Diabetes Drugs

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Author:
fusser
ID:
208800
Filename:
Diabetes Drugs
Updated:
2013-03-21 20:50:26
Tags:
test diabetes
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Description:
Test 3 pharm diabetes stuff to know
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  1. Rapid Acting Insulin
    • Lispro (Humalog)
    • Aspart (NovoLog)
    • Glulisine (Apidra)
    • Rapid onset 10-20 min
    • Peak 30-90 min (approx 1 hour)
    • Duration 3-5 hours
    • SubQ use Only
    • TEACH- Must eat w/in 15 min of injection or Rapid Hypoglycemia!
  2. Short Acting Insulin
    • Regular Insulin - clear solution
    • Only insulin used for IV admin
    • IV- onset 5 min
    •    - peak 30 min
    •    -duration 1 hour
    • SubQ- onset 30 min
    •        - peak 2-3 hours
    •        - duration 5-7 hours
    • For fine control (several doses a day) and emergency use (hyperglycemia)
  3. Intermediate Acting Insulin
    • NPH
    • Onset 1-2 hours
    • Peak 4-12 hours
    • Duration 18-24 hours 
    • Combine insulin w/ protamine &/or zinc to slow absorption = longer duration
    • SubQ use only
    • Cloudy solutions = precopitates, therefore roll vial first to re-suspend
  4. Pre-mixed Combinations
    • 70/30
    • 70% NPH 30% Regular (this mix gives prompt absorption at mealtimes with prolonged release)
    • 50/50
    • 50% NPH 50% Regular (used less)

    reduces mixing errors to have them pre-mixed
  5. Long Acting Insulin
    • Detemir (Levemir)
    • Low dose- intermediate action (12hr)
    • High dose- long duration of action (24hr)
    • Glargine (Lantus)
    • Onset 1-2 hours
    • Peak Flat, no peak even blood levels
    • Duration 24 hours
  6. Glargine (Lantus)
    • Long Acting Insulin Analog
    • Once-a-day dosing
    • Clear solution
    • 24 hour basal dose of insulin--> No peak, even blood levels
    • Given once-a-day at bedtime
    • Used in kids-- reduces hypoglycemic incidents
  7. Degludec
    • New Agent
    • Ultra long acting
    • 3x a week dosing in type II diabetics w/ poor glycemic control
  8. Insulin Administration
    • MUST know the Concentration and the Form
    •        Concentration = how many units per ml (U-100)
    •        Form is type of insulin (Regular, NPH, etc)
    • Pt teaching of diet & insulin is critical
    • Proper injection technique is critical
    •         dose, site, not to shallow
    •         90 degrees for SubQ if enough fat
  9. Glycosylated Hemoglobin
    • HbA1c
    • monitors average bg control over 60-90 days
    • Should get quarterly A1c
    • Goal is < 7.0%, for children 8.5-7.5%
  10. Glipizide (Glucotrol)
    • Oral Hypoglycemic Agent
    • Sulfonylurease Agent (2nd generation)
    • Onset 15-30 min
    • Peak 1-2 hr
    • Duration up to 24hr

    Control of type II diabetes when diet therapy fails
  11. Metformin (Glucophage)
    • Biguanide (pharmaceutical class)
    • Improves glucose use in tissues, decrease glucose production in liver
    • Increase tissue sensitivity &/or binding of insulin
    • May reduce insulin resistance in obese type II diabetics
    • Lowers blood glucose- Does NOT cause hypoglycemia even though it's an anti-hyperglycemic
    • Many lose weight w/metformin
    • Modest reduction in LDL&triglycerides, mild increase in HDL
    • Can combine w/sulfonlyurease & other oral agents
    • Adverse:
    • GI upset (20%)- take w/meals, start therapy slowly
    • Risk of lactic acidosis w/renal/hepatic disease
    • Must DC before contrast given (scans, xrays, etc) causes renal damage
    • Decreases absorption of B12 & folate supplement
  12. Thiazolidinediones-- Glitazones
    • Improve uptake of insulin in muscle
    • Decrease glucose production in liver
    • Reduce Insulin Resistance
    • Acts only in the presence of insulin
    • May reduce insulin need in type I diabetics (but will still need some insulin)
  13. Rosiglitazone (Avandia)
    • Glitazone
    • Concerns: stroke & heart attack in people w/risk factors
  14. Exenatide (Byetta)
    • Injectable med for type II diabetes--used w/metformin &/or sulfas
    • Binds to GLP-1 receptor (glucagon like peptide 1)
    • Slows stomach emptying, stimulate insulin release
    • Inhibit postprandial glucagon, supress appetite
    • Adverse: hypoglycemia- may have to decrease dose of sulfonylurea
    • may develop antibodies to exenatide->decreased effectiveness
    • Some reports of pancreatitis(rare), report NV abd pain
    • Pre-filled pen for SubQ, twice a day dosing up to 60 min ac

    Alpha Glucosidase Inhibitor (?)
  15. Glucagon
    • from pancrease alpha cells
    • induces hepatic glycogenolysis
    • use in emergency to raise bg
    • given IM or IV
    • can teach loved ones to give to pt for hypoglycemia

    also used to decrease GI motility in endoscopy

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