pharm 4 diabetes dx

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kbryant86
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246166
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pharm 4 diabetes dx
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2013-11-10 20:53:49
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pharm 4
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  1. Hemoglobin A1c
    test that gives avg. blood glucose levels for 2-3 months
  2. where is insulin synthesized?
    in the Islets of Langerhans
  3. insulin schedule therapy-
    --> conventional therapy
    • does not provide tight control
    • not based on caloric intake
  4. insulin schedule therapy-
    --> intensive conventional therapy
    pre-prandial dosage adjusted according to caloric intake

    adaptable to caloric intake --> tight control
  5. insulin schedule therapy-
    --> continuous subQ Insulin Infusion
    achieve tight control through use of infusion pump

    provide basalar level based on caloric intake
  6. short duration: rapid-acting
    • given in association with meals. Controls postpradnial blood glucose
    • given subQ and via continuous SC pump
    • can be given IV-rare

    clear solutions (except NPH)
  7. Lispro / Humalog
    • analog of regular insulin
    • onset 15-30 minutes
    • duration 3-6 hours

    short dur, rapid act
  8. Glulisine / Apidra
    • onset 10-15 minutes
    • taken at the start of eating
    • duration 3-5 hours
    • given subQ and continusously via subQ pumps

    short dur, rapid act
  9. short duration: slower acting
    • given in association with meals. control postprandial blood glucose
    • -SubQ, IM, IV, via pump
    • BEST IV form of insulin
  10. Regular / Humulin R, Novolin R
    • short dur, slower act
    • unmodified HUMAN insululin
    • SubQ injection and infusion, IM, Oral inhalation

    • onset 30-60 mintues
    • peaks 1-5 hours
    • duration up to 10 hours
  11. intermediate acting
    twice daily to control b/w meals and at night
  12. NPH / Humulin N, Novolin N
    • regular insulin plus Protamine
    • only Cloudy solution
    • given subQ twice daily, at the same time

    intermediate duration
  13. Detemir / Levemir
    • slow onset, dose dependent duration
    • for Basal glycemic control
    • admin twice daily @ same time

    • intermediate duration
    • **never mixed and never IV
  14. long duration
    • precipitates in human pH and slowly dissolves
    • -lasts 24 hours

    • mostly given at night, but time may vary
    • DO NOT mix or give IV
    • SubQ only

    clear solution
  15. Glargine / Lantus
    • Tx of type I and II diabetes
    • once daily subQ 2 same time

    Long duration
  16. combo insulin
    • used for peeps with stable condition
    • eliminates need for additional injections
    • used subQ only
  17. only NPH can be mixed with short acting
    -short act: regular, lispro, aspart, glulisine
    • only NPH can be mixed with short acting
    • -short act: regular, lispro, aspart, glulisine
  18. 4 complications of insulin use
    • hypoglycemia
    • hypokalemia
    • lipohypertrophy
    • allergic rxns
  19. what do we need to watch for in a pt. using insulin and Beta Blockers?
    beta blockers can mask the S & Sx of hypoglycemia
  20. oral insulin is only for type II diabetes and only after diet and exercise don't work
    oral insulin is only for type II diabetes and only after diet and exercise don't work
  21. Biguanides
    mech of action
    DOC for intial therapy

    • act: lower bld glucose and improve glucose tolerance.
    • -inhib glucose production in liver
    • -reduce glucose absorp in gut
    • -sensitiize insulin recepts in target tissues
  22. biguanines
    where do they work and what are the therapuetic uses?
    work= NOT metabolized, excreted unchanged by kidneys

    uses= glycemic control, prevent diabetes, gestational diabetes,
  23. biguanines:
    side effects
    toxicity
    interactions
    • se= dec. appetite, nausea, diarrhea
    • ¬† -dec absorp of vit b12 and folic acid

    toxic= lactic acid

    interact= alcohol  inhibits lactic acid breakdown
  24. Metformin
    drug that is classified as a biguanine
  25. Sulfonylureas
    introduced as oral antidiabetis meds, but hypoglycemia was major side effect
  26. sulfonylureas:
    mech of action
    therapeutic uses
    side effects
    • act= stimulate the release of insulin from pancreas
    • **doesn't work in type I b/c no insulin is produced

    use= Tx type II diabetes

    se= hypoglycemia, cardiovascular toxicity, pregnancy and lactation
  27. Thiazolidinediones / Glitazones
    • also called TZD's
    • Decrease insulin resistence
    • added on to metformin
    • used in Type II
  28. Pioglitazone / Actos
    ONLY TZD left on the market

    • reduce insulin resistence and increase production
    • usually combined with Metformin, Sulfonylurea, and/or supplament to insulin
  29. Pioglitazone / Actos:

    side effects
    • upper resp tract infections
    • headache
    • sinusitus
    • myalgia
    • HF
    • hypoglycemia
  30. Pioglitazone / Actos:

    drug interactions:
    what do you need to do with Actos when you also use inducers? inhibitors?
    inducers= higher dose of actos needed

    inhibitors= lower dose of actos needed
  31. Meglitinides / Glinides

    actions and use
    • stimulate pancreatic insulin release
    • used in mono and combined therapy
  32. Repaglinide
    a meglitinide

    rapid absorption and excretion

    can cause hypoglycemia
  33. Acarbos
    alpha-glucose inhibitor

    • acts in the intestine to delay absorption of carbs
    • effects do not depend on insulin

    se= gas, cramps, abd distention, anemia, liver problems
  34. Sitagliptin
    • classified: Gliptins
    • 3rd line drug

    • enhances actions of incretin hormones
    • mono or combined therapy
    • rapid and complete absorption
    • excreted in urine

    only used as last ditch effort
  35. stagliptin:

    side effects
    • upper resp trat infect
    • headache
    • inflamm of nasal and throat
    • pancreatitis
    • hypersense rxn
  36. Pramlintide
    new injectable drug for type I and II
  37. Exenatide and Liraglutide
    new injectable drugs for type II only

    • Ex= 1st incretin mimetic
    • =improve glucose control
    • =nausea is common
    • =risk of pancreatitis and kidney trouble

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