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15 Cards in this Set
- Front
- Back
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sulfonylureas
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first generation-1970s
-Diabinese: stim beta cells to prod. insulin -second generation-1980s -Diabeta, Micronase, Glucotrol: stim beta cells to sec insulin, incr insulin sensitivity, dec hepatic glucose prod third generation-1996 -Amaryl has dec incidence of hypoglyc may be used when renal disease present -stimulate pancreas to sec insulin -doses begun at lowest, single daily amt w/ meals -used in type 2 who is not overweight/dyslipidemic S/E: hypoglyc, wt gain due to incr insulin sec, photosensitivity, gi upsets |
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meglitinides
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-Repaglinide (Proandin)
stim. pancreas to sec insulin in response to BS levels used for type 2 who is not overweight/dyslipidemic given most ofen with metformin -take w/ meals only-rapid onset -take 15 min before meals -dosages per day based on # meals/day -not to be used in sev. infections, suregery, trauma S/E: hypoglyc, upper Resp problems, GI disturbances |
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Biguanides
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metformin (Glucophage)
dec hepatic glucose production, dec cellular insulin resistance -promotes wt loss, lowers triglycerides, LDL, total chol, incr HDL (does not stim insulin release, will not cause hypoglyc if given alone) uses: overweight type 2, dyslipidemia -not used in renal dysfunction, hepatic dys, hx of alcoholism **hold for 48H prior after media contrast iodine** monitor S/E: GI upset, N/V, bloating, dia, cramping, lactic acidosis (renal insuff), metallic taste, sweating, headache take w/ meals, caution w/ excessive alcohol intake-incr risk for lactic acidosis |
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alpha-glucosidase inhibitors
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Precose & Glyset
major action: delays digestion of complex carbs from the sm intestine (red rate of glucose absorp, lowering level in blood) reduces postprandial blood glucose and insulin levels used in type 2: overweight, dyslipidemia, has high postprandial BG levels monitor for hypoglyc not used in: IBD, bowel obst, crt clearance >2.0mg/dl, cirrhosis (precose) S/E: gi upset, dia, abdom pain, flatulence, elev liver enzymes (precose) does not cause hypoglyc if given alone |
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thazolidinediones
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pioglitazone (actos) & rosiglitazone (avanda)
"insulin sensitizers) -dec insulin resistance, improves insulin action at cell sites, incr glucose uptake, dec trigly -for type 2 who is overweight, insulin resistant, on insulin w/ continued incr blood sugar not used in: liver diease, alcohol abuse, sev cardiac disorders generally used w/ sulfonylurea & insulin S/E: edema, anemia (avandia), incr lipid levels (avandia), dec H&H (actos), resumption of ovulation/risk of pregancy |
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oral combination drugs
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combined sulfonylurea & biguanide
-glucovance (micronase/glucophage), -metaglip (glucotrol/glucophage) actions: stimulates pancreas to sec more insulin, dec stored glucose output from liver, dec insulin resistance, initial therapy if meal plan and exercise fail -lowers A1C |
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symlin (pramlintide)
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synthetic form of the hormone amylin produced w/ insulin by beta cells
-injectable w/ meals -doesn't cause hypoglycemia -improves A1C levels, promotes wt loss |
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Byetta (exenatide)
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incretin memetic that lowers BS by incr insulin sec.
-inj w/ meals, mod wt loss, imp glyc control, used after trial of glucophage and sufo has not assisted in acheiving target A1C (6-7) |
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lantus
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insulin glargine is long-acting, man-made version of human insulin
once daily dosing SQ -duration of action-24 H -used in type 1 & 2 -can not mix w/ other insulins -no peak, steady control |
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januvia
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targets 2 key defects
-insulin release -hepatic glucose reabsorption -used alone or w/ other agents to improve glycemic control in type 2 |
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Exubera
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first non-injectable insulin approved in the U.S. in 2006
-powdered form of insulin absorbed through the lungs through use of an inhaler rapid-acting, taken before a meal improves A1C control; used in type 1 or type 2 diabetes |
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insulins
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humalog (lispro)- rapid acting
regular-short acting NPH/lente/premixed 70/30 -intermediate ultralente-long-acting |
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major action of insulin
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-moves glucose/ AA into cells
-enhances fat storage -incr storage of glucose in the liver and muscle -dec formation of glucose form non-carb source |
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uses of insulin
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used in:
type 1 type 2 not well-controlled w/ oral meds type 2 and seriously ill gestational D not controlled by meal plan DKA |
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insulin: review of principals
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human insulin most widely used
-peaks more precisely -shorter duration of action -less antigen resp prod absorption: fastest in abdom, then arms and legs normal pattern-basal secretion and incr secretion w/ CHO load |
