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Diabetes tx
pharm 2 exam 4
64
Health Care
Graduate
04/13/2009

Additional Health Care Flashcards

 


 

Cards

Term
goal of DM1 tx
Definition

keep blood glucose levels close to normal

avoid wide swings!

Term
types of rapid acting insulin
Definition

glulisine

lispro

aspart

Term
short acting insulin
Definition
regular
Term
intermediate acting insulin
Definition
Neural protamine hagedorn (NPH)
Term
long acting insulin
Definition

glargine

detemir

Term
dosing of insulin
Definition

moderat ketones: 0.5 U/kg/day

large: 0.7 U/kg/day

 

divide total insulin into basal and bolus

Term
how to calc insulin dosages
Definition

1.divide total into basal and bolus

50% long acting (1-2x/day)

50% short acting (before meals)

Term
which insulin is safe to use during prego
Definition
regular
Term
which long acting insulin CANNOT be mixed with short acting
Definition
glargine
Term
which long acting insulin had albumin binding?
Definition
detemir
Term
Insulin secretagogues
Definition

Sulfonylureas

meglitinides

Term
insulin sensitizers
Definition

biguanides

thiazolidinediones

Term
Sulfonylureas gen 1
Definition

tolazamide

tolbutamide

Term
sulfonylureas gen 2
Definition

glyburide

glipizide

glimepiride

Term
MOA sulfonylureas
Definition

stimulate insulin release from beta cells

suppress hepatic gluconeogenesis

decrease glucagon levels

Term
what causes drug interactions of sulfonylureas
Definition

P450 met

highly protein bound

Term
AE sulfonylureas
Definition

hypoglycemia

wt. gain

decr. etoh tolerance

Term
which causes > hypoglycemia glyburide or glipizide?
Definition
glyburide (2x)
Term
which is more potent tolbutamide or glyburide?
Definition
glyburide (150x)
Term
which sulfonylurea is indicated for use w/ insulin?
Definition
glimepiride
Term
meglitinides
Definition

repaglinide

nateglinide

Term
MOA meglitinides
Definition
stimulate insuline secretion in response to glucose
Term
meglitinides are considered what type of glucose regulators?
Definition
post prandial
Term
when should meglitinides be taken
Definition
30 mins before meal
Term
what other drugs can meglitinides be given w/
Definition

metformin

glitazones

Term
meglitinides met
Definition
p3A4
Term
which group of drugs has the greater fasting hypoglycemia, sulfonylureas or meglitinides
Definition
sulfonylureas
Term
what drugs should NOT be given w/ meglitinides
Definition
sulfonylureas...same MOA
Term
what drug increase hypoglycemia when given w/ repaglinide
Definition
gemfibrozil
Term
what drugs inhibit the met of repaglinide
Definition
azoles, erythro,
Term
which drugs increase elim of repaglinide
Definition

barbs

rifampin

carbamazepine

Term
which has a faster onset repaglinide or nateglinide
Definition
nateglinide
Term
insulin sensitizers
Definition

biguanides

thiazolidnediones (glitazones)

Term
biguanides
Definition

metformin

(metformin + glyburide)

(metformin + glipizide)

Term
MOA metformin
Definition

decreased hepatic glucose prod

enhance glucose uptake and utilization by tissues

decr. leptin levels (incr appetite)

Term
metformin tx uses
Definition

decr VLDL and LDL

 

Term
what drug is the 1st line of tx in obese pts w/ insulin resistance and hyperlipidemia
Definition
metformin
Term
PK metformin
Definition

NO MET

NO PB

renal excr.

Term
AE metformin
Definition

hypoglycemia (rare)

decr app.->wt loss

LACTIC ACIDOSIS

Term
what pts should use caution when taking metformin
Definition

renal pts

CHF

severe infection

etoh

=d/t LACTIC ACIDOSIS

Term
when should metformin be d/c
Definition
temp if radiograph w/ contrast scheduled
Term
thiazolidnediones "glitazones"
Definition

rosiglitazone

pioglitazone

Term
MOA glitazones
Definition

bind go PPAR's

potentiate insulin sensitivity

decr peripheral insulin resistance

decr hepatic glucose prod

decr leptin levels

Term
does metformin cause wt gain?
Definition
NO
Term
tx uses of glitazones
Definition

pts w/ insulin resistance who do not respond to other tx

 

Term
what other drugs can glitazones be combined w/
Definition

metformin

sulfonylureas

insulin

Term
how long does it take for glitazones to take effect?
Definition
several weeks for full effect
Term
AE glitazones
Definition

edema

modest wt gain

mild anemia

liver probs

Term
what does rosiglitazone incr incidence of
Definition
CVD
Term
what test should be monitored in pts on glitazones
Definition

LFT's (q mo for 6 mos-> q 2 mos)

CBC

Term
when should you d/c glitazones
Definition
if > 3 abn LFT's in a year
Term
alpha glucosidase inhibitors
Definition

acardose

miglitol

Term
MOA alpha glucosidase inhibitors
Definition

inhibit alpha glucosidase in intestinal brush border

prolong abs of carbs

keeps PP glucose under control

Term
other groups of DM2 tx
Definition

dipeptidyl peptidase IV inhibitors

incretin mimetics

Term
when should alpha glucosidase inhibitors be given
Definition
w/ 1st bite of food
Term
in what pts do alpha glucosidase inhibitors work best in?
Definition

pts w/ mild-mod DM2

diet > 50% carbs

Term
AE alpha glucosidase inhibitors
Definition

GI

diarrhea, bloating, farting, crampin

Term
Exantide MOA
Definition

incr insulin secr in response to food

decr glucagon release

slows gastric emptying

decr glucose in blood

decr app

 decr fat content

affects LDL and tris

Term
tx use exenatide
Definition
adjunct w/ metformin, sulfonyurea, TZD's, or combo
Term
AE's exenatide
Definition
GI
Term
sitagliptin MOA
Definition

incr insulin release -> prolong activity of GLP-1

decr glucagon levels

Term
sitagliptin decreases
Definition
tris and FFA's
Term
AE sitagliptin
Definition

GI

HA

 

Term
order to RX DM2 tx
Definition

1. sulfonylurea

2. metformin

3. glitazones

4. meglitinide

5. exenatide

6. sitagliptin

7. insulin

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