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Pharmacology 2 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

From where is insulin secreted and stored?

A

B islet cells of pancreas

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2
Q

What are the 2 ways to make insulin?

A
  • enzymatic modification to porcine insulin

- recombinant technology with E. Coli

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3
Q

Less allergic reactions with which type of insulin?

A

Recombinant

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4
Q

Insulin activates ____ and ___, converts glucose to ____, and enhances ___ and ____ entry into cells

A

glucokinase and glucose phosphatase
glycogen
AA and potassium

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5
Q

When insulin is administered, what happens to serum K levels?

A

decrease

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6
Q

how much insulin per day?

A

1 unit / kg / day

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7
Q

Name 6 drugs that cause hyperglycemia

A
  • Glucagon
  • Oral contraceptives
  • Epinephrine
  • Steroids
  • Thyroid hormones
  • Diuretics
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8
Q

What time of molecule is insulin? Why is this significant?

A

peptide (protein) so denatures upon PO administration

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9
Q

human insulin is ____ rapidly absorbed compared to animal sources

A

more

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10
Q

Human insulin is ____ immunogenic compared to animal sources

A

less

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11
Q

What is the immediate insulin? 3 types, significance, onset, best usage, benefit?

A

Lispro, aspart, glulisine
immediately decreases blood sugar
closely resembles normal insulin
replaced “regular” insulin
15 minute onset, lasts 4 hours
Good for pump (not injection, you’d be injecting all the time!)
Flexibility in eating, can give right before meal

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12
Q

What is the short insulin?

A

Regular insulin

Takes ~2 hours to work, last 8

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13
Q

What is the intermediate insulin?

A

NPH insuin
lasts 12 hours
inject at 7am, covers lunch and dinner
does not cover breakfast, slow on slow off

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14
Q

What is the long insulin?

A

Glargina, Detemir
Injected once, lasts 24 hours.
Hard to get dose right, patient must be very stable

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15
Q

What is standard insulin amount in a mL?

A

100 units (VERY CONCENTRATED)

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16
Q

Describe the intensive prescribing approach

A

multiple daily injections of SHORT (lisper, apart, glulisine) acting agents with a long acting at bedtime

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17
Q

Describe the conventional prescribing approach

A

two injections of biphasic (70/30 ) with short acting agents PRN.

Usually give 75% of the units in AM, 25% of the units in PM.

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18
Q

If patient requires 40 units of insulin per day, and want to give 75% am 25% pm, calculate units for each dose

A

75% in AM = 30 units
25% in PM = 10 units

.7(30) = 21u NPH or detemir
.3(10) = 3u regular or lispro
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19
Q

Describe the all day prescribing approach

A

single long acting (glargine or determir) injection covered by lispro

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20
Q

DM 30 require __

A

insulin (almost always)

1/3 diet, 1/3 insulin, 1/3 PO agents

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21
Q

T OR F

Two long acting insulins should be mixed

A

FALSE

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22
Q

T OR F

Shorter acting agents may be mixed in one syringe and used immediately

A

True

23
Q

T OR F

Only non-suspended insulin products should be administered by IV gtt

WHY?

A

TRUE

long acting agents are suspensions, which will separate and precipitate

24
Q

How many days can you keep insulin out of the refrigerator?

A

30 days

25
Q

Why can’t you shake insulin?

A

proteins denature and foam

26
Q

Infections cause hyperglycemia. how do we manage this?

A

20-50% increase in insulin requirements

27
Q

How do we treat pregnant patients?

A

switch to insulin generally, it does not cross placenta

28
Q

What is the risk with of beta blockers?

A

mask hypoglycemia

decreases headaches, tremors, heart rate

29
Q

Name 4 symptoms of hypoglycemia

A

tremor
headache
malaise
tachycardia

30
Q

name the 4 classes of oral agents

A
  • sulfonylureas
  • biguanides
  • thiazolidinediones
  • SGPT-2 inhibitors
31
Q

Some patients taking sulfa antibiotics are at risk of developing ____

A

hypoglycemia

32
Q

How do sulfonylurea drugs work?

A

Block ATP-sensitive potassium channels on B-islet cells resulting in the release of stored insulin

33
Q

Sulfonylurea treat hyperglycemia by what?

A

enhancing the insulin effects on hepatic, adipose, and muscle tissue

1) stimulating release
2) increasing sensitivity to insulin

34
Q

Why only use sulfonylurea to treat type 2?

A

requires 30% pancreatic function

35
Q

How are sulfonylureas metabolized?

A

renally, highly PPB so interact with other PPB drugs

36
Q

How do biguanides work? (2 reasons)

A

1) reduction in hepatic glucose production

2) ineffective in the absence of insulin

37
Q

What biguanide was removed from market?

A

Phenformin, fatal lactic acidosis

38
Q

What is the main biguanide? What should you remember taking it?

A

Metformin, eat with food

39
Q

Contraindications for biguanide agents?

A
  • renal dysfunction, serum creatinine levels must be checked (1.4 or 1.5)
  • hepatic dysfunction
  • cardiogenic/septic shock, and pregnancy
  • iodine contrast dye (hold meds 24-48 hours)
40
Q

How do thiazolidinediones work?

A

Reduce peripheral insulin resistance and sensitize the patient to insulin

41
Q

How effective are thiazolidinediones? What is their other name?

A

Not very, use as 2nd line to BGs and SU

“Glitazones”

42
Q

What are contraindications and risks of thiazolidinediones?

A

Peripheral edema and weight gain, also patients with hepatic or heart failure

43
Q

Meglitinides are similar to what? give 2 specific types

A

Short acting secretagogues similar to sulfonylureas.

Repaglinide
Nateglinide

44
Q

What is Eventide? What does it do? How is it administered?

A

Byetta
- a functional analogue of GLP-1
- it enhances insulin secretion and delays gastric emptying
used with another agent (adjunct therapy)
- Given SQ before AM and PM meals

45
Q

Name 3 GLP-1 agonists. Why BBW?

A

Liraglutide (Victoza)
Albiglutide
Dulaglutide
- thyroid C-cell tumors

46
Q

How does a DPP-4 inhibitor work?

A

prevents metabolism of GLP-1 (which is what DPP-4 does)

example- Vildagliptin

47
Q

How does Acarbose work?

A

reduces digestion of carbs in the gut, causes diarrhea and flatulence

48
Q

How does Miglitol work?

A

reduces digestion of carbs in the gut, diarrhea and flatulence result

49
Q

How does Pramlinitide work?

A

Synthetic amylin analogue with a longer T1/2.

  • enhances effects of insulin, so must be employed with insulin (adjunct)
  • SQ dose just prior to large meals
  • nausea is A/E
50
Q

What is amylin?

A

co-secreted with insulin, reduces post-prandial glucagon secretion and slows gastric emptying, reduces caloric intake

51
Q

Name the main SGPT-2 Inhibitor. How does it work?

A

Canagliflozin

Inhibits sodium-glucose co-transporter 2, so you waste urinary glucose (pee it out)

52
Q

Name 2 side effects of SGPT-2 Inhibitors

A

polyuria

polydipsia

53
Q

What is A/E of Canagliflozin?

A

Yeast infections, UTIs, balantisis, increased LDL

Osteoporosis & Osteopenia (since waste Ca as well)

54
Q

What is diabetic ketoacidosis? TX?

A

Emergency situation of hyperglycemia
Insulin gtt @ .5-10 u/hour titrated to q1-2 hours FS to 60
(Lispro or regular insulin, not suspended or long-acting)

  • Potassium and phosphate replacement since glucose enters cells with K and stored as G6P

Pharmacology 2 (8 decks)

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