N210 Diabetes Pharmacology Lecture Notes

Front 1

Action of insulin:

Back 1

Increases glucose uptake by the body

Front 2

Action of glucagon:

Back 2

Increases the release of glucose from the liver

Front 3

Action of amylin:

Back 3

Decreases glucagon secretion (and thus release of glucose from liver), decreases appetite

Front 4

Action of GLP-1 (incretin):

Back 4

Decreases glucagon secretion (and thus release of glucose from liver), decreases appetite

Front 5

S/s of type I DM:

Back 5

Polyuria, polydipsia, polyphagia
Weight loss
Dehydration

Front 6

What is the tx for gestational diabetes?

Back 6

Insulin
Metformin w/ DMII

Front 7

Dx of diabetes:

Back 7

Positive (high) plasma glucose test on two separate days

Hemoglobin A1c can be easier to use to diagnose

Front 8

Normal BG, fasting and before meals:

Back 8

70-100

Front 9

Normal BG, 2 hours postprandial

Back 9

<140

Front 10

Normal hemoglobin A1c:

Back 10

4-6%

Front 11

Each % in the A1c = how many mg/dl of blood glucose?

Back 11

30

Front 12

What does an A1c of 6% work out to as an average daily blood glucose?

Back 12

120

Front 13

Fasting BG in pre-diabetes and diabetes:

Back 13

Pre-diabetes: 100-125
Diabetes: >126

Front 14

Random or 2-hour postprandial BG in pre-diabetes and diabetes:

Back 14

Pre-diabetes: 140-199
Diabetes: >200 + symptoms

Front 15

A1c goal for diabetics:

Back 15

< 7%

Front 16

Glucose goals for critically ill patients:

Back 16

Fasting <126
Casual glucose <180-200

Front 17

Comprehensive glycemic control for DMI patients:

Back 17

Diet
Self-monitoring of blood glucose
Exercise
Insulin replacement

Front 18

Comprehensive glycemic control for DMII patients:

Back 18

Diet
Exercise
Drug therapy
MAYBE insulin

Front 19

DMII patients should be screened/treated for:

Back 19

Hypertension
Nephropathy
Retinopathy
Neuropathy
Dyslipidemias

Front 20

Action of secretagogues:

Back 20

Stimulates B-cells to secrete more insulin

Front 21

Subtypes of secretagogues:

Back 21

Sulfonylureas
Meglitinides

Front 22

Action of insulin sensitizers:

Back 22

Improve insulin use in muscle/fat/liver

Front 23

Subtypes of insulin sensitizers:

Back 23

metformin
TZDs

Front 24

Action of glucosidase inhibitors:

Back 24

Slow digestion of carbs in the gut

Front 25

Subtype of glucosidase inhibitors:

Back 25

Alpha-glucosidase inhibitor

Front 26

Action of synthetic amylin:

Back 26

Replaces amylin

Front 27

Synthetic amylin agent:

Back 27

pramlintide (Symlin)

Front 28

Action of DPP-4 inhibitors:

Back 28

Decrease the breakdown of GLP-1

Front 29

DPP-4 inhibiting agent:

Back 29

sitagliptin (Januvia)

Front 30

Action of incretin memtic:

Back 30

Mimics the action of GLP-1

Front 31

Incretin mimetic agent:

Back 31

exenatide (Byetta)

Front 32

Is insulin anabolic or catabolic?

Back 32

Anabolic

Front 33

AE of insulin:

Back 33

Hypoglycemia
Weight gain

Front 34

Interactions with insulin:

Back 34

Hypoglycemic agents
Thiazides
Glucocorticoids
Sympathomimetics
Beta blockers (mask hypoglycemia)

Front 35

Three rapid-acting insulins:

Back 35

insulin lispro
insulin aspart
insulin glulisine

(Rapid actings don't L.A.G. behind)

Front 36

Which insulin is short-acting?

Back 36

Regular insulin

(SHORT 'n' REGULAR)

Front 37

Two intermediate acting insulins:

Back 37

NPH insulin
insulin detemir

(DETERmine that NPH is an INTERMEDIATE actor...)

Front 38

Which insulin is long-acting?

Back 38

insulin glargine

(You wouldn't want to GLARGLE insulin for a LONG time.)

Front 39

Which insulins are used as a bolus towards a target post-prandial BG?

Back 39

Rapid and short acting

Front 40

Which insulins are using based on fasting/between meal BGs?

Back 40

Intermediate and long acting

Front 41

Administration of rapid-acting insulin:

Back 41

Give 5-15 min before meal
Skip dose if meal is skipped

Front 42

Which insulin can be mixed with lispro?

Back 42

NPH

(NPH doesn't have a LISPro but they can go together!)

Front 43

Routes of insulin lispro:

Back 43

SC, IV

Front 44

Onset/peak/duration of insulin lispro:

Back 44

Onset: 10-30 min
Peak: 30-120 min
Duration: 3-5 hr

Front 45

Administration of regular insulin:

Back 45

30 minutes before meal
Skip dose if meal is skipped

Front 46

Which insulin can be mixed with regular?

Back 46

NPH

(NPH is married to a REGULAR guy)

Front 47

Routes of regular insulin:

Back 47

SC, IV

Front 48

Onset/peak/duration of short-acting insulin:

Back 48

Onset: 30-60 min
Peak: 2-5 hr
Duration: 6-10 hr

Front 49

Which insulin is cloudy?

Back 49

NPH

Front 50

How is NPH insulin dosed?

Back 50

Set dose/frequency; NOT sliding scale

Front 51

Onset/peak/duration of intermediate-acting insulin:

Back 51

Onset 1-2 hr
Peak 6-14 hr
Duration: 16-24 hr

Front 52

Onset/peak/duration of long-acting insulin:

Back 52

Onset 1-2 hr
No peak
24 hour duration

Front 53

What insulins can be mixed with long-acting?

Back 53

NONE

(You take the LONG road alone...)

Front 54

What happens to weight when starting insulin?

Back 54

Tends to go up

Front 55

Preparing NPH insulin for injection:

Back 55

Roll vial to mix prior to withdrawal

Front 56

When mixing insulins, which vial is drawn from first?

Back 56

Short acting

Front 57

When mixing insulins, which vial has air injected first?

Back 57

NPH

Front 58

How should unopened insulin vials/pens be stored?

Back 58

Refrigerator

Front 59

How should opened insulin vials/pens be stored?

Back 59

Room temp:
30 days for vials
10-14 days for pens

Front 60

What concentration should regular insulin be diluted to for IV use?

Back 60

1 unit/ml of NS or 1/2NS

Front 61

How long before administration should IV insulin be prepared?

Back 61

30 min

Front 62

Tx for insulin overdose:

Back 62

IV dextrose (D50)
or glucagon if IV glucose is not available

Front 63

How often must blood glucose be checked in a pt on IV insulin?*

Back 63

Hourly

Front 64

AEs of metformin:

Back 64

GI effects
Decreased appetite
N/D
Lactic acidosis*

Front 65

AEs of TZDs:

Back 65

Weight gain from fluid
Edema (in HF)
Low risk of hypoglycemia

Front 66

AEs of sulfonylureas:

Back 66

Hypoglycemia
Weight gain

Front 67

AEs of metaglinides:

Back 67

Hypoglycemia

Front 68

AEs of alpha-glucosidase inhibitors:

Back 68

Flatulence
Cramps

Front 69

AEs of gliptins:

Back 69

None yet!

Front 70

Difference between first- and second-generation sulfonylureas:

Back 70

Second generation is much more potent and safer in elderly

Front 71

Dosing schedule for sulfonylureas:

Back 71

Once or twice daily

Front 72

Recognizing the name of a meglitinide:

Back 72

-linide

Front 73

What patients particularly benefit from meglitinides?

Back 73

Patients with inconsistent meals who still produce insulin

Front 74

Onset and half-life of meglitinides:

Back 74

Both 1 hour

Front 75

Dosing of meglitinides:

Back 75

3-4 daily doses with meals
Skip dose if the meal is skipped!

Front 76

Dosing of metformin (Glucophage):

Back 76

2-3 daily doses

Front 77

Particular benefit of metformin:

Back 77

NO weight gain - possible weight loss

Front 78

Which patients are at particular risk for lactic acidosis on metformin?

Back 78

Renal impairment
Metabolic acidosis
Iodine based IV contrasts

Front 79

What patients are contraindicated for taking metformin?

Back 79

Liver disease
Infection
Excessive ETOH
CHF

Front 80

What will decrease the GI side effects of metformin?

Back 80

Improve with time
Taking with meals

Front 81

Sx of acidosis:

Back 81

Hyperventilation
Myalgia
Malaise
Somnolence

Front 82

Recognizing the name of a TZD:

Back 82

-glitazone

Front 83

Dosing schedule of TZDs:

Back 83

1-2 daily doses

Front 84

Onset of effects of TZDs:

Back 84

Delayed, up to 6 weeks

Front 85

TZDs increase the sx of what other condition?

Back 85

Heart failure
(Increased risk of MI)

Front 86

Dosing schedule of alpha-glucosidase inhibitors:

Back 86

3 daily doses

Front 87

Use alpha-glucosidase inhibitors with caution in which patients?

Back 87

Those with IBD, bowel obstruction, or cirrhosis

Front 88

Avoid giving what drug alongside alpha-glucosidase inhibitors?

Back 88

Metformin (double GI effects)

Front 89

Dosing schedule for sitagliptin (Januvia), a DPP-4 inhibitor:

Back 89

Once daily

Front 90

What is incretin?

Back 90

INtestinal stimulation for seCRETion of INsulin

Front 91

Hypoglycemia: BG level

Back 91

< 70

Front 92

Ways to rapidly increase BG level:

Back 92

4 oz juice or soda
5-8 lifesavers or 2-3 peppermints
2-3 glucose tablets
8 oz milk
Glucose gel under the tongue
D50 IV
1mg glucagon IM/SC/IV

Front 93

How frequently do we check blood glucose during tx for hypoglycemia?

Back 93

q15min

Front 94

What kind of snack should a pt eat after blood glucose is back above 70 after hypoglycemia tx?

Back 94

Something with protein