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Endo > Diabetes Pharm > Flashcards

Diabetes Pharm Flashcards

1
Q

Unusual/future insulin therapies (2)

A
  1. pancreatic/islet cell transplant
  2. Inhaled insulin
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2
Q

Type 1 diabetic is hungry and hasn’t taken any insulin. How long must he wait after taking rapid-acting insulin?

A

Inject rapid-acting insulin 10 minutes before eating.

rapid acting: 10 min onset of action

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2
Q

Insulin side effects:

-systemic (4)

A
  1. hypoglycemia
  2. insulin allergy
  3. insulin edema (peripheral edema 1st few week of taking insulin)
  4. weight gain (insulin is anabolic)

also, atherosclerosis and cancer risk are theoretic side effects at high does

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3
Q

Describe example of 2 shot insulin regimen for T2DM

A

70/30 insulin SQ qAM

70/30 insulin SQ qPM

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3
Q

Standard diabetic goals with insulin therapy:

  1. fasting glucose
  2. post-prandial glucose 2 hours after meal
  3. A1C
A
  1. 70-130 mg%
  2. <180 mg%
  3. <7%
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3
Q

Sulfonylureas

  • drug names (3)
  • mech of action
  • side effects
A

Glyburide, glimepiride, glipizide

Mech: binds to K+ channel on beta islet cell, closing it. This depolarizes the cell, causing Ca+ influx and therefore release of insulin.

-side effects: hypoglycemia. Disulfuram-like reaction in older 1st gen drugs.

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4
Q

SGTP-2 inhibitors

  • drug name
  • mech
  • side effects (2)
A

Sodium-glucose transport protein inhibitor

  • Canaglifozin
  • Inhibits the transport proteins that reabsorb glucose in the kidney, resulting in increased glucose urinary loss
  • side effects:
    1. yeast infections (b/c of glucose in bladder)
    2. dehydration (osmotic diuresis)

very new drug

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5
Q

Short acting insulin

  • drug name
  • bonus: brand names
A
  • Regular insulin
  • Humulin R, Novolin R
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6
Q

Which 3 diabetes drug classes are the most effective at lowering A1C

-what is their average A1C decrease effect?

A
  1. biguanides (metformin)
  2. sulfonylureas (glipizide, glyburide, glimepiride)
  3. glitazones (pioglitazone, rosiglitazone)
    - All lower A1C by average 1.5 %
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7
Q

Long acting insulin

  • drug names (2)
  • bonus: brand names
A
  1. Glargine (Lantus)
  2. Detemir (Levemir)

Pirate says “Glaar” and has long-lasting “Debts”

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7
Q

GLP-1 analogues

  • drug names (2)
  • mech
  • side effects
A
  • exenatide, liraglutide
  • mimic GLP-1 (glucagon-like peptide), which is secreted in response to eating to stimulate insulin release
  • side effects: pancreatitis, nausea/vomting
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7
Q

Treating T2DM: it’s common to Rx a combination of 2 drugs

  • Why is this?
  • example combos
A

Rx combo of A) drug that increases insulin and B) drug that increases insulin sensitivity

A) sulfonylurea

insulin

GLP-1 analog/DPP-4 inhibitor

B) metformin

glitazone

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8
Q

Describe example of basal-bolus insulin regimen in T1DM pt with insulin pump

-what type of insulin does pump have?

A

Pump has rapid-acting insulin so it’s easy to adjust onset/duration

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9
Q

You see an insulin vial with cloudy, not clear liquid

-what is it

A

NPH Insulin

  • it’s a cloudy, colloidal suspension
  • Pt must mix it before injecting
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10
Q

Intermediate acting insulin:

  • drug name
  • bonus: brand names
A
  • NPH
  • Humulin N, Novolin N
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11
Q

Which insulins can be used IV, which are SubQ?

A

Only regular insulin can be used IV.

Everything can be used SubQ

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12
Q

Insulin side effects

-local to injection site (2)

A

Local to SubQ sites:

  1. lipoatrophy
  2. lipohypertrophy (insulin is anabolic for fat)

This is why you rotate injection sites

14
Q

Insulin categories (4)

-also list the specific insulin analog names

A
  1. rapid acting
    - lispro, aspart
  2. short acting
    - regular
  3. intermediate acting
    - NPH
  4. long acting
    - glargine, detemir
15
Q

DPP-4 inhibitors

  • drug name
  • mech
A
  • Sitagliptin
  • blocks protease that degrades GLP-1, prolonging GLP-1 action of stimulating insulin release
17
Q

Intermediate acting insulin

  1. onset
  2. peak
  3. duration
A

NPH insulin

O: 1-2 hrs

P: 4-12 hrs

D: 18-26 hrs

17
Q

Describe example of basal-bolus insulin regimen in T1DM

A

Glargine SQ at bedtime

Aspart SQ TID pre-meal 10 minutes

18
Q

Long acting insulin, Detemir

  1. onset
  2. peak
  3. duration
A

Detemir

O: 4 hrs

P: 6-14 hrs

D: 24 hrs

19
Q

Rapid acting insulin:

  • drug names (3)
  • bonus: brand names
A
  1. lispro (humalog)
  2. aspart (novolog)
  3. glulisine (apidra)
20
Q

Short acting insulin

  1. onset
  2. peak
  3. duration
A

Regular insulin

O: 30 min

P: 2-5 hr

D: 6-8 hrs

21
Q

How are insulin analogs different chemically from regular insulin?

A

Insulin analogs have changes in the amino acid sequence to alter timing/duration of action

22
Q

Which insulin has no peak time of action?

A

Glargine (Lantus) long acting

Onset: 4-6 hrs

Duration 24-36 hrs

24
Q

Short acting insulin:

  1. onset
  2. peak
  3. duration
A

lispro, aspart, glulisine

O: 10 min

P: 45 min

D: 2 h

25
Q

Glitazones (thiazolidinediones)

  • drug names (2)
  • mech
  • major side effects (3)
A
  • rosiglitazone, pioglitazone
  • increase insulin sensitivity in peripheral target tissues. Binds PPAR-gamma nuclear transcription regulator to increase GLUT4 in tissues.
  • side effects:
    1. hepatotoxicity
    2. weight gain
    3. edema
26
Q

Why is rapid-acting insulin better than regular insulin for a meal?

A
  1. quicker onset of action prevents immediate hyperglycemia (10 min vs 30 min)
  2. shorter duration prevents postprandial hypoglycemia (2 hrs vs 6-8 hrs)
27
Q

Long acting insulin, Glargine

  1. onset
  2. peak
  3. duration
A

Glargine

O: 4-6 hrs

P: none

D: 24-36 hrs

29
Q

What is a side of insulin that can occur during the first few weeks of starting insulin?

A

Insulin Edema–peripheral edema occurs only in pts that just started insulin

30
Q

Describe example of 3-shot insulin regimen for T2DM

-why would pt prefer this instead of 2-shot regimen?

A

NPH and Regular SQ qAM

Regular SQ qPM

NPH SQ bedtime

-Injecting NPH later at bedtime allows insulin to be effective at breakfast time

30
Q

You diagnose a pt with T2DM and he also has renal insufficiency. What drug to avoid?

A

Metformin (biguanide)

-risk of fatal lactic acidosis in pts with renal insufficiency

31
Q

Name the classes of diabetes drugs (not including insulin):

(7)

A

Sulfonylureas

Biguanides

Glitazones (thiazolidinediones)

alpha-Glucosidase inhibitors

GLP-1 analogues

DPP-4 inhibitors

SGTP-2 inhibitors

33
Q

Which diabetic drug class is the only one without hypoglycemia side effect?

A

Biguanides (metformin)

-it decreases gluconeogenesis

36
Q

Insulin premixed:

which drugs are in the mixture?

  1. 70/30
  2. 50/50
  3. 75/25
A

intermediate mixed with short/rapid acting

  1. NPH/reg

2 NPH/reg

  1. NPH/lispro
37
Q

Alpha-glucosidase inhibitors

  • drug name
  • mech
  • side effects
A
  • acarbose
  • inhibits intestinal brush-border enzymes that break down carbs, resulting in partial malabsorption of carbs.
  • side effects: bloating, gas, diarrhea–from bacterial fermentation of carbs
38
Q

Insulin detemir

-how does it achieve long-acting ability?

A

Detemir self-associates (binds to itself) in the SubQ injection site and also binds to albumin in the bloodstream

39
Q

Biguanides

  • drug name
  • mech
  • side effects (2)
A
  • metformin
  • decreases liver gluconeogenesis (liver is more sensitive to insulin)
    1. GI effects (abdominal discomfort, diarrhea)–common
    2. Lactic acidosis–rare, fatal. Don’t prescribe to pts with renal insufficiency
40
Q

Insulin glargine

-how does it achieve long-acting ability?

A

Glargine is soluble at pH4 but poorly soluble at pH7. Thus, when injected subQ, it precipitates in the interstitial fluid and slowly mobilizes from the depot site.

41
Q

Rapid-acting insulin

-how do they achieve rapid-acting ability?

A

Insulin has a tendency to form hexamers in solution. Breakdown takes time.

Rapid-acting insulin more rapidly forms monomers from hexamers

Endo (18 decks)

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