306- Pharm: Diabetes

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KristaDavis
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170603
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306- Pharm: Diabetes
Updated:
2012-09-13 09:03:59
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306 Pharm Diabetes
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Exam 1
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  1. Prototype- Regular Insulin
    Pharmacotherapeutics
    **All Type 1 diabetics

    -Uncontrolled type 2 DM

    -Hyperkalemia

    -Admin. SC, IV

    -Scheduled (Basal dose)

    -Sliding scale (example BG-100/30 for BG > 200
  2. Prototype- Regular Insulin
    Pharmacodynamics
    • --Needed for proper glucose use
    • --Facilitate entry of glucose into cells
    • --Mimics endogenous insulin
  3. Prototype- Regular Insulin
    Pharmacokinetics
    *Destroyed by gastric acid

    *No oral administration

    *Slow, steady absorption

    *Abd. most rapid absorption

    *Regular - only one given IV

    *Deteriorates if exposed to light

    *Store room temp for 1 month

    *Longer storage put in refrigerator

    *Excreted via kidney
  4. Adverse Effects -- PROTOTYPE - REGULAR INSULIN
    *Hypoglycemia

     *Lipodystrophy
  5. Contraindications-- Prototype Regular Insulin
    • -Hypoglycemia
    • -Sensitivity to insulin components
  6. Prototype Regular Insulin-- ASSESSMENT
    • ¢Immune state
    • ¢Allergies
    • ¢History of insulin administration
    • ¢OTC drugs
    • ¢Complications of DM
    • ¢Electrolytes
    • ¢CBC
    • ¢Blood lipid levels, A1c levels
  7. Education -- Prototype Regular Insulin
    ¢S/S hypo/hyperglycemia

    ¢Proper dosage

    ¢Preparing

    ¢Admin. Technique

    ¢Room temp 1 month

    ¢Rotate site

    ¢If infection, do not reuse needles

    ¢Must eat with insulin
  8. Types of Rapid Acting Insulin:
    • Insulin Aspart (Novolog)
    • Insulin Lispro (Humalog)
    • Insulin glulisine (Apidra)
  9. Rapid Acting Insulin
    • *Onset  5 – 15 min.
    • *Peak  30 min to 3 hrs
    • *Duration  2 to 5 hrs
    • *Can be mixed with NPH for SQ (SC) injection
    • *Covers glucose levels from meal immediately after injection
    • *Given SQ and IV
  10. Example of Short Acting Insulin:
    Regular Insulin (Humulin R, Novolin R)
  11. Facts of Short Acting Insulin:
    • -Onset  30 min – 1 hr.  SC —10 – 30 min. IV
    • -Peak  2 -4 hrs.
    • -Duration  6 – 8 hrs
    • -Covers glucose levels from meals immediately after injection
    • -Give SQ, IV, Insulin pump
  12. Example of Intermediate Acting Insulin:
    -NPH (Humulin N, Novolin N) 
  13. Facts of Intermediate Acting Insulin:
    -Onset 1 – 2 hrs

    -Peak  6 – 12 hrs

    -Duration 18 – 24 hrs

    -Only cloudy insulin

    -Should eat at time of onset and peak action

    -Covers subsequent meals not covered by rapid and short acting injections
  14. Examples of Long Acting Insulin:
    • -Glargine (lantus)
    • -Detemir (Levemir)
  15. Facts of Long Acting Insulin:
    • -Onset 1 hr
    • -Peak  None
    • -Duration 24 hrs
    • -Basal (absorbed very slowly over 24 hrs)
    • -Never mix with any other insulin
    • -Administered once daily
  16. When mixing and administering Insulin.....
    • -Compatibility and mixing
    • -Storage
    • -“Drawing up” from vial
    • -Preparing skin
    • -Injecting
  17. Complications of Insulin Administration
    • -Hypoglycemia
    • -Allergic reaction
    • -Lipodystrophies
  18. B.G. lowering agents:
    • —Tricyclic antidepressants
    • —MAOIs
    • —Aspirin
    • Oral anticoagulants
  19. B.G. elevating agents:
    • —Thiazide diuretics
    • —Glucocorticoids
    • —Thyroid drugs
    • —Estrogen
    • (BCPs)
  20. Pre-Mixed Insulins:
    • -NPH/regular 
    •   (—Ex. Humulin 70/30)
    • -Insulin aspart protamine/insulin aspart
    • -Insulin lispro protamine/insulin lispro
    •   (—Ex. Humalog 75/25)
  21. ORAL HYPOGLYCEMIC AGENTS-SULFONYLUREAS
    glipizide (Glucatrol), glyburide (DiaBeta)
  22. Pharmacotherapeutics of Sulfonylureas
    -Used for patients with type 2 diabetes in conjunction with nutrition therapy

    Taken before meal
  23. Pharmacokinetics of Sulfonylureas
    • -Taken PO before meal
    • -Rapid GI absorption
    • -Onset within 2 hrs
    • -Liver metabolized
    • -Urine & feces excreted
  24. Pharmacodyanmics of Sulfonylureas: 
    • -Primary action-stimulate beta cells  to secrete insulin
    • -Decrease liver glycogenolysis
    • -Increase peripheral tissue sensitivity to insulin
    • -Must have a pancreas that functions
  25. Contranindications of Sulfonylureas:
    • -Severe hepatic or  renal impairment
    • -Sulfa drug allergy
  26. Adverse Effects of Sulfonylureas:
    • -Hypoglycemia
    • -GI distress
  27. Education of Sulfonylureas:
    • -S/S hypoglycemia
    • -How to tx hypoglycemia
    • -Avoid alcohol
    • -Consult physician before OTC med use
  28. Assessment of Sulfonylureas:
    • -Renal & hepatic function
    • -OTC use
    • -Herbal preparation use
  29. Examples of MEGLITINIDES
    repaglinide (Prandin), nateglinide (Starlix)
  30. Meglitinides
    • -Pharmacotherapeutics
    •      —Stimulate insulin release
    • -Pharmacodynamics
    • -Pharmacokinetics
    • -Contraindications
    •      —Liver dysfunction
  31. Adverse Effects of Meglitinides
    -Hypoglycemia
  32. Example of BIGUANIDE
    Metformin (Glucophage)
  33. Biguanide
    Pharmacodynamics

    Facilitates or encourages action of insulin on peripheral receptor sites

    Inhibits glucose production by liver

    Reduces glucose absorption in gut

    Pharmacotherapeutics

    Type 2 DM

    Up to 2 wks. For therapeutic effect of dose

    Pharmacokinetics

    Slow absorption from GI

    Rapid distribution to tissues

    Kidney excretion (unchanged)

    Contraindications

    Renal  or hepatic impairment

    Alcoholism
  34. Adverse Effects of Biguanides
    • GI distress
    • Metallic taste sensation
    • Lactic acidosis
  35. Contraindications of Biguanides
    • Renal  or liver impairment
    • Chronic heart failure
    • Alcoholism
    • Hx. Of lactic  acidosis
  36. Assessment
    • -Renal & Liver function tests
    • -Weight
  37. Education of Biguanides
    • -Education
    • -No alcohol use
    • -Take med with meals
    • -Consult with MD for OTC meds
    • **Hold for 48 hrs with IV contrast dye**
  38. Pharmacotherapeutics of
    ALPHA GLUCOSIDASEINHIBITORS
    —Inhibits absorption of sugars (carbs) from intestines
  39. Examples of Alpha Glucosidaseinhibitors
    Acarbose (Precose), Miglitol (Glyset)
  40. Adverse Effects of Alpha Glucosidaseinhibitors
    • -GI distress
    • -Liver dysfunction
  41. Examples of THIAZOLIDINEDIONES (GLITAZONES)
    proglitazone (Actos), rosiglitazone (Avandia)
  42. Adverse Effects of Thiazolidinediones
    • Severe fluid retention
    • Contraceptives
    • **Black box warning – pt must sign warning form
  43. Edcation techniques for Thiazolidinediones
    • -S/S of liver damage
    • -S/S of heart failure
  44. Examples of Dipeptidyl Peptidase-4 Inhibitor
    sitagliptin (Januvia)
  45. Pharmacotherapeutics of Dipeptidyl Peptidase
    • —Increases insulin secretion
    • —Decreases glucagon secretion to reduce glucose production
  46. Incretin Mimetic
    Exenatide (Byetta)

    •improves beta-cell responsiveness

    •Suppresses glucagon secretion

    •Slows gastric emptying

    •Reduces food intake

    •Given by SC injection

    •Adverse Effects

    •Headache, dizziness, nausea, vomiting, diarrhea, jitteriness
  47. Amylin Analogue
    Pramlintide (Symlin)

    -Suppresses glucagon secretion – reduces postprandial glucose

    -Slows gastric emptying

    -Induces satiety

    -Given SC ac ONLY in abd or thigh, NEVER arm

    • Adverse Effects:
    • —Dizziness, anorexia, nausea, vomiting, fatigue
  48. Glucose elevating agents prototype
    Glucagon
  49. Pharmacotherapeutics of Glucagon 
    • -Reverse severe hypoglycemia
    • -IM, IV, SQ
    • -Must be reconstituted
  50. Pharmacodynamics of Glucagon
    • -Stimulate glycogenolysis in peripheral  tissues
    • -Maximum effect with IV 30 minutes
  51. Pharmacokinetics of Glucagon
    • -½ life 3-10 minutes
    • -Liver metabolized
    • -Urine & bile excreted
    • -May be refrigerated for 48 hours
  52. Contraindications of Glucagon
    • -Insulinoma
    • -Caution in pregnancy & lactation
  53. Assessment before Glucagon
    -Blood glucose level before and after glucagon admin.

    -LOC (level of consciousness)
  54. Education of Glucagon
    • -Hypoglycemia prevention measures
    • -How to administer glucagon
    • -Fast intervention to prevent CNS  damage

    • **In hospital will most likely use D50W  IVP for severe
    • hypoglycemia
  55. Pharmacotherepeutics of Glucose
    -Reverse severe hypoglycemia

    -10-20 g. po, may repeat in 10 min.

    -Dextrose 25 or 50% IV bolus
  56. Pharmacodynamics of Glucose
    -Provides immediate source of glucose in systemic circulation
  57. Assessment of Glucose
    • •Blood glucose level before and after admin.
    • •LOC (level of consciousness)
    • •Cause of hypoglycemia
    • •Assess IV site for redness, increased temp, tissue necrosis or sloughing
    • •Monitor urine output
    • •Give complex carbs/protein when awake

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