Pharm III Study Guide

Pharm III Study Guide - 1 Pharm Diabetes Mellitus Insulin o...

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1 Pharm Diabetes Mellitus Insulin o Glucose levels Normal fasting: 90-109 mg/dL Diabetic: >126 mg/dL o Types Short-acting – Lispro (humalog) – similar to regular human insulin, good flexibility, best if given 15 minutes before a meal Aspart – analog of human insulin, immediately before or after a meal, used in combination Glusiline – synthetic analog of natural insulin, best if given 15 minutes before a meal or within 20 minutes of start of meal Regular – only insulin that can be given IV Intermediate NPH – used for daylong control, usually given twice/day, cloudy, * only longer-acting insulin suitable to mix with regular insulin Detemir – slower onset and lower duration than NPH, clear solution Long-acting Glargine – used once daily, usually taken at bedtime, no peak in action less risk of hypo- or hyperglycemia Short-Acting Peak Lispro 0.5-2.5 Aspart 1-3 Glusiline 1-1.5 Regular 1-5 Intermediate NPH 6-14 Detemir 6-8 Long-Acting Glargine none o Dosing Type I – 0.5-0.6 units/kg/day Type II – 0.2-0.6 units/kg/day Schedules Conventional (2/3 breakfast, 1/3 dinner) o Breakfast, dinner – regular + NPH o Lunch, bedtime – nothing o Need to have a snack before bed to prevent nocturnal hypoglycemia Intensified conventional o Breakfast, lunch, dinner – regular o Bedtime – glargine o Desired glycemic control o Drug interactions Any drug that causes hypoglycemia will intensify the effect if on insulin (alcohol, beta blockers, etc.) Beta blockers – can mask signs of hypoglycemia and impair glycogenolysis o Pre-meal plasma glucose: 90-130 mg/dL o Peak post-meal plasma glucose: below 180 mg/dL
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2 Type II diabetes drugs o Sulfonylureas – stimulates release of insulin from pancreas Adverse effects – hypoglycemia o Biguanides – helps body better use available insulin, reduces glucose production, lowering the demand for insulin Adverse effects – GI problems ranging from metallic taste in mouth to diarrhea o Alpha-glucosidase inhibitors – delays digestion of ingested carbs, resulting in a smaller rise in blood glucose after meals Adverse reactions – abdominal pain, diarrhea, flatulence, hypoglycemia o Thiazolidinediones or Glitazones – increases sensitivity to insulin in muscle and adipose tissue and decreases hepatic glucose output Adverse effects – increased cholesterol, weight gain FDA alert: could potentially increase the risk of heart disease o Meglitinide – lowers blood glucose concentrations by stimulating pancreatic secretion of insulin Adverse effects – hypoglycemia o Incretin mimetic – mimics the glucose-lowering actions of incretins (hormone) Actions – increase in secretion of insulin, slow absorption of glucose from gut and reduction in the action of glucagon Adverse effects – nausea o Dipeptidyl peptidase IV inhibitors – blocks DDP-4 which degrades incretin hormones, this increases
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