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Nurs 5229 Clinical Pharmacotherapeutics > Diabetes Deck 2 > Flashcards

Diabetes Deck 2 Flashcards

1
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) - Agents

A

liraglutide (Victoza™), dulaglutide (Trulicity™), exenatide (Byetta™), semaglutide
(Ozempic™, Rybelsus™ - oral)
○ The “-glutides”

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2
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) Moa

A

: increase insulin release in the presence of elevated glucose,
decreases glucagon secretion, and delays gastric emptying (reducing the rate at which
postprandial glucose appears in circulation); decreased appetite

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3
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) - Efficacy

A

○ Nausea, decreased appetite, vomiting, indigestion, diarrhea
○ Headache
○ Injection site reactions

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4
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) - SE

A

○ Pancreatitis

○ Gallstones/Cholecystitis

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5
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) - Serious SE

A

○ A1C, Blood glucose

○ Weight

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6
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) Contraindications

A

○ History of medullary thyroid carcinoma

○ History of multiple endocrine neoplasia syndrome type II

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7
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) - place in therapy

A

○ Common agent used after metformin
○ Benefit in patients with ASCVD
○ Beneficial for weight loss

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8
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) - Administration

A

Technique varies across agents
■ Injection technique for Victoza and Ozempic are similar to insulin pens
■ Trulicity is a self contained system
■ Bydureon pen is being discontinued; Kit is hard to use

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9
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) - Pearls

A

Lower dose is started and titrated to higher dose to reduce GI issues. Starting doses are generally
not sufficient for BG control/management
○ Generally one of these agents is covered by insurance, but varies
○ Trulicity and Ozempic are once weekly
○ Rybelsus is oral but not well covered yet
○ Bydureon kit is hard to set up – if only agent covered can be helpful to train a family
member/Home Health to assist with administration

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10
Q

Glucagon-Like peptide-1 agonist (GLP-1

Agonists) - Monitoring

A

○ A1C, Blood glucose

○ Weight

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11
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) - Agents

A

canagliflozin (Invokana™), empagliflozin (Jardiance™), dapagliflozin (Farxiga™)
○ The “-flozins”

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12
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) - MOA

A

Inhibits glucose reabsorption in the kidneys through inhibition of
sodium-glucose cotransporter 2; Decreases serum glucose concentrations

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13
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) Efficacy

A

○ Additional benefit in chronic kidney disease
○ Additional benefit in cardiovascular disease: empagliflozin, canagliflozin (ASCVD); empagliflozin,
canagliflozin, and dapagliflozin (HF)

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14
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) - SE

A

○ Genitourinary infections (UTIs, Yeast Infections)

○ Increased urination

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15
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) - Serious SE

A 
○ Kidney Injury
○ Hypovolemia
○ Limb/Foot amputations
○ Bone fractures (canagliflozin)
○ DKA risk
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16
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) Monitoring

A

○ Blood Pressure
○ A1C, Blood glucose
○ Volume status

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17
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) Contraindications

A

○ Dialysis

○ Acute Kidney Injury

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18
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) - Place in therapy

A

○ Common agent used after metformin
○ Benefit in patients with ASCVD and/or HF or CKD
○ Benefit for weight loss

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19
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) - Administration

A

○ Take before the first meal of the day

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20
Q

Sodium-Glucose Cotransporter 2 Inhibitors

(SGLT2-inhibitors) Pearls

A

○ Generally avoided in older patients due to infection risk
○ Can be expensive if not covered by insurance but benefits with ASCVD/HF/CKD pushing for more
coverage

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21
Q

Insulin General fact

A

Replaces the insulin the body produces to help with blood glucose uptake in the tissues
● Many, many different products
● Human and synthetic insulin products
● Differ based on molecular structure which determines duration, onset, and peak of these
agents

22
Q

Insulin Dosing regimens

A

○ Long + Rapid Acting/Short acting

○ Intermediate BID

23
Q

Insulin - Available In

A

pens, vials, and IV
○ Generally stored in the refrigerator but can be stored at rooom temp when in use
○ Beyond use dates vary when removed from refrigeration

24
Q

Insulin - Administered

A

subcutaneously in the thighs, arms, buttocks, or abdomen (most common)

25
Q

Insulin - Adminsitration schedule

A

e depends on the product

26
Q

Insulin Monitoring

A

○ A1C
○ Blood sugars
○ Hypoglycemia

27
Q

Insulin - Adverse Effects

A

○ Hypoglycemia
○ Injection site reactions
○ Weight gain

28
Q

Insulin - Dosing

A

○ Generally guided by blood glucose
○ High fasting - Adjust basal
○ High 2 hour PP - Adjust mealtime

29
Q

Insulin - Short Acting - Agents

A

○ Insulin glulisine (Apidra™)
○ Insulin Lispro (Humalog™)
○ Insulin Aspart (Novolog™)

30
Q

Insulin - Short Acting generally administered

A

10-15 minutes

before a meal or immediately after

31
Q

Gluisine Onset Peak Duration

A 
Onset ~10 - 20
minutes
Peak 0.5- 1.5
hours
Duration ~5 hours
32
Q

Humalog Onset Peak Duration

A 
Onset 
15-30 min 
Peak
0.5-2.5
hours
Duration 3-6.5
hours
33
Q

Insulin - Long Acting Agents

A

Agents:
○ Insulin detemir (Levemir™)
○ Insulin glargine (Lantus™/Basaglar™)
○ Insulin glargine (Toujeo™) 300 units/mL
○ Insulin degludec (Tresiba™) – Ultra-long acting

34
Q

Insulin - Long Acting Gneral dosing

A

Generally once daily, but will sometimes see BID dosing

35
Q

Levemier onset peak duration

A

Onset 1-2 hours
Peak 6-8 hours
Duration 7.6 - 24+

36
Q

Lantus onset peak duration

A

Onset 1 to 1.5 hours
Peak None
Duration 24 hours
(11-24+ hours)

37
Q

Toujeo Onset peak duration

A

O - 5 hours
P - None
D - >24 hours

38
Q

Tresiba onset peak duration

A

O - 30 to 90 min
P - None
D - At least 42 hours

39
Q

Insulin - Ultra Rapid Acting - Agents

A

○ Fiasp™ (insulin aspart)

○ Lyumjev™ (insulin lispro-aabc)

40
Q

Lyumjev - Formulated

A

with
niacinamide for faster absorption
○ Inject within 20 minutes after the
start of the meal

41
Q

Fiasp - Inject at the

A

start of the meal or
within 20 min after the start of the
meal

42
Q

Insulin - Short Acting Regular - Agents

A

○ Humulin R™

○ Novolin R™

43
Q

Insulin - Short Acting Regular - can be used

A

in insulin pumps

44
Q

Humulin R - One to three

A

times daily

30 minutes before a meal

45
Q

Novolin R - One to three t

A

times daily

30 minutes before a meal

46
Q

Insulin - Short Acting Regular - used in conjunction with

A

h basal/long

acting insulin

47
Q

Insulin - Intermediate Acting (NPH) - Agents

A

○ Novolin N™

○ Humulin N™

48
Q

Human insulin (rDNA origin) in

A

isophane suspension

49
Q

Insulin - Intermediate Acting (NPH) generaly

A

Generally administered twice daily but can be further divided
● Generally fewer injections
● NPH = neutral protamine Hagedorn

● Appears cloudy

50
Q

Insulin - Premixed Insulins

A

○ Novolog 70/30 (aspart protamine + aspart)
○ Humalog 75/25 (lispro protamine + lispro)
○ Humalog 50/50 (lispro protamine + lispro)
○ Novolin 70/30 (NPH + regular insulin)
○ Humulin 70/30 (NPH + regular insulin)

51
Q

Insulin - Premixed Insulins - Fast facts

A

Generally administered twice daily
● Less flexibility to dose based on meals eaten as with other regimens
● Fewer injections each day
● Appear cloudy

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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