lOMoARcPSD|27916040
COMPLETE NR565 REAL
ADVANCED PHARMACOLOGY
FUNDAMENTALS FINAL EXAM
STUDYGUIDE VERIFIED & RATED
A+ |WEEK 5-WEEK 8 |2024|
GUARANTEED PASS
, lOMoARcPSD|27916040
Diabetes Mellitus
▪ Leading cause of kidney failure, nontraumatic limb amputation, new cases of adult blindness,
heart disease and stroke.
▪ Acute symptoms of diabetes plus casual plasma glucose concentration greater than or equal to 200
mg/dL.
▪ Casual is defined as any time of day without regard to time since the last meal. The classic symptoms
of diabetes are polyuria, polydipsia, and unexplained weight loss.
▪ 2 2-hour post-load plasma glucose in an oral glucose tolerance test greater than or equal to 200 mg/dL.
The test uses a glucose load containing the equivalent of 75 g of anhydrous glucose dissolved in water.
▪ HgbA1C greater than or equal to 6.5%
▪ Fasting plasma glucose greater than or equal to 126 mg/dL.
▪ Fasting is defined as no caloric intake for at least 8 hours
Pre Diabetes
▪ Fasting plasma glucose 100 to 125 mg/dL (IFG) or
▪ HgbA1c 5.7% to 6.4%
▪ Plasma glucose 140 to 199 mg/dL (IGT) 2 hours post-ingestion of a standard glucose load (75 g)
Criteria for diagnosis
▪ FPG > or = to 126
▪ Oral glucose tolerance test (OGTT) 2hr plasma glucose > or = t0 200
▪ Random Plasma glucose > or = to 200mg/dL plus DM symptoms
▪ HgbA1C 6.5% or higher
Treatment
▪ Step 1Lifestyle change and metformin
▪ Step 2 Continue step 1 and add second drug
▪ Step 3 continue step one and progress to 3 drug combination
▪ If step 3 includes basal insulin falls, combine injectable regimen with possibly a GLP-1 receptor agonist
Insulin
▪ MOA: Anabolic, energy conservation, promotes cellular growth and division
▪ Baseline data: random plasma glucose, urinate glucose and ketones, A1c, serum electrolyte
▪ Monitor glucose lever and A1c every 2-4 times per year (every 3 month max)
▪ CI: medication that impact blood glucose (sulfanuria and steroids)
▪ SE: educate s/s of hypo and hyperglycemia
Insulin lisipro Regular insulin Humulin N and Lantus Insulin
Rapid: Humalog Humulin R, Novolin N (insulin degludec
Novolin R: short (NPH): glargine) (Tresiba)
acting intermediate Ultralon
acting g
onset 15-30min 30-60min 60-120min 70min 30-
, lOMoARcPSD|27916040
90min
duratio 3-6hrs 6-10hrs 12-24hrs 18-24hrs >24hrs
n
Biguanides: Metformin (max 2000mg/day)
▪ MOA: inhibits glucose production in liver, reduces glucose absorption in the gut, synthesizes
insulin receptor to increase glucose uptake
▪ Therapeutic use
Glycemic control, DM2 prevention, gestational DM, PCOS
▪ Side effect: decrease appetite, nausea, diarrhea, absorption of vitamin B12 and folate (can cause
spinal bafida and neural tubal defect if taken while pregnant)
▪ Black box: lactic acidosis (hemodialysis might be needed)
▪ Monitor renal function
Sulfonylureas
▪ MOA: stimulate insulin release from pancreatic islets
▪ Basic data: random plasma glucose, fasting plasma glucose, A1c, serum electrolyte, urine ketone and
glucose
▪ Monitoring: glucose level and A1c 2-4times/year
▪ CI: pregnancy, Brest feeding, renal dysfunction and hepatic dysfunction
▪ SE: educate s/s of hypoglycemia
Meglitinides (Glinides)
▪ MOA: same as sulfonylureas, stimulate pancreatic insulin release
▪ Baseline data: random plasma glucose, fasting plasma glucose, A1c, serum electrolye, urine glucose
and ketones
▪ monitoring : glucose level, A1C 2-4 times per year
▪ CI: liver impairment, gemfibrozil
▪ SE: education on ss of hypoglycemia
▪ If Sulfonylureas don't work this drug group also does not work
Thiazolidinediones (glitazones or TZDs)
▪ MOA: decrease insulin resistance
▪ Baseline: random plasma glucose, fasting plasma glucose, A1c, serum electrolytes, urinary
ketones and glucose
▪ Monitoring: glucose and A1c 2-4 times a year
▪ SE: Heart failure and educate ss of hypoglycemia
Sodium-glucose cotransporter 2 inhibitors
▪ MOA: limits reabsorption of glucose in the renal tubules
▪ Baseline data: random plasma glucose, fasting plasma glucose, A1c, serum electrolyte, urine glucose
and ketones
▪ Monitoring : glucose level, A1C 2-4 times per year
▪ CI: caution with vulvovaginal infection and UTI
▪ SE: dehydration and education on ss of hypoglycemia Incretin
hormone are gut peptide not present in type two DM
Dipeptidyl Peptidase – 4 inhibitors (Gliptins)
▪ MOA: enhance action of incretin hormones
COMPLETE NR565 REAL
ADVANCED PHARMACOLOGY
FUNDAMENTALS FINAL EXAM
STUDYGUIDE VERIFIED & RATED
A+ |WEEK 5-WEEK 8 |2024|
GUARANTEED PASS
, lOMoARcPSD|27916040
Diabetes Mellitus
▪ Leading cause of kidney failure, nontraumatic limb amputation, new cases of adult blindness,
heart disease and stroke.
▪ Acute symptoms of diabetes plus casual plasma glucose concentration greater than or equal to 200
mg/dL.
▪ Casual is defined as any time of day without regard to time since the last meal. The classic symptoms
of diabetes are polyuria, polydipsia, and unexplained weight loss.
▪ 2 2-hour post-load plasma glucose in an oral glucose tolerance test greater than or equal to 200 mg/dL.
The test uses a glucose load containing the equivalent of 75 g of anhydrous glucose dissolved in water.
▪ HgbA1C greater than or equal to 6.5%
▪ Fasting plasma glucose greater than or equal to 126 mg/dL.
▪ Fasting is defined as no caloric intake for at least 8 hours
Pre Diabetes
▪ Fasting plasma glucose 100 to 125 mg/dL (IFG) or
▪ HgbA1c 5.7% to 6.4%
▪ Plasma glucose 140 to 199 mg/dL (IGT) 2 hours post-ingestion of a standard glucose load (75 g)
Criteria for diagnosis
▪ FPG > or = to 126
▪ Oral glucose tolerance test (OGTT) 2hr plasma glucose > or = t0 200
▪ Random Plasma glucose > or = to 200mg/dL plus DM symptoms
▪ HgbA1C 6.5% or higher
Treatment
▪ Step 1Lifestyle change and metformin
▪ Step 2 Continue step 1 and add second drug
▪ Step 3 continue step one and progress to 3 drug combination
▪ If step 3 includes basal insulin falls, combine injectable regimen with possibly a GLP-1 receptor agonist
Insulin
▪ MOA: Anabolic, energy conservation, promotes cellular growth and division
▪ Baseline data: random plasma glucose, urinate glucose and ketones, A1c, serum electrolyte
▪ Monitor glucose lever and A1c every 2-4 times per year (every 3 month max)
▪ CI: medication that impact blood glucose (sulfanuria and steroids)
▪ SE: educate s/s of hypo and hyperglycemia
Insulin lisipro Regular insulin Humulin N and Lantus Insulin
Rapid: Humalog Humulin R, Novolin N (insulin degludec
Novolin R: short (NPH): glargine) (Tresiba)
acting intermediate Ultralon
acting g
onset 15-30min 30-60min 60-120min 70min 30-
, lOMoARcPSD|27916040
90min
duratio 3-6hrs 6-10hrs 12-24hrs 18-24hrs >24hrs
n
Biguanides: Metformin (max 2000mg/day)
▪ MOA: inhibits glucose production in liver, reduces glucose absorption in the gut, synthesizes
insulin receptor to increase glucose uptake
▪ Therapeutic use
Glycemic control, DM2 prevention, gestational DM, PCOS
▪ Side effect: decrease appetite, nausea, diarrhea, absorption of vitamin B12 and folate (can cause
spinal bafida and neural tubal defect if taken while pregnant)
▪ Black box: lactic acidosis (hemodialysis might be needed)
▪ Monitor renal function
Sulfonylureas
▪ MOA: stimulate insulin release from pancreatic islets
▪ Basic data: random plasma glucose, fasting plasma glucose, A1c, serum electrolyte, urine ketone and
glucose
▪ Monitoring: glucose level and A1c 2-4times/year
▪ CI: pregnancy, Brest feeding, renal dysfunction and hepatic dysfunction
▪ SE: educate s/s of hypoglycemia
Meglitinides (Glinides)
▪ MOA: same as sulfonylureas, stimulate pancreatic insulin release
▪ Baseline data: random plasma glucose, fasting plasma glucose, A1c, serum electrolye, urine glucose
and ketones
▪ monitoring : glucose level, A1C 2-4 times per year
▪ CI: liver impairment, gemfibrozil
▪ SE: education on ss of hypoglycemia
▪ If Sulfonylureas don't work this drug group also does not work
Thiazolidinediones (glitazones or TZDs)
▪ MOA: decrease insulin resistance
▪ Baseline: random plasma glucose, fasting plasma glucose, A1c, serum electrolytes, urinary
ketones and glucose
▪ Monitoring: glucose and A1c 2-4 times a year
▪ SE: Heart failure and educate ss of hypoglycemia
Sodium-glucose cotransporter 2 inhibitors
▪ MOA: limits reabsorption of glucose in the renal tubules
▪ Baseline data: random plasma glucose, fasting plasma glucose, A1c, serum electrolyte, urine glucose
and ketones
▪ Monitoring : glucose level, A1C 2-4 times per year
▪ CI: caution with vulvovaginal infection and UTI
▪ SE: dehydration and education on ss of hypoglycemia Incretin
hormone are gut peptide not present in type two DM
Dipeptidyl Peptidase – 4 inhibitors (Gliptins)
▪ MOA: enhance action of incretin hormones
