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diabetic meds1
all medications for diabetes
| Question | Answer |
|---|---|
| Humalog (Lispro) | Rapid acting onset: <15 minutes Peak: .5-1.5 hrs Duration: 3-4 hrs |
| Novolog (Aspart) | Rapid acting Onset: .5 hours Peak: 1-2 hrs Duration: 4 hrs |
| Apidra | Rapid acting Onset: <.5 hrs Peak: .5-2.5 hrs Duration: <6 hrs |
| Regular insulin | Short acting Onset: .5-1 hr Peak: 2-3 hrs Duration: 4-6 hrs |
| NPH | Intermediate acting Onset 2-4 hours Peak 6-10 hours Duration 10-16 hours |
| Lente | Intermediate acting Onset 3-4 hours Peak 6-12 hours Duration 12-18 hours |
| Insulin detemir (Levemir) | Long acting Increased length of absorption Peak none Duration up to 24 hours Higher doses have higher duration Used for basal insulin |
| Insulin glargine (Lantus) | Long acting Onset 4 hours Peak none Duration 24 hours Used for basal insulin |
| Insulin dosage for DM1 | Average is 0.5-0.6U/Kg/day |
| Insulin dosage for DM2 | Average is 0.7 – 2.5 units/kg/day |
| Sulfonylureas (MOA) | Closes the K channel of the beta cells which opens the Ca channel, which releases more insulin |
| Acetohexamide (Dymelor) | 1st generation sulfonylurea |
| Chlorpropamide (Diabenese) | 1st generation sulfonylurea |
| Tolazamide (Tolinase) | 1st generation sulfonylurea |
| Tolbutamide (Orinase) | 1st generation sulfonylurea |
| Glimepiride (Amaryl) | 2nd generation sulfonylurea |
| Glipizide (Glucotrol) | 2nd generation sulfonylurea |
| Glyburide (DiaBeta, Micronase/Glyburide, micronized (Glynase) | 2nd generation sulfonylurea |
| short-acting secretogogues (MOA) | ups insulin secretion by binding near sulfonylurea receptor. Intensity of action dependent on glucose levels (less insulin produced if glucose is low). 1st line for non-obese, new diabetics |
| Nateglinide | Short-acting secretogogue Rapidly absorbed after oral administration Metabolism by CYP2C9 and CYP3A4 Renally cleared Half-life 1.5 hours |
| Repaglinide | Short-acting secretogogue Rapidly absorbed after oral administration Metabolism by CYP3A4 Excreted in bile Half-life 1 hour |
| Metformin | Biguinide Reduces hepatic glucose production Reduces intestinal glucose absorption Increases insulin sensitization Does not increase insulin secretion May decrease LDL and increase HDL |
| Metformin considerations | first line for new, obese DM2 pts can use in kids over 10 no liver metabolism, urine excretion 1/2 life- 6hrs watch kidney function- can build up and cause/worsen lactic acidosis (hold before and after IV dye exams) |
| THIAZOLIDINEDIONES | Activation of PPAR-γ, Nuclear transcription factor important in fatty acid metabolism Reduces insulin resistance by sensitizing fat/muscle cells to insulin needs plenty of insulin for these drugs to work Not good for hepatic disease, but ok for renal |
| pioglitizone | THIAZOLIDINEDIONE Not well absorbed orally 99% protein bound Metabolized by CYP2C8 and CYP3A4 to active and inactive metabolites Half-life of 3-7 hours Total pioglitazone 16-24 hours 15-30% renally excreted |
| rosiglitizone | THIAZOLIDINEDIONE 99% bioavailable after oral ingestion Almost totally protein bound Metabolized by CYP2C8 and CYP2C9 to inactive metabolites Metabolites renally cleared Side effect is edema- can worsen CHF |
| ALPHA – GLUCOSIDASE INHIBITORS | Competitive, reversible inhibitor of glucosidase in the small intestine Leads to slowed absorption of complex starches Decreased post – prandial blood glucose rise may take a few months to see full effect |
| acarbose | ALPHA – GLUCOSIDASE INHIBITOR 0.5-2% absorbed Not protein bound Distribution half-life 3.7 hours Metabolized by intestinal bacteria and enzymes Excreted in bile |
| miglitol | ALPHA – GLUCOSIDASE INHIBITOR 100% absorption at lower doses 50-60% at higher doses Not protein bound Elimination half-life 2 hours Not metabolized Excreted unchanged in the urine |
| Dipeptidyl Peptidase – 4 Inhibitor (Januvia) | Inhibition of dipeptidyl peptidase-4 (DPP-4) GLP and GLP-1 are metabolized rapidly by DPP-4 enzyme - these help reabsorb glucose Well absorbed orally Protein binding about 40% Minimal hepatic metabolism Renal excretion |
| Glucagon – Like Peptide (incretin) mimetic | Exenatide (Byetta) Regulates glucose homeostasis Enhance glucose dependent insulin secretion from pancreatic beta cells Suppress glucagon secretion Promotes satiety Slows gastric emptying must be used with sulfonylurea or metformin |
| Amylin mimetic | Pramlintide (Symlin) plays a role in glucose metablism postprandially Injection given before meals For use with insulin Do not mix with insulin |
Created by:
khilovsky
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