Exam2StudyGuide - Diabetes Mellitus 1. Type 1 Diabetes...

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Diabetes Mellitus 1. Type 1 Diabetes – failure of the pancreas to produce insulin Type 2 Diabetes – insulin secreted; body is resistant 2. Diagnosis - symptoms of diabetes and random blood glucose > 200 mg/dL - fasting blood glucose > 126 mg/dL - 2 hr blood glucose > 200 mg/dL during a OGTT using 75g glucose in H20 3. Micro-vascular complications (-pathy) - neuropathy, nephropathy, retinopathy Macro-vascular complications - (CAD), (CVD), (PVD) 4. Hypoglycemia – shaking, sweating, anxious, dizzy, hungry, rapid heartbeat, impaired vision, weakness, fatigue, headache, irritable Hyperglycemia – extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, nausea 5. ADA Recommendations: Glycemic control: A1c - <7% Preprandial BG – 90-130 mg/dL (fasting) Postprandial BG - <180 mg/dL (2 hours after eating) Hemoglobin A1c Testing: higher the number, the more sugar is built up 6. Oral anti-diabetic agents A) Insulin secretagogues 1. Sulfonylureas a. ex: Glyburide, Glyburide micronized, Glipzide, Glimepiride b. MOA : stimulate pancreatic beta cells to increase insulin secretion c. ADR’s : Hypoglycemia, weight gain, pregnancy category C d. Adv : low cost, 2 nd generation has fewer side effects e. Dis : hypoglycemia, becomes less effective over time f. Therapy : first line in newly diagnosed Type 2 2. Meglitinides a. ex : Repaglinide, Nateglinide b. MOA : stimulate insulin release from pancreatic beta cells to reduce postprandial hyperglycemia c. ADR’s : hypoglycemia, weight gain, pregnancy category C d. Adv : do not cause continuous insulin secretion; cause less hypoglycemia/ weight gain than sulfonylureas e. Dis : more costly, drug interactions f. Therapy : mono or combo therapy - repaglinide may be alternate to sulfonylurea in renal impairment B) Insulin Sensitizers 1. Biguanide a. Ex: Metformin b. MOA : lowers basal blood glucose c. ADR’s : GI effects; lactic acidosis (rare)
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d. Adv : modest weight loss, dec triglycerides, dec LDL cholesterol e. Dis : lactic acidosis; poor compliance due to GI side effects f. Therapy : first line in pts with type 2 diabetes w/o renal impairment 2. Thiazolidinediones (TZDs) a. Ex : Pioglitazone, Rosiglitazone b. MOA : enhancement of insulin sensitivity - decrease hepatic output - lowers free fatty acid concentrations c. ADR’s : weight gain, edema, possible hepatotoxicity d. Adv: may improve beta cell function, lower A1c by 1-2%, improves lipid profiles e. Dis : insulin dependent action; fluid retention; expensive; drug interactions with pioglitazone; LFT monitoring f: Therapy : good combo agent or replacement agent for metformin - 2nd line after metformin and sulfonylureas due to cost/ADRs - do not cause hypoglycemia in monotherapy g. Contraindications : congestive heart failure elevated liver enzymes, liver disease, edema, pregnancy/breast feeding C) Alpha-Glucosidse Inhibitors 1. Ex: Acarbose, Miglitol b. MOA : blocks gut absorption of complex sugars c. ADR’s : flatulence, GI distress, diarrhea
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This test prep was uploaded on 04/07/2008 for the course PHARM 338 taught by Professor Karboski during the Fall '07 term at University of Texas at Austin.

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Exam2StudyGuide - Diabetes Mellitus 1. Type 1 Diabetes...

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