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37 Cards in this Set
- Front
- Back
Rxs for DM type I
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Insulins
Pramlintide acetate (symlin) |
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Rapid onset insulins
onset and DOA |
Insulin-lispro
Insulin-aspart Insulin-glulisine 10-30 min------3-5 hr Regular insulin 30-60 min-------5-12 hr A little LISPro ASPART GLU the INSULIN |
|
intermediate onset insulins
onset dOA |
Insulin Lispro Protamine
Isophane insulin 1-2h------10-20 h Insulin zinc 2-4 h------12-20 h The lispro's PROtAMIne ISOPHINE ZING! |
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Long acting insulin
|
Extended insulin zinc,
2-4 h 16-24 h Insulin detemir 1 h-----20 h Insulin glargine 1-2 h 24 h The EXTENDED ZING is DETEMIR and G-LARGin USually one takes a long acting guy and then a short acting PRN tailored to the needs |
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Pramlintide acetate
indications MOA SEs |
AMYLIN analog----cosecreted with insulin---dec G.EMPTYING,^satiety, decr post meal glucose and glucagon prod in liver
for use in DM type I (taken at a meal) UNCONTROLLED*****on insulin SE-HYPOGLYCEMIA***** |
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Insulin SEs
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• Hypoglycemia
Beta blockers mask symptoms Warning symptoms are blocked (e.g., tachycardia) • Develop Ab’s to insulin Does NOT interfere with therapy • Hypokalemia Insulin ↑ cellular uptake of K+ • Injection at same site repeatedly Lipodystrophic injection site reaction NOTE Strenuous exercise ↓ amount of insulin needed(glucagon,cortisol, GH secreted) |
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Insulin Moa
|
RECEPTOR pr. TK---->MAPK (mitogenic)
&------->+p-IRS--IPS/akt--->protein/glycogen/fat synth, mobilize GLUT4 t-porter (via CBL protooncogene) to PM in adipose and muscle to sequester glucose and some AAs |
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classes of drugs used to treat DM type II
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sulfonylureas
Biguanides thiazolidinediones DPP-4 (-) meglitinides a-glucosidase (-) incretin analogs glucagon/glucose |
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Sulfonylureas 1st generation
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Tolbutamide
Chlorpropamide acetaheximide tolazamide (CHLO-PROPA acetOhexi TOLAZAM TOLBUTA) |
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Sulfonylureas 2nd generation
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Glyburide
Glipizide Glicazide Glimepiride |
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Sulfonylureas 1st generation
SEs |
• tolbutamide is More cardiotoxicity than other sulfonylureas (but has a short T1/2 and is good for pts prone to hypoglycemia)
ALL 1st GEN- • Extensive protein binding LOTS of interactions Displacement = hypoglycemia • Flushing & hypotension when taken with alcohol Disulfran reaction (inhibit alcohol dehydrogenase and increase acetaldehyde) |
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Sulfonylureas 2nd generation
SEs |
• Fewer drug interactions (less protein binding)
• Often minimal side effects Persistent hypoglycemia Muscle weakness Dizziness Confusion • Weight gain (exacerbates diabetes) • Note: side effects don’t usually cross over However, if patient doesn’t respond to 1 sulfonylurea …probably fail to respond to others as well this is for both generations some say they increase Heart attacks |
|
Sulfonylureas
mOA |
blocks ATP K+ channel in B-cells
= depolarize-----increase insulin secretion |
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glucovance
|
metformin +Glyburide
|
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Biguanides
named |
metformin
|
|
metformin
MOA advantages |
increased post receptor action
increased GLUT-4, dec gluconeo, dec insulin resistance GOOD-no hypoglyc or ^insulin secretion, good lipid profile, dec DIs than sulfonyls |
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metformin
SEs CIs |
• Fewer drug interactions than sulfonylureas
• Lactic acidosis***** Phenformin removed from market for this • GI distress • Metallic taste • Contraindications Lactic acidosis Renal, hepatic, cardiac disease Excess alcohol ingestion Acute infection / severe stress Severe caloric restriction / exhausting exercise Pulmonary insufficiency Pregnancy or breastfeeding |
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Thiazolidinediones
named |
the GLITAZONES
Rosiglitazone Pioglitazone Thi-azol-i-dined before ROSI & PIO S' GLITA-ZONE PPARtY the agony the INSOLENT Sensitive muscle.... |
|
Rosiglitazone
Moa |
Thiazolidinedione
PPARγ agonists (Peroxisome proliferation activated receptor gamma) Mediates DNA-directed, RNA-mediated protein synthesis |
|
Pioglitazone
actions |
Increases Transcription of “insulin sensitive” genes
Stimulates glucose transport • Stimulates Glut 4 receptors Inhibits Glucose production Stimulates Regulation of FA metabolism Increases sensitivity of target cells to insulin****** Improve lipid profile |
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Thiazolidinediones
specific to each and as a group SEs CIs |
Rosiglitazone-may increase MI
Pioglitazone-Induces CYP 3A4 Decreases availability of other drugs e.g. oral contraceptives BOTH-• Fluid retenti---Edema---careful in CHF CIs hepatic dis, HF, PREG (?)(as with all NEW dmII drugs have not been proven USE INSULIN) in Polycystic ovary disease Women may resume ovulation (Use contraception) NEW WARNING may increase fractures in funky spots in old women |
|
DPP-4 inhibitors
|
sitaglipin phosphate (increased incretin scene)
DiPP-4 INCRETable stuff ShIT-A-GLIP-TIN (phosphate) was everywhere…… With the truly INCRETable…………EXE-NATI (de) who was everywhere…… ( the incretins..^insulin,satiety dec-Gluca,GE) |
|
sitaglipin phosphate
Moa |
dpp-4 inhibitor (dipeptidyl peptidase ?)
enzyme that degrades incretins like GLUCAGON LIKE peptide-1 (GLP-1)(inhibits glucagon) that are secreted pre and post a meal this increase in incretins basically increases INSULIN and decreases GLUCAGOn.....and other insulin type stuff |
|
meglitinides
named |
the glinides (similar to sulfonylureas)2nd line drugs
nateglinide repaglinide |
|
repaglinide
MoA and everything |
nateglinide also
like sulfonyls increase insulin secretion preg not established Oral Short acting Taken before each meal Metabolized by CYP 3A4 |
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alpha-glucosidase inhibitors
named |
miglotol
acarbose |
|
miglotol
MoA |
miglotol
acarbose oligosacharides---Inhibit enzyme on brush border of enterocytes in small intestine (inhibits α-glucosidase) Delay carbohydrate digestion & absorption (NOT prevented) Plasma insulin response is blunted |
|
alpha-glucosidase inhibitors
named SEs of each and both |
miglitol NO Hepatotoxicity
• Not well tolerated GI (Flatulence***, diarrhea, etc.) ACARbose Hepatic toxicity • Not well tolerated GI (Flatulence, diarrhea, etc.) |
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alpha-glucosidase inhibitors
indications |
miglotol
acarbose for severe!! hyperglycemia (not moderate) |
|
GLP-1 analog
named |
EXEnatide
incretin |
|
EXEnatide
MOA indications |
GLP-1 analog (from a lizard)
^insulin & satiety DEcrease-glucagon and G. emptying (use as anti obese ?) approved if uncontrolled on others this is the only injectable DM II drug TAKEN PRE MEAL |
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Tx algorythm for TYPE II DM
|
start with diet blah
then metformin (he's the man) then others add prn insulin is third and final (except in pregnancy) |
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gestational Diab Tx
|
diet number one
insulin if needed must keep tight control in polycystic ovary disease may keep on metformin not thiazolidin..... |
|
Tx HYPOglycemia
|
glucose (ER IV dextrose)
glucagon |
|
GLUCAGON
Moa indication |
Increases Blood glucose
Increases Glycogenolysis & gluconeogenesis • Positive Inotrope/chronotrope on heart • Relaxes GI smooth mm. indications- • Hypoglycemia • Beta blocker toxicity • Verapamil toxicity • Radiologic exam of GI tract • Overdose of sulfonylurea or insulin IM good if combative |
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QUinilones and DM
|
cause up and down blood glucose
|
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Hypoglycemia in a diabetic can
result from: |
insulin overdose
-excessive exercise -delayed or decreased food intake |