Pharm Exam 4 Study Guide PDF

Diabetes Mellitus Overview of Diabetes Mellitus Chronic disorder characterized by abnormal carbohydrate metabolism due to either insufficient insulin production (Type 1 DM) or insulin resistance (Type 2 DM). Long-term complications: macrovascular (heart disease, stroke) and...

Diabetes Mellitus Overview of Diabetes Mellitus Chronic disorder characterized by abnormal carbohydrate metabolism due to either insufficient insulin production (Type 1 DM) or insulin resistance (Type 2 DM). Long-term complications: macrovascular (heart disease, stroke) and microvascular (retinopathy, nephropathy, neuropathy). Insulin Therapy Mechanism of Action: Promotes glucose uptake by cells, stores glucose in the liver, and prevents the breakdown of fat and protein. Types of Insulin: ○ Rapid-acting (e.g., Lispro, Aspart, Glulisine): Onset 10-30 min, peak 0.5-3 hr, duration 3-6 hr. ○ Short-acting (e.g., Regular insulin): Onset 30-60 min, peak 1-5 hr, duration 6-10 hr. ○ Intermediate-acting (e.g., NPH insulin): Onset 1-2 hr, peak 6-14 hr, duration 16-24 hr. ○ Long-acting (e.g., Glargine, Detemir): Onset 1-2 hr, no peak, duration 24 hr or more. ○ Ultra-long acting (e.g., Degludec): Duration over 42 hours, no peak. Administration: Subcutaneous injection or IV (only regular insulin). Rotate injection sites to avoid lipohypertrophy. Side Effects: Hypoglycemia, weight gain, allergic reactions. Important Considerations: Timing of administration relative to meals, individualized based on blood glucose monitoring. Rule of 15: 1. Consume 15 grams of fast-acting carbohydrates: ○ Examples include: 4 glucose tablets. 4 ounces (½ cup) of fruit juice or regular soda. 1 tablespoon of sugar or honey. 6-7 hard candies (like Lifesavers). 2. Wait 15 minutes, then check your blood glucose level again.  3. If blood glucose is still low (below 70 mg/dL or 3.9 mmol/L), repeat the process: ○ Consume another 15 grams of fast-acting carbohydrates. ○ Wait another 15 minutes. ○ Check your blood sugar again. 4. Once blood glucose returns to normal, eat a small snack or meal that includes protein and complex carbohydrates to stabilize blood sugar (e.g., a sandwich, crackers with peanut butter, or a small handful of nuts). This rule helps prevent severe hypoglycemia and gives a structured, manageable way to bring blood glucose levels back to a safe range without overcorrecting and causing hyperglycemia (high blood sugar). Oral Antidiabetic Drugs (for Type 2 DM) Biguanides Example: Metformin Mechanism: Reduces glucose production by the liver, enhances insulin sensitivity. Benefits: No risk of hypoglycemia, weight loss. Side Effects: Gastrointestinal upset, lactic acidosis (rare but serious). Contraindications: Renal impairment, liver disease, alcohol abuse. Summary: Metformin is a drug that is used to help treat diabetes, specifically T2DM. Glucose production from the liver is decreased and insulin sensitivity is increased. Some of the side effects of taking metformin include GI distress, contraindicated in patients with renal failure due to increased level of lactic acid (lactic acidosis), and decreased vitamin B12. Sulfonylureas Examples: Glipizide, Glyburide, Glimepiride. Mechanism: Stimulate the pancreas to release more insulin. Side Effects: Hypoglycemia, weight gain. Drug Interactions: Alcohol, beta-blockers. Summary: Meglitinides (Glinides) Examples: Repaglinide, Nateglinide. Mechanism: Similar to sulfonylureas, but shorter acting. Administration: Take before meals to prevent postprandial hyperglycemia. Side Effects: Hypoglycemia (less risk than sulfonylureas), weight gain. Thiazolidinediones (Glitazones) Examples: Pioglitazone, Rosiglitazone. Mechanism: Reduce insulin resistance by increasing glucose uptake in muscles and adipose tissue. Side Effects: Fluid retention, heart failure, bladder cancer (pioglitazone), fractures in women. Monitoring: Liver function tests, heart function. Alpha-Glucosidase Inhibitors Examples: Acarbose, Miglitol. Mechanism: Delay carbohydrate digestion and absorption in the intestine, leading to lower postprandial glucose. Side Effects: Flatulence, cramps, diarrhea, liver dysfunction (acarbose). Administration: Take with meals. DPP-4 Inhibitors (Gliptins) Examples: Sitagliptin, Saxagliptin, Linagliptin. Mechanism: Inhibit enzyme DPP-4, preventing breakdown of incretin hormones, which help regulate glucose levels. Side Effects: Upper respiratory infections, pancreatitis, joint pain. SGLT-2 Inhibitors Examples: Canagliflozin, Dapagliflozin, Empagliflozin. Mechanism: Increase glucose excretion through the urine by inhibiting glucose reabsorption in the kidneys. Benefits: Weight loss, reduced blood pressure, cardiovascular enefits. Side Effects: Genital infections, UTIs, dehydration, ketoacidosis. GLP-1 Receptor Agonists (Incretin Mimetics)  Examples: Exenatide, Liraglutide, Dulaglutide. Mechanism: Mimic the incretin hormone GLP-1, which increases insulin secretion and slows gastric emptying. Administration: Subcutaneous injection. Side Effects: Nausea, vomiting, weight loss, pancreatitis. Amylin Mimetics Example: Pramlintide. Mechanism: Reduces postprandial glucose by slowing gastric emptying and suppressing glucagon secretion. Administration: Subcutaneous injection, typically used in Type 1 and insulin-dependent Type 2 DM. Side Effects: Hypoglycemia (especially with insulin), nausea. Hypoglycemia Management Symptoms: Sweating, tremors, confusion, weakness, palpitations, headache, irritability. Treatment: ○ Mild: 15-20g of fast-acting carbohydrates (e.g., glucose tablets, juice). ○ Severe: Glucagon injection or IV dextrose for unconscious patients. Monitoring and Patient Education Self-monitoring of blood glucose (SMBG): Essential for adjusting treatment regimens and avoiding complications. A1C Target: Usually