Drugs for DM and Adrenal Cortex Disorders

Change amino acid sequence or add a protein.

Transports glucose, amino acids, nucleotides, and potassium into cells. Promotes synthesis of glycogen, proteins, and triglycerides.

Hypoglycemia and hypokalemia.

1 month.

Short-acting insulin.

No. Insulin detemir (Levemir) and insulin glargine (Lantus) are intermediate- and long-acting insulins respectively and are clear.

Use the same site only one time per month and keep the sites one inch apart.

Insulin lispro (Humalog), insulin aspart (Novolog), insulin glulisine (Apidra), regular insulin (Humulin R or Novolin R).

5-10 minutes before meals

30-60 minutes before meals

30-60 minutes before breakfast and dinner

Once per day. At bedtime.

Beta-blockers mask the signs of hypoglycemia and also prevent glycogenolysis, which allows glycogen to breakdown into glucose (necessary to prevent hypoglycemia).

Tachycardia, palpitations, sweating, nervousness, headache, confusion, drowsiness, fatigue.

Glucose tablet, orange juice, sugar cubes, honey, corn syrup. Must use glucose tablets if take alpha-glycosidase inhibitors that prevent the breakdown of sugars into monosaccharides.

Glucagon. Accelerates hepatic gluconeogenesis.

Reduces liver production of glucose, slightly inhibits intestinal absorption of glucose, and increases cell sensitivity to insulin.

Stop drug 1-2 days before procedure, drink lots of fluids, restart drug if BUN, Cr have normalized 48 hours after the procedure.

Stimulates the release of insulin from pancreatic beta cells, and increases cell sensitivity to insulin with prolonged administration.

Sulfa

Dilsulfiram-like reaction

Glinides must be given immediately before meals, because their action is much faster than sulfonylureas (onset 2 hrs).

Sensitizes cells to insulin.

Avoid with severe heart failure due to water retention.

Prevents breakdown of carbohydrates into monosaccharides.

Sulfonylureas

The hypothalamic releases CRH, which stimulates the anterior pituitary to release ACTH.  ACTH then stimulates the adrenal cortex to make cortisol, which then suppresses CRH and ACTH.

5-10 X the basal production

Pharmacologic doses are used to treat inflammation, suppress the immune response, and treat cancers like leukemia & lymphoma.

Physiologic doses mimic the release of glucocorticoids from healthy adrenal glands.

They increase glucose levels by stimulating gluconeogenesis, reducing peripheral utilization of glucose, reducing glucose uptake by muscle and fat, and promoting glycogenesis.

They stimulate catabolism to provide amino acids for gluconeogenesis.

Potbelly, moon face, buffalo hump

Decrease capillary permeability, maintain vasoconstriction and BP.

Increase RBC

Increase neutrophils

Increase muscle perfusion, increase muscle work capacity

Depression, lethargy, irritability, psychosis, euphoria, insomnia, suicidal ideation

BP, blood glucose levels

Sodium and water.  Potassium and hydrogen.

Burst of glucocorticoids

Mineralocorticoid.  Sodium and water.  Potassium and hydrogen.

Hydrocortisone.  Glucocorticoid and some mineralocorticoid properties. 

Sodium and water. Potassium and hydrogen.

Weight, blood pressure, hypokalemia

Excessive glucocorticoid.  Obesity, hyperglycemia, hypertension, hypernatremia, hypokalemia, hypervolemia, decreased resistance to infection, psychiatric changes, muscle wasting, osteoporosis, thinning of skin, fat redistribution, hirsutism, acne, menstrual irregularities

Hydrocortisone, prednisone, dexamethasone.  Daily dose at bedtime OR 2/3 dose in AM & 1/3 dose in PM.

Fludrocortisone (or Florinef).

Glucocorticoids and mineralocorticoids. Hypoglycemia, hyponatremia, hypotension, hyperkalemia, increased skin pigmentation, weakness.

Hypotension, dehydration, weakness, vomiting, diarrhea, shock, death.

Short-acting like cortisone and hydrocortisone.

Suppress inflammation, suppress immune response, treat cancers, replace adrenal hormones in adrenal hormone insufficiencies (Addison’s disease and adrenal crisis), and prevent respiratory distress syndrome in premature infants.

Penetrate the cell membrane and cause transcription of messenger RNA coded for regulatory proteins.

Suppress immune response and inflammation, decreases capillary permeability, and affect carbohydrate, fat, and protein metabolism.

Fetal adrenal hypoplasia (adrenal insufficiency)

Pharmacologic

Inhibition of prostaglandin secretion

Impair wound healing

Adrenal insufficiency (adrenal crisis)

Diuretics, beta-adrenergic agonists.

NSAIDS, ASA, alcohol.

Lowest dosage for shortest duration; switch from multiple doses to one AM dose; alternate day dosing; use of topical, inhalation or local injection instead of systemic doses.

Monitor height and weight, I&O, VS, electrolytes, CBC, cortisol, LFTs, BUN, creatinine.  Encourage an eye exam every 6 months.  Discourage breastfeeding if patient is taking more than 5mg of Prednisone per day.  Watch neonate for adrenal insufficiency if the mother was on corticosteroids during pregnancy.

Take PO steroids with food.  Limit joint movement for 1-2 days after joint injection.  Check for bruising & edema.  Taper doses.  Avoid communicable diseases.  Avoid ASA, NSAIDS, and alcohol.  Take missed doses when remembered (but do not double doses).  Encourage weight bearing exercises.