Antidiabetic Drugs-Exam 3

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Antidiabetic Drugs-Exam 3
2015-07-24 12:11:36
Exam 3
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  1. Define hyperglycemia
    too much sugar in blood
  2. How does hyperglycemia occur?
    • Insulin is ineffective (DM I)
    • Not producing enough insulin (DM II)
    • Developed insulin resistance (DM II)
  3. When is DM II asymptomatic?
    • in the early stages
    • people may not even know it happens
  4. What was DM II called?
    Adult onset DM
  5. What is DM II blamed on?
    • Sedentary lifestyle
    • Obesity
  6. What is the goal in working with DM?
    • Control blood sugars
    • there is no cure
  7. What are the two types of antidiabetics?
    • Insulin
    • _____
  8. What are the metabolic issues with DM
    • change in metabolism of carbs, fats and proteins
    • increases blood sugar
  9. What are the vascular issues with DM
    • Atherosclerosis
    • change in circulation that leads to HTN, MI, stroke and
    • Change in microcirculation in retina (blindness) and kidney (renal failure
  10. Describe DM I
    DM I-starts early, autoimmune, sudden onset, more difficult to control, more complications, they require administration of insulin
  11. Describe DM II
    DM II- hyperglycemia due to decrease in insulin production and/or insulin resistance
  12. DM I medication
  13. DM II medication
    • insulin
    • PO drugs
  14. Classic SS of DM
    • polyuria-lg amounts frequently
    • polydipsia- thirsty 
    • polyphagia- hungry
  15. Normal blood sugar and hemoglobin A1C
    • 70-100 mg/dl
    •  < 5%
  16. Pre-Diabetic fasting blood sugar and hemoglobin A1C
    • 100-125 mg/dl
    • 5.7%-6.4%
  17. Diabetic fasting blood sugar and hemoglobin A1C
    • >125 mg/dl
    • >6.5%
  18. Lab test for DM
    hemoglobin A1C
  19. How long to RBC live for?
    120 days
  20. How long does Hemoglobin last on the RBC?
    lifetime of the RBC
  21. Exogenous Insulin vs Indogenous insulin
    same effect
  22. What is the level for hyproglycemia?
    < 60
  23. What else is insulin used to treat besides DM?
  24. What are SS of hypoglycemia?
    • BC <60
    • shaking
    • SNS stimulation: tachycardia, pale, confused, cool, clammy
  25. What are the goals of insulin?
    • BS 70-110 (WNL)
    • Prevent complications with DM
    • Prevent hypoglycemia
  26. What is the most common ADE of DM?
  27. How is the serious ADE for insulin?
  28. What type of syringes are there for insulin?
    • 50 unit
    • 100 units
  29. In a normal functioning pancreas does it ever reach 0?
    • no
    • the pancreas is always creating some insulin
  30. what is the onset/peak/duration of humalog (Lispro)
    • 10-15 min
    • 1 hour
    • 3 hours

    Rapid Acting
  31. What is indicated for Lispro?
    rapid reduction of BS
  32. What is the indication of Regular "R"
    Give 20-30 min ac (before meals)
  33. What is the onset/peak/duration of Regular "r"
    • 1/2-1 h
    • 2-3 h
    • 4-6 h

    Short Acting
  34. What is the indication of NPH/Lente?
    give pc (after meals)
  35. What is the onset/peak/duration of NPH/ Lente?
    • 3-4 h
    • 4-12 h
    • 16-20 h

    Intermediate acting
  36. What is hte indication for Ultralente?
    Control FPG
  37. What is the onset/peak/duration of ultralente?
    • 6-8 h
    • 12-16h
    • 20-30 h
  38. What is the indication with glargine (Lantus)
    do NOT mix with other insulin
  39. What is the onset/peak/duration of glargine (Lantus)
    • 1 h
    • NO peak
    • 24 h
  40. What is a 70/30 insulin?
    • 70% NPH
    • 30% Regular
  41. What do rapid and short acting cover?
    immediately AFTER the injection
  42. What does intermediate acting insulin cover?
    subsequent meals
  43. What does long acting insulin cover?
    provide a basal level of insulin
  44. Which insulin is given IV?
    regular Insulin
  45. How often should DM I take their blood sugar?
  46. How often should DM II take blood sugar?
  47. How long can you leave an insulin pump in?
    3 days
  48. Which type of DM is on Oral Agents?
    DM II
  49. if the BS is >400
    Call MD
  50. What are the oral medications for DM II for impaired insulin production?
    • sulfonylureas
    • megitinide
  51. What is the prototype for sulfonylureas?
    glipizide (Glucotrol)
  52. What is the MoA of sulfonylureas (glipizide)?
    increase insulin production
  53. What are the ADE for sulfonylureas?
    • Serious: hypoglycemia
    • Common: N, abd fullness
  54. Who takes the oral hypoglycemics?
    • DM II 
    • pancreas is not producing enough insulin
  55. What is the prototype for Meglitinide?
    Repaglinide (Prandin)
  56. What is the MoA of Meglitinide?
    increase insulin production
  57. What is the ADE of meglitinide?
  58. Are sulfonylureas are used in pregnancy T/F?
  59. What are the antihyperglycemics?
    • Thiazolidinediones (Giltazones)
    • Biguanide
    • Alpha-Glucosidase Inhibitors
  60. What is the prototype of thiazolidinediones?
  61. What is the MoA of pioglitazone?
    decrease insulin resistance
  62. What are the ADE of pioglitazone?
    • increase incidence of angina, MI 
  63. What is the prototype for biguanide?
    metformin (glucophage)
  64. What is the MoA of metformin?
    • decrease insulin resistance
    • decrease hepatic glucose production
  65. What are the ADE of metformin?
    • N/B/abd discomfort
    • BLACK BOX: lactic acidosis
  66. What is lactic acidosis?
    low pH of body tissue and blood
  67. What should you always recommend to a DM II pt?
    diet and exercise
  68. What is the prototype of alpha-glucosidase inhibitors?
    miglitol (Glyset)
  69. What is the MoA of miglitol?
    delays GI absorption of glucose
  70. What in combination can cause acute renal problems
    contrast dye and metformin (glucophage)
  71. What are the common ADE of alpha-glucosidase inhibitors (Miglitol/glyset)?
    • abd discomfort
    • D
    • Flatulence

    Abd complaints
  72. How often do pts take alpha-flucosidase inhibitors?
    right before each meal
  73. What are alpha-glucosidase inhibitors contraindicatied with?
  74. What are decrease insulin resistance drugs called?
  75. What are some non-pharm approaches to DM?
    • maintain normal weight
    • regularly exercise (utilizes insulin they have)
    • Knowing early recognition and tx of problems
  76. What are current recommendations for DM and CVD risk factors?
    • Statin
    • ASA/day
    • ACE Inhibitor