Pharm: Diabetes mellitus Drugs

What is the cause of type 1 diabetes?

Autoimmune process-->beta cell destruction

What is the drug therapy for type 1 diabetes?

insulin is needed will die w/o it

What is the cause of type 2 diabetes?

insulin resistance and inappropriate insulin secretion

What is the treatment for type 2 diabetes?

live style change, weight loss, oral anti-diabetic drugs, insulin

S/S of Hypoglycemia (STARVED)

Shaking/sweaty
Tired/weak/fatigue
Anxious/head ache
Rate up (fast HR)
Vision impaired
Eat (hunger)
Dizzy

What are the 4 factors that decrease blood glucose?

4 M's:
Meds (insulin and OAD's)
Move (exercise)
Mass (cancer)
Moderate Alcohol

There are 3 factors the increase Blood Glucose (3S's):

Sweets (food)
Stress
Steroids

Monitoring test: fasting Blood sugar should be:

<110

2 hours after meals blood sugar should be:

<140

Hgb A1c should be

less than or equal to 6.5%

Hgb A1c is what?

sugar coated Hgb

How often should Hgb A1c be tested?

every 3 months

T or F: RBC's coated with sugar live longer than RBC's not coated with sugar

False: RBC's coated w/sugar do not live long

How do you treat Hypoglycemia in a conscious, asymptomatic patient?

rule of 15

What is the rule of 15

15 carbs, wait 15 min. and repeat 3x's

How do you treat hypoglycemia in an unconcious or NPO patient?

Dextrose 50% (D50) IV push, glucagon SQ

What is the MOA of insulin?

regulate blood glucose by binding to insulin receptors on the cells.

Insulin does what to glucose so it can be used? (use)

helps move the glucose from blood to cells for energy production

How does insulin help store glucose? (store)

glucose is in the form of glycogen in the liver and muscles for energy source (glycogenesis).

What does insulin help do to excess glucose?

Helps store extra glucose as fat in adipose tissue

If there is no secretion and/or action of insulin, this will result in

high blood glucose levels (hyperglycemia)

What are the expected effects of Insulin Therapy?

maintain blood glucose
keep blood lipid levels normal range

Side effect-

site irritation

Adverse effects: Hypoglycemia, why such a big deal?

Brain cells are very sensitive to low blood glucose levels: the patient can become insulin shock (nonresponsive very quickly) and die

2 forms of insulin (injection, NO ORAL form)

single daily injections, 8-10 injections dalily
Insulin pump is best

T or F: Diabetics should eat 3 moderate meals a day.

False: frequent meals prevent hypoglycemic episode

Types of Insulin:

Rapid action, short acting, intermediate, long acting

What is the onset time, peak time, an duration of Rapid acting insulin?

Onset: 10-15 min
Peak: 60-90 min
Duration: 4-5 hours

How is rapid acting insulin given?

bolus

What is the onset time, peak time, an duration of short acting insulin?

Onset: 30-60 min
Peak: 2-4 hours
Duration: 5-8 hours

What is the onset time, peak time, an duration of Intermediate acting insulin?

Onset: 1-3 hours
Peak: 5-8 hours
Duration: 12-18

How is short acting insulin given?

Drip

What is the onset time, peak time, an duration of long acting insulin?

Onset: 90 min
Peak: --
Duration: 12-24 hours

How is long acting given?

Vaso

What are 2 long acting insulin drug names?

Lantus
Levemir

Long acting insulin is the ideal basal insulin, why?

Mimic normal pancreatic basal insulan
Long acting (24 hours)

Pediatric considerations for long acting Lantus/Levemir:

Parental involvement

Pregnancy (gestational diabetes considerations for long acting Lantus/Levemir:

Insulin preferred to drug

Older adult considerations for long acting Lantus/Levemir:

Increased rick of hypoglycemia, especially if taking beta blockers, warfarin
Blood glucose may be more difficult to control due to poor eating

Oral antidiabetic drugs are used to contorl which type of diabetes?

type 2

what 3 oral antidiabetic drug classes are not recomended for children?

sulfonylureas
alpha-glucosidease inhibitors (AGI)
thiazolidinediones (TZD)

what 2 oral antidiabetic drug classes are prescribed for children >10?

Metformin
meglitinides

What is a oral insulin secretagogoues?

secrtagogoues=one substance to make another substance produced
Increase secretion of insulin: trigger beta cells in pancreas to boost insulin production

What are 2 secretagogoues subtypes?

Sulfonylureas and meglitinides

Are sulfonylureas long or shot acting secretagogues?

Long acting

Sulfonylureas drug name:

Glipizide (glucotorl)
-zide, -mide, -ride, means sulfa

Sulfonylureas are used in which type of diabetes?

TYPE 2 ONLY!!!

Sulfonylureas SE:

weight gain, photosensitivity, SJS

When should sulfonylureas be taken?

In the AM to prevent hypoglycemia

Meglitinide: Short or long acting?

short acting secretagogues

Meglitinide drug names:

repaglinide (Prandin), nateglinide (Starlix)
-nide (NOT SULFA)

Maglitinide: No meal =

no meglitinide

Biguanide: Metfromin (aka sensitizers) MOA

reduce glucose released from the liver, increased cell sensitivity to insulin in the peripheral tissue (muscle)

Biguanide: Metformin: Use?

FIRST LINE and most commonly used for type 2 IN ALL AGE GROUPS

WARNING FOR METFORMIN!!!

withhold before and 48 hours after ANY RADIOLOGY TESTING using IV dye

Why hold metformin before and 48 hours after radiology testing?

increase risk of lactic acidosis (check renal function before you restart).

Major side effect of Metformin

Weight LOSS, lactic acidosis (muscle aches)

Metformin, monitor what?

renal function

Thiazolidinedione (TZD) or Glitazones Drug names:

-glitazone, piglitazone (Actos)

Thiazolidinedione (TZD) or Glitazones MOA:

Reduces insulin resistance = improves cell response to insulin
Increase glucose up take & suppresses hepatic glucose production

Thiazolidinedione (TZD) or Glitazones SE:

WEIGHT GAIN!!, heart disease, anemia (dilutional) = extreme water retention

What do you monitor with Thiazolidinedione (TZD) or Glitazones?

CBC. BP

How long does it take for Thiazolidinedione (TZD) or Glitazones to take effect?

4-6 weeks and is loooooong acting

Alpha Glucosidase Inhibitors (AGI) drug names:

precose (acarbose)

Alpha Glucosidase Inhibitors MOA

block alpa-glucosidase enzymes in small intestine to inhibit carb breakdown to glucose (delay and decrease glucose absorption from GI).

What are the SE's from Alpah Glucosidase Inhibitors?

gassy, WEIGHT LOSS

Teaching on Alpha Glicosidase Inhibitors:

watch for hypoglycemia.

If hypoglycemia occurs give:

glucose tabs/gel or corn syurp, jelly beans

Incretins are, what?

gut hormones, produced in the GI tract respond to carb, protein, fat intake

What is the main ingredient in Incretins?

GLP-1 2 minute hormone.
Inactivated by DPP-4 ( half live < or = 2 min)

Incretins MOA:

increase insulin production in pancreas
inhibit glucagon

Incretins: extrinsic drugs:

exenatide (dyetta), liraglutide (victoza)

Incretins indications: for who?

adjunctive therapy for DM type 2 - insulin dependent, prandial only

Incretins SE/AE:

WEIGHT LOSS and hypoglycmia (severe)

Incretins Nursing implication: SQ injection, when?

befroe two main daily meals, NOT AFTER

DPP-4 (Gliptins) drug name

sitagliptin (Januvia)

Dpp-4 Inhibitors indication:

insulin dependent, prandial only

DPP-4 Sitagliptin SE:

infection and headach

Amylin is the sister of:

Insulin

Amylin properties:

insulin independent, prandial only. Can work alone-need food

Incretins and Amylin MOA

collectively reduce the total insulin demand
supress glucagon
slow gastric emptying and inhib digestive secretion
decrease appetite by promoting satiety

EXtrinsic drugs (or analog, mimic drugs):

Pramlintide (symlin): SQ only before main meals

What drugs act on the Pancreas to increase insulin production?

Sulfonylureas Meglitinides
DPP-4 inhibitor incretins (GLP-1)

What drugs increas GI absorbtion of glucose?

DPP-4 (GLP-1)
biguanides (metformin)
alpha glucosidease inhibitors (AGI) Amylin

What drugs act on the liver?

biguanides (metformin)
Glitazones (TZD)

What drugs act on muscle (cause water retention/weight gain)?

Glitazones (TZD)

Biguanides (metformin) are the best, why?

increase fullness, decrease glucogon, synthesize perf tissues

Sulfonylureas meglitinides are the: best or the worst?

worst

DPP-4 inhibitor make pancreas make mor insulin and

absorption of glucogon better

Glitazones (TZD) cause water retention and weight gain as they act on what?

liver and muscle

Amylin increases

fullness