diet alone. |
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Glimepiride
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2nd generation Sulfanylurea
Mechanism:*↑insulin release from pancreatic B-cell. *inhibits ATP-sensitive K+ channel --> ↓ efflux of K+ --> depolarization --> open voltage-gated Ca channel --> ↑Ca influx --> release of preformed insulin Adverse Reaction:*hypoglycemia *weight gain Clinical Use:*Hyperglycemia control in type 2 diabetics who cannot control with diet alone. |
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Glipizide
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2nd generation Sulfanylurea
Mechanism:*↑insulin release from pancreatic B-cell. *inhibits ATP-sensitive K+ channel --> ↓ efflux of K+ --> depolarization --> open voltage-gated Ca channel --> ↑Ca influx --> release of preformed insulin Adverse Reaction:*hypoglycemia *weight gain Clinical Use:*Hyperglycemia control in type 2 diabetics who cannot control with diet alone. |
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Glyburide
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2nd generation Sulfanylurea
Mechanism:*↑insulin release from pancreatic B-cell. *inhibits ATP-sensitive K+ channel --> ↓ efflux of K+ --> depolarization --> open voltage-gated Ca channel --> ↑Ca influx --> release of preformed insulin Adverse Reaction:*hypoglycemia *weight gain Clinical Use:*Hyperglycemia control in type 2 diabetics who cannot control with diet alone. |
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Repaglinide
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Meglitinides
Mechanism:*↑insulin release from pancreatic B-cell. *inhibits ATP-sensitive K+ channel --> ↓ efflux of K+ --> depolarization --> open voltage-gated Ca channel --> ↑Ca influx --> release of preformed insulin Adverse Reaction:*hypoglycemia Clinical use:*Control post-randial glucose elevation in type 2 diabetic patients *monotherapy or combination |
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Nateglinide
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Meglitinides
Mechanism:*↑insulin release from pancreatic B-cell. *inhibits ATP-sensitive K+ channel --> ↓ efflux of K+ --> depolarization --> open voltage-gated Ca channel --> ↑Ca influx --> release of preformed insulin Adverse Reaction: *Less hypoglycemia than other insulin secretagogue Clinical use:*Control post-randial glucose elevation in type 2 diabetic patients *monotherapy or combination |
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Metformin
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Biguanides
Mechanism:*Antihyperglycemic NOT hypoglycemic *↑AMP-kinase --> ↓Hepatic gluconeogenesis, ↓Renal gluconeogenesis, ↓Glucose absorption from GI tract Adverse Reaction:*DOES NOT cause hypoglycemia *GI side effects *Lactic acidosis: ↓gluocneogenesis --> impairs hepatic metabolism of lactic acid *↓B12 absorption (long term) Clinical use:*Type 2 diabetes *Insulin resistance *↓serum lipids *combination therapy |
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Pioglitazone
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Thiazolidinediones
Mechanism:*PPAR-y activation --> ↑adiponectin --> ↑glucose transport into muscle and ↑fatty acid oxidation *↑insulin sensitivity Adverse Reaction:*↑HDL *Fluid retention:anemia, weight gain, edema (obese at greatest risk) *rare hepatotoxicity Clinical use:*Type 2 diabetes treatment *Type 2 diabetes prevention *monotherapy or combination |
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Rosiglitazone
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Thiazolidinediones
Mechanism:*PPAR-y activation --> ↑adiponectin --> ↑glucose transport into muscle and ↑fatty acid oxidation *↑insulin sensitivity Adverse Reaction:*↑HDL *Fluid retention:anemia, weight gain, edema (obese at greatest risk) *rare hepatotoxicity Clinical use:*Type 2 diabetes treatment *Type 2 diabetes prevention *monotherapy or combination |
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Acarbose /Miglitol
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Alpha-glucosidase inhibitors
Mechanism:*↓action of a-glucosidase -->↓intestinal absorption of carbohydrates, starch, dextrin and disaccharide --> ↓postrandial glucose Adverse Reaction:*malabsorption *GI disturbance *No hypoglycemia when used alone Clinical use:*Type 2 diabetes *monotherapy and in combination |
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Pramlintide
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Amylin analog
Mechanism:*↓Glucagon release --> ↓gastric emptying Adverse Reaction:*Hypoglycemia, GI symptoms Clinical use:*Adjunctive mealtime administration in type 2 diabetes. |
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Exanatide
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GLP-1 analog
Mechanism:*Synthetic analog of glucagon-like-polypeptide (GLP-1) *Potentiates glucose-mediated insulin secretion --> ↓postrandial glucagon release, ↓gastric emptying, CNS anoretic effect Adverse Reaction:*GI symptoms Clinical use:*Adjunctive in type 2 diabetes. |
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Sitagliptin
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Dipeptidyl peptidase -4 inhibitor
Mechanism:*Inhibits DPP-4 --> weight loss *DDP-3 degrades incretin and other GLP-1-like molecules Adverse Reaction:*hypoglycemia Clinical use:*Adjunctive in type 2 diabetes. |
