Diabetes Mellitus Pharm.

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  1. Human Regular Insulin (Humulin R, Novolin R)
    Short acting hypoglycemic drug
    • Therapeutic class: Antihyperglycemic/ Hormone
    • Preg Cat. B
    • MOA: promotes cellular uptake of glucose, amino acids, and potassium; to promote protein synthesis, glycogen formation and storage, fatty acid storage-it conserves energy stores by promoting the utilization of glucose for energy and inhibits gluconeogenesis.
    • Onset: IV (15min), SC (30-60min)
    • Peak: IV (30-60min), SC (2-4h)
    • Duration: IV (30-60min), SC (5-7h)
    • Indications: Hyperglycemia, DKA, given as monotherapy for type 1 and combination for type 2, gestational diabetes.
    • Contraindications: caution in pregnancy, renal impairment/failure, fever, thyroid disease, insulin can worsen hypokalemia. Rotate injection sites/ only insulin able to be administered IV.
    • Adverse effects: Hypoglycemia.
    • Interactions: potentiation of hypoglycemia (alcohol, salicylates, MAOI, anabolic steroids, guanethidine, garlic, ginseng.) Beta-adrenergic blockers may mask effects of hypoglycemia. 
    • Lab tests: Insulin may interfere with liver tests and throid function tests. also my lower potassium, calcium and magnesium levels.
  2. Insulin aspart (Novolog)
    Apidra is also rapid acting
    rapid acting insulin
    • Functions in the same way as other types of insulin. 
    • Onset: 15min
    • Peak: 1-3h
    • Duration: 3-5h
    • SC:5-10 min before a meal.
  3. isophane (NPH, Humulin N, Novolin N, ReliOn N)
    intermediate acting insulin
    • Functions in the same way as other types of insulin.
    • Onset:1-2h
    • Peak: 4-12h
    • Duration: 18-24h
    • SC: 30 min before a meal.
  4. lispro (Humalog)
    Rapid acting insulin
    • Functions in the same way as other types of insulin.
    • Onset: 5-15min
    • Peak: 30min to 1h
    • Duration: 3-4h
    • SC: 5-10min before
  5. insulin glargine (Lantus)/ detemir (levemir)
    Long acting insulin
    • Functions in the same way as other types of insulin.
    • Onset: 1.1h
    • Peak: No real Peak
    • Duration: 10-24h
    • SC: Once daily
  6. What insulin is mixable?
    • Humulin R and isophane (NPH) 70/30 (70%NPH and 30% regular) is the most commonly mixed insulin.
    • glargine(Lantus) appears to never be mixed with other insulin.
    • Need to consider the duration of effect of certain types of insulin.
  7. Metformin (glucophage)
    Type 2 diabetic med
    • Therapeutic class: Antidiabetic drug
    • Preg Cat. B
    • MOA: reduces fasting and postprandial(after meal) glucose levels by decreasing the hepatic production of glucose (gluconeogenesis) and reducing insulin resistance. Allows current insulin in blood to be used by the cells which allows glucose to enter the cells. This Medication does not cause hypoglycemia.
    • Onset: <1h
    • Peak: 1-3h; ER-4-8h
    • Duration: 12h; ER 24h
    • Indications: Type 2 hyperglycemia, hyperlipidemia, hypercholesterolemia. Off label use for women with polycystic ovary syndrome.
    • Contraindications: Impaired renal function, due to possibility of lactic acidosis, hepatic failure, cardiac failure, Hx of lactic acidosis, concurrent serious infection. 2 days pre/post IV radiographic contrast.
    • Adverse effects: GI related, nausea, abd discomfort, agitation, fatigue, metallic taste.
    • Interactions: Alcohol increases risk of lactic acidosis, furosemide/nifedipine may increase risk of hypoglycemia, increase risk of acute renal failure/ lactic acidosis with contrasts. Polypharm may increase the load on the kidneys.
    • Lab Tests: May cause false-positive results for urinary ketones.
  8. Sulfonylureas: chlorpropamide (diabinese)
    glyburide and glipizide fall under here as well
    • First generation hypoglycemics, acts by stimulating the release of insulin from pancreatic isle cells (beta cells) and increasing the sensitivity of insulin receptors on target cells.
    • Indications: Hyperglycemia
    • Contraindications: severe renal impairment, hepatic impairment.
    • Adverse reaction: when alcohol is taken some pt. experience a disulfiram reaction- Flushing of skin, palpitation and nausea. blood dyscrasias possible as well.
  9. Alpha-Glucosidase inhibitor
    acarbose (Precose)
    Type 2 diabetic med
    • Act by blocking enzymes in the small intestine which are responsible for breaking down complex carbohydrates into monosaccharides.
    • Slows down digestion of glucose.
    • Indications: hyperglycemia
    • Contraindications: caution for renal impairment and hepatic impairment. 
    • Adverse: abdominal cramping, diarrhea, and flatulence.
    • Lab tests: liver function tests.
  10. Thiazolidinediones
    pioglitazone (Actos)/ (Avandia)
    type 2 diabetic med
    • reduces blood glucose by decreasing insulin resistance and inhibiting hepatic gluconeogenesis.
    • Indications: Hyperglycemia
    • Contraindications: Renal failure, Hepatic failure, CHF. 
    • Adverse: Heart failure and associated symptoms (SOB, Fatigue), FVE.
  11. Meglitinides
    nateglinide (Starlix)/ repaglinide (Prandin)
    Type 2 diabetes med
    • Act by stimulating the release of insulin from pancreatic islet cells. similar to sulfonylureas. Shorter acting equal in efficacy to sulfonylureas. 
    • Most common adverse effect is hypoglycemia.
  12. Incretin enhancers 
    exenatide (Byetta)-GLP-1 Agonist
    sitagliptin (Januvia)-DPP-4 inhibitor
    • Incretins released from small intestines and signals the pancreas to increase insulin secretion and the liver to stop producing glucagon.
    • inhibitors allow the hormone levels to rise and produce a greater response.
  13. Substances that can produce hyperglycemic effects include
    • Phenytoin (Dilantin)
    • Corticosteroids
    • Diuretics
  14. Substances that can produce hypoglycemic effects include
    • Alcohol
    • Angiotensin-converting enzyme (ACE)inhibitors
    • Beta-adrenergic blockers
Card Set
Diabetes Mellitus Pharm.
DM pharmacology
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