Week 4 Diabetes Med List Table 總整理 (1).docx

**Insulin Type** **only for type 1 (insulin分泌不足)** **Onset** **(Min)** **Peak** **(hr)** **Duration** **Appearance** **Route** **Nursing Considerations/Side effects** **Rapid Acting meal time使用** **用sliding scale insuling監測** - - - 15 1 3-5 SQ 低血糖 體重增 **Short...

**Insulin Type** **only for type 1 (insulin分泌不足)** **Onset** **(Min)** **Peak** **(hr)** **Duration** **Appearance** **Route** **Nursing Considerations/Side effects** **Rapid Acting meal time使用** **用sliding scale insuling監測** - - - 15 1 3-5 SQ 低血糖 體重增 **Short Acting** - 30 (IV會更快) 1-5 6-10 SQ, IV 低血糖 體重增 Hourly BG checks. ICU 和K的關係????? (insulin也會把K+存入細胞) **Intermediate acting = basel insulin** - 60 8 24 cloudy SQ 低血糖 體重增 **Long Duration = basel insulin整晚用** - - 70 n/a 24 SQ 低血糖 體重增 - 全部insulin的儲存方法: p.21 2-8度 開了就不要凍了 Insulin pump 機器 只給type1用，自己控制insulin給，但還是要內三四小時確認自己的blood glucose. (兩三天換一次)。要小心低血壓 Mix insulin 先放clear 再放cloudy的，cloudy的要agitation攪拌 要可以快速回答Ptt第一頁的前12題 Fasting blood glucose 80-100 normal. Pre 100-125. 還沒吃飯125都算糖尿病 200以上不管飯前飯後都算糖尿病 +-------------+-------------+-------------+-------------+-------------+ | **Oral | | | | | | Diabetes | | | | | | Meds （only | | | | | | for | | | | | | diabetes | | | | | | type | | | | | | 2，因為它們都假設be | | | | | | ta | | | | | | cell | | | | | | 可正常工作"胰島素正常 | | | | | | 分泌，但type1 | | | | | | | | | | | | DM是beta工作不好 | | | | | | | | | | | | ）** | | | | | +=============+=============+=============+=============+=============+ | **Name** | **MOA/Effec | **Metabolis | **SEs/AEs/B | **Other/Nur | | | t** | m** | lack | sing** | | | | | box | | | | | | warning** | | +-------------+-------------+-------------+-------------+-------------+ | **Biguanide | | | | | | ** | | | | | +-------------+-------------+-------------+-------------+-------------+ | **Metformin | 它的三種效果 | | GI upset | 配飯吃 | | \[Glucophan | | | | | | ge\]** | | | Anorexia | 從small | | | 1. 2. 3. | | 厭食，缺乏食慾 | dose開始 | | | | | | | | | | | | 監測腎的功能 | | | | | Flatulence腹 | | | | | | 脹/放屁 | | | | | | | Can also | | | | | B12 | treat: | | | | | deficiency | | | | | | (fatigue) | 給polycystic | | | | | | | | | | | Rare,but | ovary | | | | | dangerous: | syndrome | | | | | Lactic | (PCOS) | | | | | acidosis | 多囊性卵巢症，降低an | | | | | (tradycardi | drogen雄性激素 | | | | | o, | | | | | | RR | | | | | | increase, | 給pre-diabet | | | | | vomiting ) | es的人吃 | | | | | 特別是有kidney | | | | | | | | | | | | disease的人，因 | | | | | | 為腎功能不好會導致-- | | | | | | ----------- | | | | | | -----？ | | | | | | | | | | | | 也不要喝酒，不然會la | | | | | | ctic | | | | | | acidosis | | | | | | | | | | | | Abdominal | | | | | | 腹部絞痛 | | | | | | | | | | | | 體重會"減輕" | | | | | | | | | | | | | | | | | | Severe | | | | | | contraindic | | | | | | ated | | | | | | (禁忌) | | | | | | infections | | | | | | (sepsis/spe | | | | | | tic | | | | | | shock) | | | | | | | | | | | | 照CT前，因爲cons | | | | | | truct | | | | | | dye要停藥48hr | | | | | | | | | | | | 防止傷腎? | | | | | | | | | | | | 不會影響到胰臟(和其他 | | | | | | 要不同，why其他要和 | | | | | | 胰臟有關?) | | | | | | | | | | | | -很棒，skip | | | | | | a | | | | | | meal，也因為不會造 | | | | | | 成低血糖 | | +-------------+-------------+-------------+-------------+-------------+ | **Sulfonylu | | | | | | reas | | | | | | (-rides, | | | | | | -zides) | | | | | | 一天一顆** | | | | | +-------------+-------------+-------------+-------------+-------------+ | **Glyburide | **刺激pancrea | **50%由kidne | **變胖** | **只能用在type2 | | （聯想long | tic | y代謝** | | ** | | ride）** | B cells to | | **可能低血壓=\>要 | | | | lease more | | 檢查hepatic | **不能喝酒，不然會更 | | **Glipizide | insulin** | | lab** | sick，因為它的效果 | | ** | | | | 和disulfiram | | | | | **SE | 這藥一樣，會對酒反應不 | | | | | 可能像酒醉那樣, | 舒服，NVD。** | | | | | | | | | | | disulfiram* | | | | | | * | | +-------------+-------------+-------------+-------------+-------------+ | **Meglitini | | | | | | des | | | | | | (-glinide) | | | | | | 短效** | | | | | +-------------+-------------+-------------+-------------+-------------+ | **Repaglini | **刺激pancrea | | **變胖（所有incr | **主要和Sulfon | | de** | tic | | ease | ylureas不同處： | | | B cells to | | insulin的都會增 | 須在飯前吃** | | **Nateglini | lease more | | 加體重）** | | | de** | insulin** | | | | | | | | | **不能skip | | | | | | meal** | +-------------+-------------+-------------+-------------+-------------+ | **Thiazolid | | | | | | inediones | | | | | | (-glitazone | | | | | | ) | | | | | | TZD | | | | | | 可以直接處理 | | | | | | | | | | | | insulin | | | | | | resistance* | | | | | | * | | | | | +-------------+-------------+-------------+-------------+-------------+ | **Rosiglita | **-增加insuli | | | **不適合heart | | zone** | n | | | | | | responsive的 | | | failure pt, | | **Pioglitaz | 敏感度 | | | 因此要會導致腎累積更多 | | one** | （PPAR）** | | | 水。** | | | | | | | | | **用來和metfor | | | | | | min＆sulfony | | | | | | lurea一起用** | | | | +-------------+-------------+-------------+-------------+-------------+ | **GLP- | | | | | | 1Agonist = | | | | | | Incretin | | | | | | Mimetics | | | | | | (-glutide) | | | | | | 一週注射一次** | | | | | +-------------+-------------+-------------+-------------+-------------+ | **Semagluti | **模仿increti | | **GI | | | de | on** | | upset** | | | (Ozempic)** | | | | | | | **導致DPP-4 | | **Severe | | | | degradation | | abd pain | | | | (降解)** | | (pancreatit | | | | | | is)** | | | | | | | | | | | | **Rare:"可能導 | | | | | | 致thyroid | | | | | | tumors"** | | | | | | | | | | | | **抑制食慾（可瘦身） | | | | | | ，因** | | | | | | | | | | | | **導致slow | | | | | | gastric | | | | | | emptying** | | +-------------+-------------+-------------+-------------+-------------+ | **DPP-4 | | | | | | Inhibitors | | | | | | (-gliptin)* | | | | | | * | | | | | +-------------+-------------+-------------+-------------+-------------+ | **Sitaglipt | **阻斷DPP-4，以 | | **Headache | | | in | 刺激insulin釋放 | | (HA)** | | | (Januvia)** | ，減少升糖素釋放** | | | | | | | | **重要Severe | | | | | | | | | | | | abd pain | | | | | | (pancreatit | | | | | | is)** | | | | | | | | | | | | **Joint | | | | | | pain** | | +-------------+-------------+-------------+-------------+-------------+ | **SGLT-2 | | | | | | Inhibitors | | | | | | (-flozen) | | | | | | sodium- | | | | | | glucose | | | | | | contranspor | | | | | | ts | | | | | | 2 | | | | | | inhibitors | | | | | | 開腸剖肚。 | | | | | | 少見，但Founier | | | | | | 's | | | | | | gangrene很危險 | | | | | | 。** | | | | | +-------------+-------------+-------------+-------------+-------------+ | **Empaglifl | **在尿裡放更多glu | **Renal** | **體位下降** | | | ozin | cose，使其get | | | | | (Jardiance) | | | | | | ** | out of | | **Gential | | | | body** | | mycotic | | | | | | infections* | | | | | | * | | +-------------+-------------+-------------+-------------+-------------+ 若liver不好，AST&ALT這兩個酵素會升高 若renal不好，BUN和Creatine都會升高 Incretin: release from GI tract. trigger more insulin's release. Break down DPP-4 Amylin: release from pancreas. Delay gastric emptying, 使glucose慢點進血液裡 hypoglycemia: 不治療會lose of consciousness 治療後，則需每十五分鐘check BG 一次 BG 80算normal，70蠻低，60就很危險了，更低可能會irritable(易怒的) 治療方法：1. 喝橘子汁 15min. 2. IM/ SQ/ IV/ nasal. 10min 3. D50 IV 要 slow & steady 5min type1 DM 血壓突然太高（可能會看起來反而像hypo），BG level above 300，會ketoacidosis 酮酸中毒 type2 DM 血壓突然太高會 HHNS (hyperosmolar hyperglycemic nonketotic syndrome) 以上兩種狀況發生，我們都會用short-acting 或regular IV insulin drip。 要注意為什麼 Type 1 DM看起來 obtunded ( 神智不清的) ex. Drowsy (昏昏欲睡的), possible unarousable (可能無法喚醒的)，有可能是hypo ，也可能是hyperglycemia