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Pharmacology
Diabetes Chapter 36
| Question | Answer |
|---|---|
| What is diabetes? | Diabetes mellitus is a group of diseases characterized by hyperglycemia. (fasting plasma glucose >100mg.dL) and abnormalities in fat, carbohydrate and protein metabolism that lead to microvascular, macrovascular and neuropathic complications. |
| In what organ is insulin and glucagon produced? | Pancreas |
| After a meal the glucose in the blood is high, which is also known as... | Hyperglycemia |
| True or False: When blood sugar is high the pancreas releases insulin | True |
| Once the pancreas releases insulin, the blood sugar is lowered which is also known as | Hypoglycemia |
| Characteristics of insulin | Affects carbs, fats and protein metabolism in most cell of the body with exception to the kidney, GI and liver which do not require insulin for glucose transport |
| After a meal the glucose in the blood is high, which is also known as... | Hyperglycemia |
| Characteristics of TYPE I Diabetes | One of the most common diseases of childhood, AKA juvenile diabetes, With DM I there is a lack of insulin secretion by the pancreas. |
| True or False: When blood sugar is high the pancreas releases insulin | True |
| What causes type I diabetes? | It is caused by an autoimmune destruction of the beta cells in the pancreas. |
| What are the signs and symptoms of Type I Diabetes | Sustained Hyperglycemia, Polyuria,Polyphagia,Polydipsia,Glucosuria, Weight loss,Fatigue |
| Sustained Hyperglycemia is characterized as | fasting blood glucose >126 on 2 separate occasions |
| What is the function of glucagon? | Glucagon is secreted by the pancreas and it blocks insulin. It moves glucose from the cells to the blood |
| What is TYPE II Diabetes? | Related to obesity, inactivity and diet, AKA non-insulin dependent. |
| When is glucagon secreted? | It is secreted when the glucose level is low to help maintain adequate levels of glucose in the blood |
| How do we treat TYPE II Diabetes | Oral hypoglycemics, Diet control and exercise, May require insulin |
| What is gestational diabetes? | Women who have abnormal glucose tolerance during pregnancy, Does not include diabetic women who become pregnant. |
| Diabetes ranges | Normal FPG < 100 mg/dL,Between 100 and 126- IFG,Between 140-199- IGT. |
| What is insulin onset? | time required for the medication to have an initial effect or action |
| What is insulin peak? | when the agent will have the maximum effect |
| What is insulin duration? | How long it will remain active in the body |
| What is Exubera | Exubera- is a powder form of human insulin- onset is similar to SZ short acting insulin (lispro) and duration similar to Reg. insulin. Onset of action occurs within 10-20 min and max. effect is 2 hours after inhalation and duration is 6 hours. (Inhaled) |
| Exubera (inhaled insulin) is contradicated with which patients | It is contraindicated in pts who smoke Also is not for pts with lung disease or with a current respiratory disorder (stuffy, runny nose, cold, etc) |
| What is the onset, peak and duration of rapid insulin | Onset less than 30 minutes, peak 30 min-3 hours, Short acting peak activity is usually between 2-4 hours, duration 2-6.5 |
| What are the names of the common rapid insulin? | Novalog (aspart), Humalog (Lispro), |
| What is the onset, peak and duration of short insulin | onset about 30 min, peak 2.5-5 hours, duration 5-10hours |
| What are the names of the short insulin? | Humulin R or Novolin R |
| What is the onset, peak and duration of Intermediate insulin | Peak activity is usually between 4-12 hours, onset 1-4 hours, duration 16-28 |
| What are the names of the intermediate insulin? | NPH, Humulin N, Novolin N, Lente, Humulin L, Novolin L |
| What is the onset, peak and duration of Long insulin? | peak activity is usually 6-20 hours, onset 1 hour, duration about 24 hours |
| How many minutes before a meal is Short, intermediate and long acting are usually given? | 30 minutes before meals |
| How long before meals is Insulin aspart (Novolog) given? | 5-10 minutes before meal |
| How long before Insulin glargine (Lantus)given? | given at the same time every day |
| How long before Insulin Lispro (Humalog)given? | given 0-15 minutes before meals |
| How long does it takes for Novolog to begin to drop glucose? | 15 minutes |
| When is lantus given | At nights |
| This medication works really fast need to assess for hypoglycemia 1-3 hours after administration | Lispro |
| Side effects of insulin includes | hyper or hypoglycemia, allergic reactions (some are made from pig or cow) also need to rotate sites |
| How do you store insulin? | Should be stored in a fridge but can be kept at room temp for 30 days. If an insulin needs to be mixed in the vial it should be rolled not shakenrue |
| What is the correct way to mix insulin? | Clear then cloudy |
| True or False: Most insulins can be mixed. | True |
| What is the mixture for Humulin Insulin? | Humulin 70/30, Novolin 70/30 (NPH 70% and Regular 30%) |
| What is the mixture for NPH Insulin? | NPH 50% and Regular 50% |
| Characteristics of oral hypoglycemics | There are 5 classes, Therapy is usually started with a single agent but may need to add an additional agent, If this doesn’t control the glucose levels insulin is usually added. |
| The 5 classes of Oral hypoglycemics includes: | Alpha-glucosidase Inhibitors, Biguanides, Meglitinides,Sulfonylureas (first and second generation),Thiazolidinediones, Combination drugs |
| What are Alpha-glucosidase Inhibitors? | Alpha glucosidase inhibitors are enzyme inhibitors that inhibits pancreatic alpha amylase and GI alpha glucoside hydrolas enzymes used in the digestion of sugars. |
| Characteristics of Alpha-glucosidase Inhibitors: | In pts with diabetes this enzyme inhibition results in delayed glucose absorption and lowering of postprandial hyperglycemiaShould be used with diet and can be used in combo with other meds. |
| What are the side effects of Alpha-glucosidase Inhibitors? | Abdominal cramps, diarrhea and gas |
| What are the Alpha-glucosidase Inhibitors medications? | Acarbose (Precose),Miglitol (Glyset) |
| What is Biguanides? | Metformin decreases hepatic glucose production, reduces absorption of glucose from the small intestine and increases insulin sensitivity improving glucose uptake in peripheral muscle and adipose cells. |
| What are the characteristics of Biguanides? | Insulin must be present for metformin to be active so it doesn’t work in DM I |
| What are the side effects of Biguanides? | Nausea, vomiting, anorexia, abdominal cramps and gas |
| What are Biguanides Mendications? | Metformin HCL (Glucophage) |
| What is Meglitinides? | Are non-sulfonylurea oral hypoglycemic agents that lower blood glucose by stimulating the release of insulin from the beta cells of the pancreas. |
| What are the characteristics of Meglitinides? | These don’t work in DM I- these have a short duration of action which helps to stop hypoglycemic problems in pts. |
| Most common side effect of Meglitinides includes: | Hypoglycemia |
| Meglitinides medications includes: | Nateglinide (Starlix),Repaglinide (Prandin) |
| What is Sulfonylureas, first generation? | Sulfonureas lower blood glucose by stimulating the release of insulin from the beta cells of the pancreas. They also diminish glucose production and metabolism of insulin by the liver. |
| Side effects of Sulfonylureas, first generation? | Nausea, vomiting, anorexia and abdominal cramps |
| Sulfonylureas, first generation medications includes: | Acetohexamide (Dimelor),Tolbutamide (Orinase) |
| Sulfonylureas, second generation medications includes: | Glimepiride (Amaryl),Glyburide(DiaBeta),Glipizide (Glucotrol) |
| What are Thiazolidinediones (TZD)? | TZDs lower blood glucose by increasing the sensitivity of muscle and fat tissue to insulin allowing more glucose to enter the cells in the presence of insulin for metabolism |
| What are the characteristics of Thiazolidinediones (TZD)? | They don’t stimulate the release of insulin from the beta cells but insulin must be present for these agents to work.It may take 4-6weeks for notable effect and several months for full therapeutic effect. |
| Side effects of Thiazolidinediones (TZD)includes: | include- nausea, vomiting, anorexia and abdominal cramps |
| Thiazolidinediones (TZD)medications includes: | Pioglitazone (Actos),Rosiglitazone (Avandia) |
| What are the different types of combination drugs? | Glipizide/metformin (Metaglip),Glyburide/metformin (Glucovance),Rosiglitazone/metformin (Avandamet) |
| Side effects of combination drugs includes: | Hypoglycemia,Nausea,Vomiting,Loss of appetite,Photosensitivity,Potentials to interact with other drugs is very common. |
| What is Incretin-mimetic agent? | Incretin-mimetic agent. |
| What are the characteristics of Incretin-mimetic agent? | It is used as additional therapy for DM2 pts. It enhances insulin secretion only in the presence of hyperglycemia and insulin secretion decreases as blood glucose gets near normal levels.Byetta is an injection given SQ. |
| What are the side effects of Incretin-mimetic agent? | Nausea, vomiting and diarrhea |
| Incretin-mimetic agent medications includes: | New type of drug,Reduce basal glucose concentrations,Reduces A1C levels,Exenatide (Byetta. |
| What is Amylinomimetic Agent? | Synthetic analog of amylin which is a protein that is screted from pancreatic beta cells with insulin in response to food intake. Pts who have a deficiency in insulin also have deficiency in amylin. |
| What are the chracteristics of Amylinomimetic Agent? | The goal is to reduce elevated postprandial hyperglycemia in DM 1 or 2 pts who are taking other medsIt is also SQ and can’t be mixed with insulin- need to be given as 2 different shots at least 2 inches apart. |
| Side effects of Amylinomimetic Agent? | Nausea, vomiting and indigestion. |
| What are the Amylinomimetic Agent? | Synthetic substance,Pramlintide (Symlin) |
| What cautions are to be taken when taking Insulins? | Not to be taken along with Albuterol, diuretics, morphine, nicotine oral contraceptives. |
| What cautions are to be taken when taking Biguanine oral antidiabetics? | Not to be used with patients with heart failure, shock, septicemia and liver disease. |
| What cautions are to be taken when taking Antihypoglycemic agents? | Not to be taken with Warfins. |
Created by:
smensah
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