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31 Cards in this Set
- Front
- Back
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Ultra rapid onet, Short DOA
-insulin lispro (humalog) -insulin aspart (novalog) -insulin glulisine (Apidra) |
ONset 15min
DOA. 2-5hr Sliding scale Soulable clear -IV ok (not for Glulisine) use at start of meals |
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Rapid onset, Short Duration
Regular Insulin (crys. zinc) |
onset. 30 min
DOA 5-7 hr Sliding scale Soluble clear -IV ok Used IV for emergencies(ketoacidosis) Inject sc 30-60 mins before meal |
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Intermediate onset, Intermediate DOA
- NPH -Lente |
Onset 2-4hr
DOA 10-16 hr Suspenstion(crystallin/insulin/zinc/protamine) NOT IV safe ...SC only Phosphate buffer Used to maintain fast glucose levels |
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Slow Onset, Extended duration
-Ultralente |
onset 6-10 hr
DOA 20+hr Suspension More Zn = larger crystals |
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Intermediate Onset, Extended DOA
-Insulin Glargine(lantus) -insulin Determir (Levemir) |
-(glardine)
+onset 1.1 hr +DOA 24 hr peakless +Clear sol in vial at pH4(micro-precipitates upon inject) +dose QHS -(determir) +onset 2 hr +duration 22hr Peakless +sol in vial and upon inject +regular insulin bound to FA to extend action |
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1st Generation Sulfonylureas
Chlorpropamide (Diabinese) |
-36hr T1/2 (bad OD
-Disulfram- like rxn to ethanol(nausea) -SIADH increase sen. of kidney to ADH= water retention |
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2nd Generation Sulfonylureas
Glyburide (Micronase) |
QD-BID dosing
Liver metaboilsm |
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2nd Generation Sulfonylureas
Glipizide(glucotrol) Glipizide XL |
Shortest DOA= used BID
XL(extended length) = QD Liver metabolism |
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2nd Generation Sulfonylureas
Glimepiride(amaryl) |
QD dosing
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Meglinitides
-Repaglinidine (Prandin) -Nateglinide (starlix) |
Admin before meal to reduce post-prandial glucose levels
-short t1/2 so sulfa allergy S.E -weight gain -GI upset -Headache -Hypoglycemia |
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Biguanides
-Metformin(Glucophage) |
NOT Hypoglycemic agent
#1 agent Type-2 Incre HDL, decr Tri, decr tot Cholest ANti-Hyperglycemic (possible lactic acidosis (dont use in kidney or liver disease patient, CHF) S.E -Gidisturbace (diahhrea) --> release 5-HT in gut |
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Alpha Glucosidase Inhibitor
Acarbose ( Precose) Miglitol (glyset) |
TID with first bite of meal
Modest thera action Prevent sucrose breakdown -(only gluc or dectrose use if hypoglycemia) S.E. = Gas -poorly tolerate contra when IBS and Obstruction |
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Thiazolidinediones (TZD)
Rosiglitazone (avandia) Pioglitazone (actos) |
Incre effectiveness of insulin and reduced amount of external insulin req by 30%
Liver fn test every 4month for 1 yr Slow onset(2mon for max effect) S.E.= weight gain (2-10 lbs) Fluid Retention9ince plasma vol and extra vascular fluid bad in CHF) Increase SC fat Increa MI incident with Rosig GI distrubances fatigue headache contra in prego and breast feed |
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GLP-1 Agonist
(incretin Mimetics) Exenatide (byetta) Liraglutide(Victoza) |
t1/2 2.4 hr (exe)
13 hr (LIR) Causes weight loss not 1st line SE - nausea and vomiting diahhrea wieght loss pancreatitis (rare in both) Thrid C-cell carcinoma in rats (lir) renal insuffucuency (exe) |
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DPP-4 Inhibitors
Sitaglipin (Januvia) Saxgliptin (onglyza) |
Monotherapy or add on
t1/2 11.8-14.4 hr 1 dose inhibit DDP$ activity for 24 hr weight neutral very low S.E Type 2 only Contra with insulin Delay gastric empty (decrease absort) tak othe med atleast 1 hr before (antibiotic and contraceptive especially) headache and runny nose b/c DDP$ may be involed in immune response Pancreatitis rare with Sitgliptin |
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Amylin Agonist
Pramlintide(symlin) |
Type 1 or 2 who use insulin at meal time
inject SC before meal Weight loss S.E - -Nausea -->titrate dose(28-48%) -Vomiting -Anorexia -headache -caution in patients with diabetic gastroparesis -drug interaction cause slow s gastric empty 1 hr beofre or 2 hr after do co admin anti cholinergic may slow gastric motility (acarbose or misglitol) |
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Hypothyroid treatment.
Desiccated Thyroid |
Foreign Source= allergy
Dont know T3T4 conc. |
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Hypothyroid treatment.
Liothyronine -cytomel -triostat |
Synthetic T3-->more side effect T4
Shorter half life 1 day less affinity for binding proteins sometimes used along with T4 to trest myxedema coma |
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Hypothyroid treatment.
Fixed Ratio (liotrix) Prep |
4:1 mix T4:T3
T3 cause tremor, headache, palpitation, diarrhea |
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Hypothyroid treatment.
Levothyroxine -Levothyroid -Synthroid |
DOC
Syn T4 (no antigenicity) predictable Long half life 1 wk DOC for myxedema-->IV to saturate TBG and bind other proteins rest convert T3 |
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HyperThyroid treatment
Propranolol |
Reduce peripheral manifest (tachy, tremor sweat)
Beta blocker also inhibit peripheral conversion of T4 to T3 by inhibiting 5-deiodinase |
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Hyperthyroid treatment
Thionamides -Propylthiouracil (PTU) -Methimazole |
Inhibit iodine oxidation and iodotyrosyl coupling--> bind thyroid peroxidase
Onset delayed must deplete t3t4 stores Adverse effet (agranulocytosis (rare and dermatological) PTU for thyroid storm (no methimazole) Methimazole 10x potent response 3-4 weeks |
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Hyperthyroid treatment
Radio active Iodine (RAI) |
I131 destroy cels via beta particles emission
high cure rate no sugery response 3-6month contra preg (destroyfetal thyroid) risk delayed hypothyroidism |
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Hyperthyroid treatment
Anion Inhibitors -Perchlorate -Thiocynate |
Compete for I uptake in thyroid
Perchlorate assoc w/ aplastic anemia Perchlorate 10x potent |
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Hyperthyroid treatment
Iodides |
fast anti thyroid effect 2-7 day (thyroid storm use)
Lugol and Saturated sol of potassium Iodide Inhibit uptake of Iodode inhibit organification of I--> high intra thyroidlevel-->inhibit transcription of TPO and NADPH oxidase Admin Thioamines first to prevent formation of T3T4 Major mech of action- inhibit thyroid hormone release at high serum levels response 1 wk most used before surgery to make gland firm and decrease vascularity not with RAI (compete for uptake) or prego (fetal goiter) used to protect thrypoid from radiation SE= rash, angioadema, metallic taste, sore or bleeding gums |
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Hyperthyroid treatment
Iodinated Contrast media |
Inhibit convert from T4 to T3 in liver , kidney, pituitary gland, and brain
iodide released from media cause high I level treat thyroid storm |
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Thyroid storm
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sudden excerbation of hyperthyroidism via rapid release of thyroid hormone
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Thyroid Storm Treatment
-PTU -Propranolol |
-PTU inhibit conversion
-Propran for sympathetic effect som inhibit of conversion |
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Thyroid Storm Treatment
-K iodide -Iodinated contrast media |
-K --4hr after PTU - decrease any futher releae T3T4
-Iod media--used instead iodate to stop release |
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Thyroid Storm Treatment
- Hydrocortisone or dexamethasone |
Inhibit conversion and protect shock
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PTU
propran K Iodides Iod cintrast media Hydrocortisone or dex Regimen |
will reduce serum T3 to almost norm in 24-48 hours
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