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Drugs used in Diabetes
Pharm II - Block III
28
Pharmacology
Not Applicable
07/14/2010

Additional Pharmacology Flashcards

 


 

Cards

Term
What are the different types of diabetes?
Definition

Type 1 - insulin dependent - juvenile onset

 

Type 2 - Non insulin dependent - mature onset

Term
What is the function of insulin?
Definition
activates the uptake and utilisation of glucose thus decreasing blood glucose levels
Term
Name the ultra rapid and very short acting insulin preparation
Definition

Lispro

Regular/ crystalline zinc

 

 - Lysine and proline residue are switched

Rapid onset and short acting allows it to be taken immediately before a meal

 

–Active within 5-10 mins.

–Peak action at 30-90 mins.

–Effect lasts 2-4 hrs.

Term
Which Insulin preparations are given via IV 
Definition

Lispro

Regular/ crystalline zinc - given in emergency cases

Term

Patient comes in with:

Polyuria, Polydipsia

Nausea, Fatigue

Fruity breath

Fatigue & Dehydration

What is the Diagnosis & how do you treat?

Definition

Diabetic ketoacidosis

IV crystaline zinc/ regularr

Term
Name the intermediate onset & intermediate action insulin preparations
Definition

Isophane insulin suspension (NPH insulin)/ NPH - Neutral Protamine Hegedorn

 

Lente

Term
What is the preferred intermediate onset & action insulin preparation to mix with regular/ crystalline zinc & why?
Definition
NPH, as lente can slow down the onset of action of regular/ crystalline zinc insulin
Term

Name the Slow onset & long acting insulin preparations

When is it taken?

Definition

Ultra lente

Glargine

 

Usually once a day dose

Term

Which insulin preparation is the only one with no peaks?

What is an advantage of this?

Definition

Glargine

used to supply a constant background level, given once a day due to its ultra long duration of action

 

NO HYPOGLYCEMIA 

Term
What increases insulin release?
Definition

B agonist

M agonist

Glucose

Sulfonylureas

Term
What decreases insulin release?
Definition
A2 agonist
Term
How is Glargine chemically different to insulin?
Definition

On the Alpha chain  Asparagine is replaced with Glycine

 

On the Beta chain 2 extra Asparagines are added to the end of the chain

Term
What are the potential toxicities of insulin?
Definition

Hypoglycemia (except Glargine)

Allergy

Lipodystrophy - atrophy of fatty tissue at site of injection

Term
What drug is contra indicated in diabetic patients & why?
Definition
Propanolol - as it masks the symptoms of hypoglycemia
Term

Patient comes in with lethargy, tachycardia, sweeting, palpatations, nausea & hunger

What is the diagnosis?

How is it treated?

Definition

Hypoglycemia ADR of insulin preps

give IV dextrose & glucagon

Term
What is given for the treatment of type 2 diabeties ONLY?
Definition
Oral hypoglycaemic agents ie. sulfonylureas, metformin etc.
Term

Sulfonylureas

MOA

Drugs

 

 

Definition

Blocks the ATP sensitive K+ channels - causing increase in Ca2+ influx - Causing insulin release

 

1st generation - Acetohexamide, Tolbutamide, Chlorpropamide

 

2nd generation - Glipizide, Glyburide & Glimepiride

Term
What is the ADR's associated with sulfonylureas?
Definition

Disulfiram reaction (1st generation only)

Hypoglycemia

Hypersensativity (possible cross allergy with sulfonamides)

Drug interactions - causing increased hypoglycemia

Term
What patients should not take Sulfonylureas?
Definition

1. Pts with liver disease

2. Obese patients ( as it increases lipogenesis)

3. Patients on propanolol

Term
What are the drug interactions associated with sulfonylureas?
Definition

It is highly protein bound

1. displaced by - phenylbutazone, clofibrate & sulfonamides

2. Inhibit metabolism - warfarin, phenytoin, acute alcohol intake

3. prolong pharmacodynamic action - propanolol, lithium, theophylline

4. Induce metabolism - phenobarbitone, rifampicin

Term
What is special about Glimepiride?
Definition

Promotes peripheral disposal of glucose by enhancing translocation of GLUT4 to the plasma membrane

 

** lower risk of hyperinsulinemia & hypoglycemia

Term

Biguanides

MOA

Drug?

ADR?

Definition

Decrease hepatic gluconeogenesis (NO HYPOGLYCEMIA!!!)

Metformin

Lactic acidosis (seen in patients who are chronic alcoholics & hepatic impairment)

Vit B12 deficiency

Term
When is metformin contraindicated?
Definition

Patients with severe CV, renal, liver disorders

Alcoholics (increased risk of lactic acidosis)

Term

Thiazolidinediones aka Glitazones

Drugs

MOA

Definition

Pioglitazone, Rosiglitazone

 

Binds to PPAR's (peroxisome proliferator-activating receptor) - enhance insulin sensitivity in the peripheral tissues & decrease insulin resistance in the periphery)

Term

Alpha- Glucosidase inhibitors

Drugs?

MOA?

ADR?

Definition

Acarbose & Miglitol

 

Competitive inhibitors of alpha - glucosidase in brush birders in small intestine**

 

GI discomfort, bloating, welching, diarrhea etc

Term
If a patient experiences hypoglycemia while being treated with Acarbose or miglitol what is given & why?
Definition
IV dextrose - you can not give sugar/ candy, this will not be effective as these drugs delay the absorption of glucose.
Term

Meglitinides

Drugs?

MOA?

Use?

Definition

Repaglinide, Netaglinide

 

stimulates release of insulin from pancreatic Beta cells

 

Adjunctive use in type 2 diabetes - admin just before meals due to short t 1/2

Term

Glucagon- Like peptide -1 (GLP-1)

analog?

MOA?

Definition

Exenatide

GLP-1 receptor full agonist used in combination with other agents in type 2 diabetes

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