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PHARMACOLOGY > Diabetes Drugs > Flashcards

Diabetes Drugs Flashcards

1
Q

What type of substance is Insulin?

A

Hormone

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2
Q

Where in the body is Insulin made?

A

pancreatic beta cells

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3
Q

How does insulin effect blood glucose levels?

A

facilitates uptake of glucose into skeletal muscle and adipose tissue by increasing nbr of glucose transporters (GLUT 1 & GLUT 4)

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4
Q

What is the molecular structure of insulin?

A

2 amino acid chains (A&B) - 51 amino acids, 3 disulfide bonds

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5
Q

Disease: not enough insulin

A

Type I / IDDM / Juvenile Onset Diabetes

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6
Q

Disease: response to insulin not adequate

A

Type II / NIDDM / Adult Onset Diabetes

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7
Q

what condition does insulin treat other than diabetes?

A

hyperkalemia

(IV-Insulin –> dose-dependent decline in serum potassium

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8
Q

Treatment for Hyperkalemia

A 
10 units IV insulin  +
25g dextrose
lowers serum potassium by 
1 meq/L (mmol/L) w/in 10-20 min
lasts 4-6 hours
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9
Q

ECG changes from hyperkalemia

A

peaked T-waves (think peaked, potassium, Paris - Eiffel Tower)

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10
Q

Insulin production - basal rate

A

1 U/hr … up to 40 U/day

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11
Q

Insulin (endogenous) duration of action

A

30-60 min

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12
Q

Insulin - mechanisms of action

A

increase number of glucose transporters (GLUT 4) so facilitates uptake of glucose into skeletal muscle and adipose tissue

(GLUT 1 transporters respond to blood glucose levels)

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13
Q

Insulin - metabolism

A

kidney and liver - 50% 1st pass

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14
Q

IV Insulin - elimination half-time

A

5-10 min

but sustained effect b/c tightly bound to tissue receptors

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15
Q

What is the relationship between plasma insulin concentration and number of insulin receptors?

A

inverse
(e.g., high glucose levels -> high insulin levels -> down regulation of insulin receptors -> insulin resistance -> need even more insulin to overcome)

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16
Q

What is insulin made from?

A

Now: manufactured by recombinant DNA technology

Before: extracted from beef & pork (good not any more –> reduces chance of allergy)

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17
Q

Categories of insulin (by duration of action)

A

Rapid-acting (Lispro)
Short-acting (regular - CZI - crystalline zinc insulin)
Intermediate-acting (Isophane: NPH)
Long-acting (Ultralente)

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18
Q

What type of insulin do we use in the OR?

A

Short-acting (regular)
(e.g., Humulin or Novolin)

Only IV insulin (can also be given subQ)
From pork, beef, human, or genetically engineered w/ E. coli

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19
Q

Short-acting Insulin onset/duration

A

Onset 30-60 min

Duration 6-8 hours

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20
Q

Names for Intermediate-acting Insulin

A

Isophane Insulin Suspension =

Neutral Protamine Hagedorn (Humulin-N and Novolin-N)

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21
Q

Where does the protamine in NPH come from?

A

Salmon sperm

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22
Q

Intermediate-Acting Insulin onset/duration

A

Onset 1-2 hours

Duration 10-16 hours

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23
Q

Name(s) for long-acting insulin

A

Ultralente

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24
Q

Why is Ultralente Insulin long-acting?

A

Large particle size and crystalline form

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25
Q

Basic approach to taking insulin daily

A

maintain basal level, plus rapid-acting at meal times if necessary

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26
Q

1 U Insulin - effect on blood glucose

A

1 U insulin lowers blood glucose 25-30 mg/dL

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27
Q

Formula for insulin dosage in OR

A

Units/hr = (glucose/150)

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28
Q

After giving insulin in the OR, how long to wait before testing blood glucose?

A

30 min

29
Q

Most common basal insulins patients take

A

Lantus (glargine ~24 hrs)

Levemir (detemir ~18 hrs)

30
Q

Side effects of insulin

A 
Hypoglycemia
Allergic reactions
Lipodystrophy
Resistance
Drug Interactions
31
Q

Most serious side effect of hypoglycemia

A

Irreversible brain damage

32
Q

Initial symptoms of hypoglycemia

Other symptoms

A

Initial: diaphoresis, tachycardia, hypertension

Other:
Rebound hyperglycemia
CNS symptoms
Treatment options

33
Q

Insulin - drug interactions

A

Epinephrine (inhib. secretion of insulin)
MAO Inhibitors (potentiate hypoglycemic effects)
Antibiotics (Tetracycline) (increase duration and can cause hypoglycemia)
Salicylates

34
Q

Categories of oral drugs for treatment of NIDDM

A

Sulfonylureas
Meglitinides
Biguanides
Aloha-Glucosidaise Inhibitors

35
Q

Sulfonylureas (oral hypoglycemic) - mechanism

A

stimulate release of endogenous insulin

so only for Type II - Type I can’t be stimulated

36
Q

Sulfonylureas - risk

A

hypoglycemia

37
Q

Sulfonylureas - example

A

Glyburide

38
Q

Meglitinides - mechanism

A

stimulate insulin secretion

39
Q

Meglitinides - risk

A

hypoglycemia

40
Q

Meglitinides - example

A

Repaglinide

41
Q

Biguanides - mechanism

A

inhibit glucose production by liver

42
Q

Biguanides - example

A

Metformin

43
Q

Metformin - what type of rug

A

Biguanide

44
Q

Glyburide - what type of drug

A

Sulfonylurea

45
Q

Alpha-Glucosidase Inhibitors - mechanism

A

slow digestion and absorption of carbohydrates

46
Q

Alpha-Glucosidase Inhibitors - example

A

Arcabose

47
Q

Glyburide - don’t give to patient allergic to:

A

sulfa drugs

it’s a Sulfonylurea, derivative of sulfonamide.

48
Q

Sulfonylureas - Pharmacokinets

A

GI absorption
Protein binding (90-95%)
Metabolism: Liver (renal excretion)

49
Q

Side effects of sulfonylureas

A

hypoglycemia, esp. w/long acting

50
Q

Fetal effects of sulfonylureas

A

cross placenta - can cause fetal hypoglycemia

51
Q

Glyburide (Micronase)

  • which generation sulfonylurea
  • duration
A

2nd generation

stimulates insulin over 24 hours

52
Q

Glipizide (Glucotrol)

  • which generation sulfonylurea
  • duration
A

2nd generation

stimulates insulin over 12 hours

53
Q

When to use Metformin

A

When sulfonylurea treatment has failed

54
Q

Advantage of biguanides in treatment of NIDDM

A
  • decrease in blood glucose with very low risk of hypoglycemia
  • positive effect on blood lipids - may lead to some weight loss
55
Q

Risk w/biguanides in treatment of NIDDM

A

severe lactic acidosis

56
Q

Metformin (Glucophage) - metabolism

A

100% renal clearance (unchanged - no hepatic metabolism)

Use cautiously (or not at all) with renal failure)

57
Q

Metformin (Glucophage) - mechanism of action

A

lowers blood glucose

(inhibits hepatic gluconeogenesis, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization)

58
Q

Arcabose - type of drug

A

Intestinal glycosidase inhibitor

59
Q

Arcabose - mechanism

A

decreases carbohydrate digestion and absorption

60
Q

Arcabose - benefits

A
  • NO hypoglycemia

- can be used with insulin

61
Q

Blood glucose level for surgery

A

180 (closer to 120 if possible)

62
Q

How much insulin should patient take morning of surgery?

A

Half dose

63
Q

Infusion level for Insulin

A

BG/150 = Units/hr

64
Q

Add what when administering insulin?

A

10 - 20 meq KCL to each liter of IV fluid (to avoid hypokalemia)

65
Q

Should patients take oral hypoglycemic agents morning of surgery?

A

No

66
Q

When to discontinue oral hypoglycemics before surgery?

A

24-48 hours

67
Q

Target blood glucose to maintain during surgery

A

150-180 mg/dL

68
Q

Cardiac risk w/diabetic patients

A

occult cardiac disease (don’t get angina because of de-innervation around heart)

69
Q

Test to determine long-term blood glucose control (and therefore cardiomyopathy and heart failure)

A

Hb A1C
Normal 5
7 or below = good
8-10 poor control

PHARMACOLOGY (5 decks)

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