FNP III Diabetes Review
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How do sulfonylureas work?
How do can you differentiate between a first gen sulfonylureas and a second gen?
Sulfonylureas work by promoting insulin release.
- First gen end in MIDE (MIDE = Mono, 1st gen)
- Tolbutimide (orinase); Tolazamide (Tolinase); Chlorpropamide (Diabanese)
- Second gen end in IDE
- Gylburide (DiaBeta)
- Glypizide (Glucotrol)
- Glimepiride (Amaryl)
Use with CAUTION in individuals with sulfonamide allergy
How does metformin work? What class is it?
What do you monitor to use it?
Should you hold metformin with radiocontrast use and surgery?
Metformin (Biguanide Class) works by decreasing production of glucose in the liver. Increases peripheral uptake of glucose.
With radiocontrast use and surgery, omit day of and 48 post. Re-initiate when baseline renal function has been re-established.
How do Thiazolindinediones work?
What condition do you avoid prescribing?
Thiazolindinediones work by decreasing insulin resistance.
- Rosiglitazone (Avandia)
- Pioglitazone (Actos)
Avoid in liver disease, monitor transaminases.
How do Alpha-Glucosidase inhibitors work?
Alpha-glucosidase inhibitors work by delaying the absoption of dietary carbohydrates.
- Drug Names:
- Acarbose (Precose)
- Monitor transaminases
- Adverse reactions in Asthma, dizziness
How does Byetta (Exenatide) work?
Byetta works by mimicking incretin. Stimulates insulin production in response to elevated serum glucose.
Slows gastric emptying.
Name a Phenylalanine drug?
Starlix works like a sulfonylurea but has fewer side effects than biguanides or alpha-Glucosideas inhibitors.
Describe the action of insulin lispro / humalog?
- Onset >15min
- Peak 30-60 min
- Duration 3-4 hours
Describe the action of Regular Insulin?
- Onset: 30-60 min
- Peak: 2-6 hours
- Duration: 6-8 hours
Describe the action of (NPH) humulin 50/50?
- Humulin 50/50=
- NPH insulin 50% and Regular insulin 50%
- Onset: 30-60 min
- Peak: 3-5 hours
- Duration: 24 Hours
Describe the action of NPH insulin?
Name NPH insulins?
NPH insulins include: Humulin N, Iletin II NPH, Novalin N, Purified pork NPH
- Onset: 1-1.5 Hours
- Peak: 4-12 Hours
- Duration: 18-24 Hours
Describe the action of lantus?
PEAKLESS, absorbed slowly with gradual onset and peak lasting up to 24 hours.
What is the Somogyi effect?
The Somogy effect is when an insulin-induced hypoglycemia triggers excess secretion of glucagon and CORTISOL, this leads to hyperglycemia.
What is the "dawn" phenomenon?
Result of reduced insulin sensitivity between 5 am and 8 am caused by earlier spikes of growth hormone.
May split evening intermittent dose of insulin between dinner and bed time.
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