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Diabetes rxprep
| Question | Answer |
|---|---|
| what is diagnosis of diabetes | 1) Diabetes sx like 3 P's or unexplained wt loss AND random plasma glucose >200 mg/dL. 2) FPG >or eq 126 mg/dL 3) 2hr plasma gucose of >oreq 200 mg/dL during a 75 g oral glucose tolerance test 4) HbALC >/eq 6.5% |
| a1c goal | ADA <7%. ACE <6.5% |
| dka diagnosis and sx and tx | glucose >300 mg/dL, ketones in urine and blood, etc 166; sx hyperglycemia, 3P's, blurred vision, met acidosis (fruity breath, dyspnea), dehydration; tx with IV FLUIDS NS or 1/2NS and insulin |
| Metformin MOA | decreases hepatic glucose output so liver releases less glucose into the bloodstream. |
| Glucophage or XR | Metformin |
| Glumetza | Metformin |
| Fortamet | metformin |
| glucovance | metformin and gyburide |
| actoplus met | metformin and pioglitazone |
| avandamet | metformin and rosiglitazone |
| janumet | metformin and sitagliptin |
| max dose of metformin | titrate to 2 g daily.. can also do 850 mg TID=2550mg daily |
| 2 contraindications to not using metformin 1st line | alc>10%, fbg>250mg/dL; use basal insulin instead |
| Metformin SEs | 169 diarrhea, WT NEUTRAL!, NO HYPOGLYCEMIA, lactic acidosis rare but serious; decreases folate and vit b12 absorption so causes neuropathic damage so consider vitamin supplement. |
| Metformin CI's | Scr 1.5 mg/dL or greater in males. or 1.4 or greater in femailes. CrCl <60ml/min; hold prior to IV contrast dye and wait 48 hrs after procedure (check for normal renal fctn); do NOT use with hypoxia |
| Metaglip | metformin and glipizide |
| Sulfonylurea MOA | stimulates insulin secretion from the pancreas. do NOT use with meglitinides due to similar MOA |
| diabenese and info | chlorpropamide; no longer used due to long DOA and increase risk of hypoglycemia |
| glucotrol or XL and info | glipizide. ir 2.5-10 mg BID, XL 2.5-10mg daily; max 20 mg daily |
| glimepiride and info | Amaryl. a bit safer than the others |
| diabeta and info | glyburide not recommended Sulfonylurea by ADA. has metabolite that is renally cleared that accumulates with renal dysfunction! and diabetic pts have renal problems! |
| micronase | glyburide |
| which are the preferred sulfonylureas | glipizide (glucotrol) and glimepiride (amaryl) |
| sulfonylurea SEs | HYPOGLYCEMIA, wt gain (like insulin can cause wt gain), decreased efficacy after long term use |
| difference bw glinides and sulfonyureas | glinides are more mealtime and shorter acting insulin secretogues vs Sulfonylureas which are more long acting |
| glinides MOA | stimulate insulin secretion from the pancreas. do not use with sulfonylureas due to same MOA |
| Prandin and sig | repaglinide take TID 15-30 mins before meals |
| Starlix | Nateglinide (slightly less effective than Prandin) |
| Glinides SEs | hypoglycemia, WT NEUTRAL so benefit over sulfonylureas |
| Actos | Pioglitazone, thiazolidinedione |
| duetact | pioglitazone and glimepiride |
| avandia and info | rosiglitazone, is a thiazolindinedione, restricted use du to CVD risk of MI and stroke, REMS requirement |
| Thiazolidinedione MOA | PPR peroxisome proliferator-activated receptor y agonist, increases peripheral insulin sensitivity, increases insulin entry into muscle cells and are insulin sensitizers |
| thiazolidinedione BBW and SES | BBW may exacerbate HF and possible risk bladder cancer; SEs: peripheral edma, wt gain, chf, increase fracture risk, increase LFT's |
| alpha glucosidase inhibitors moa | works on brush border of intestine to slow down absorption of glucose and carbs by inhibiting alpha glucosidase in intestine and alpha amylase in pancreas to delay absorption of glucose. inhibitis metab of sucrose to glucose and fructose. |
| precose | acarbose alpha glucosidase inhibitors |
| gyset | miglitol alpha glucosidase inhibitors |
| alpha glucosidase inhibitors SEs and CIs | flatulence, diarrhea so titrate slowly. good for increase HDL and decrease TGs and CH, WT NEUTRAL, check liver enzymes with acarbose rarely; CI in IBS, intestinal obstruction or significant GI dz. |
| alpha glucos counseling | take with first bite of food. if low blood sugar, cannot take sucrose because inhibits metab of sucrose to glucose and fructose so take glucose tabletes or gel. |
| DPP4 inhib MOA | incretin enhancer. inhibits DPP4, an enzyme that breaks down incretins GLP1 and GIP. Incretins stimulate the pancreas to release insulin and liver to decrease glucose production |
| Januvia | Sitagliptin |
| Onglyza not top 200 | Saxagliptin |
| DPP4 SEs | well tolerated, no hypoglycemia, no wt gain, nasopharyngitis, upper resp infxns, ALLERGIC RASH, warnings about ACUTE PANCREATITIS |
| Glucagon like peptide agaonist MOA | incretin mimetic; increases insulin and decreases glucagon secretion; also slows gastric emptying and promotes satiety and wt loss |
| byetta and dosing instructions | exenatide. start 5mcg then 10mcg twice daily sc, take 30-60 min before breakfast and dinner. |
| byetta SEs | nausea primary SE so titrate up. WT LOSS. pancreatitis, do not use CrCl less than 30 ml/min |
| Victoza info and comparison to byetta | liraglutide; given once daily without regard to meals, BBW thyroid carcinomas in rats and mice, more wt loss and less hypoglycemia than exenatide, NAUSEA/V/D, HA, pancreatitis. |
| pramlinitide MOA | analogue of amylin, which is produced by pancreatic beta cells that assist in postprandial glucose control. Amylin slows gastric emptying, prevents increase in serum glucagon after meal, and increases satiety. |
| Symlin not top 200 | Pramlinitide |
| main SEs with Symlin | hypglycemia! reduce mealtime insulins by 50%. NAUSEA in over 30% pts, anorexia, wt loss, CI in gastroparesis or hypoglycemic unawareness. |
| Welchol | Colesevelam 178 |
| Cycloset | Bromocriptine 178 |
| Humalog | Insulin Lispro, rapid acting |
| Novolog | Insulin aspart, rapid acting |
| Apidra | insulin glulisine, rapid acting |
| what are the regular or short acting insulings | humulin R, Novolin R |
| short acting insulin onset and doa | inject right b4 eat or up to 15 mins before eat and can last up to 5 hrs. |
| regular insulin onset and doa | inject 30 mins before breakfast and dinner, lasts 4-6 hrs. usu mixed with nph or N insulin. |
| NPH intermediate insulins | Humulin N and Novolin N |
| Humulin N and Novolin N doa | lasts up to 24 hrs and can peak anywhere from 4 to 14 hrs. |
| Basal insulins dose | lantus and levemir dosed once or twice daily. if once daily at bedtime. |
| Lantus | insulin glargine. onset 1 hr. lasts 24 hours. no peak. acidic so may sting a little. |
| levemir | insulin detemir. onset 4 hrs. lasts 24 hrs. no peak |
| gestational diabetes goals and txment | preprandial blood glucose less than 95 mg/dL and A1c less than 6%. treat with rapid acting or regular insulin NOT basal insulin. |
Created by:
Snickers504