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61 Cards in this Set
- Front
- Back
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What is the hallmark of DM therapy?
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insulin
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What is a goal of hgb a1c?
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<7% is good control
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What drug stimulates carb metabolism, glucose uptake into muscle, adipose (lipogenesis), and stimulates protein synthesis?
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insulin pharmacology and uses
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Which type of DM pt requires insulin therapy?
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type 1, as they make NONE
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What other pts' (other than type 1) may require insulin therapy?
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type 2 who have failed
type 2 in hospital who cannot tolerate oral meds gestational diabetics |
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Which of the following is NOT a rapid acting insulin?
-humalog (lispro) -novalog (aspart) -regular -apidra (glulisine) |
regular is NOT rapid acting acts in about 30" and has a duration of 6-8 hours
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What is the average onset of action for humalog, novalog, and apidra?
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15"
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What are the uses of rapid acting humalog, novalog, and apidra?
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sliding scale, pump, and mealtime
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NPH, detemir (levimir), glargine (lantus) are considered ___ insulins
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background
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What is the time of onset for regular insulin? the peak? the duration?
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onset 30"
peak 2-4 hours duration 6-8 hours |
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What type of insulin more closely mimic's the bodies insulin?
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rapid acting
humalog (lispro) novalog (aspart) apidra (glulisine) |
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What is the onset, peak and duration times of the rapid acting insulins? humalog, novalog, and apidra?
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onset 15"
peak 1 hour duration 3.5-4.5 hours |
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Which insulin is very good used in a pump?
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regular
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Name some common "mixed" insulins.
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Humulin 70/Novolin 30
humulin 50/50 humalog 75/25 humalog 50/50 novolog 70/30 |
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what is in humulin 70/novolin 30? how does it work?
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70% NPH-slower acting
30% regular insulin-faster acting |
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Why cant the 'background' insulins be used at mealtime?
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much slower onset, peak is much later, complicated use must take with rapid acting to cover meals
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What is the onset, peak, and duration of NPH?
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onset 1-2 hours
peak 6-12 hours duration 18-24 hours |
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what is the onset, peak and duration of detemir (levemir)?
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onset 3-4 hours
peak 6-8 hours duration 6-23 hours (doesn't last as consistently as lantus) |
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What is the onset, peak and duration of glargine (lantus)?
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onset 3-4 hours
peak unknown duration >24 hours |
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What is one of the administration s/e of lantus that pt's complain about?
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it's acidic, so it burns upon injection
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if a pt. is on ssc "regular" insulin and their BS is 181. how much ssc would you give them?
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3 units for BS 121-200
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if a pt is on ultra short ssc coverage and their BS is 313, how much would you give them?
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8 units
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ultra short treatment for BS of 201-250 is? 251-300? 301-350? 351-400?
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4 units
6 units 8 units 10 units and call MD |
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regular ssc treatment for BS of 0-120? 121-200? 201-250? 251-300? 301-350? 351-400?
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none
3 units 7 units 10 units 12 units and call MD |
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What is MOA for sulfonylurea agents?
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helps pancrease secrete insulin in response to food
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Why is glyburide (micronase, glynase, diabeta) good for pt compliance?
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1-2 QD
can get generic |
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What are the s/e of the sulfonylurea drugs?
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-hypoglycemia
-lose effectiveness (5% per yr) -wt. gain |
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T/F
Sulfonylurea drugs are used in type I DM only. |
false! type 2 dm ONLY
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When can you adjust the dose of a sulfonylurea drug?
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after 1 week of treatment, but no less
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Sulfonylurea drugs usually lower hgb a1c by how much?
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1.5-2%
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What body habitus do sulfonylurea agents not work as effectively?
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already obese patients-dont do it
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T/F
Sulfonylurea agents work very effectively in gestational dm pts. |
false! they are contraindicated stupid!
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Biguanide is a class of drugs commonly known as....
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metformin, glucophage....
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What is the MOA of metformin?
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-decreases hepatic production of glucose
-inc. effect of insulin in liver and skeletal tissues -doesn't inc. insulin production or secretion -can adjust dose after 1 week -lowers hgba1c by 1.5-2% |
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what is the DOC for type 2 DM?
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glucophage-not harmful to kidney's but pt with renal failure may develop lactic acidosis if taking metformin so watch them
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What are the s/e of metformin (glucophage)?
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-n/v/d/anorexia (sometimes used as a wt. loss drug)
-lactic acidosis when given with nephrotoxic meds (IV dye) -must be held for 48 hours prior to IV dye study |
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Name 2 common glitazones.
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avandia
actos |
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What is MOA for glitazones.
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-reduces insulin resistance: improves insulin action in tissues
-may inc. storage of glucose as glycogen -suppresses glycogenolysis -does not affect number of insulin receptors -can adjust dose after one mth -reduces hgb a1c by 1-1.5% |
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Which drug class is least effective? Sulfonylureas, metformin, glitazones?
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glitazones are the least effective of all of them. Avandia may be a little better than Actos
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What major problem can occur when taking Actos?
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increased risk of CV events
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What are the s/e of glitazones?
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fluid retention/peripheral edema
chf incr. risk of CV events weight gain |
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Prandin is classified as a Non-____
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sulfonylurea drug
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What is MOA of Prandin?
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-ultra short acting
-makes pancreas secret insulin in response to food -used with pts with post eating sugar spikes -s/e is short lived hypoglycemia |
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___ are large proteins secreted from specialized cells in the GI tract and are co-secreted with insulin.
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incretins
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___stimulates insulin synthesis and release; lowers post-prandial glucagon secretion; slows gastric emptying; stimulates beta-cell proliferation.
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Glucagon-like peptine-1 (GLP-1)
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____-reduces post-prandial glucagon secretion
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amylin (comes from the pancrease)
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What synthetic incretin (GLP-1) is isolated from Gila monster salive, which is resistant to degradation by DPP-IV?
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exenatide (Byetta)-therefore it lasts longer than natural human GLP-1.
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Byetta is for adult use with type 2 dm, usually in combo with other meds...such as...
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sulfonylurea and/or metformin
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What is the MOA for Byetta?
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-incre. insulin secretion
-slows gastric emptying -may decre. food intake |
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What are the s/e of Byetta?
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-significant hypoglycemia
-nausea -wt. loss -pancreatitis |
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How is Byetta given?
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BID sub q injections
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Byetta should not be given to which type of pt's?
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with delayed gastric emptying, and/or renal dysfunction
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Byetta is 4th line therapy, why?
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very expensive
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What type of drug is Symlin?
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synthetic incretin, analog of amylin
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What type of pt's are appropriate for Symlin? What are it's s/e?
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adults with type 1 or 2 dm, generally given with insulin.
s/e's-hypoglycemia, nausea, anorexia |
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What must you tell your insulin dependent pt's to do when starting them on symlin?
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reduces their insulin dose by 50%, and then retitrate.
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Januvia is what class of drug? What is its MOA?
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It is a DPP IV inhibitor. it inhibits the enzyme dipeptidyl peptidase IV, which is responsible for destroying glucagon-like peptide-1 (GLP-1) and glucose-dependent insulintropic polypeptide (GIP).
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Januvia is used for what type of dm pts?
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type 2 only.
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Januvia MOA, made a little easier?
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inhibits enzymes that destroys incretin so they stay around longer, slow gastric emptying, and suppress appetite.
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What is glucagon used for?
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hypoglycemia
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What 2 oral agents work well together, complement each other?
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sulfonylurea & metformin
sulfonylurea & glitazone |
