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Pharmacology III Exam I: Endocrine > Diabetic Medications > Flashcards

Diabetic Medications Flashcards

1
Q

What pancreatic islet cell are damaged in diabetes?

A

B cells that secrete insulin

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2
Q

a pancreatic cells secrete?

A

Glucagon

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3
Q

What are the actions of insulin?

A
  • Lowers BG level
  • Regulates fat metabolism
  • Regulates protein metabolism
  • Increases K+ uptake into the cells
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4
Q

When is Type I DM usually diagnosed?

A

Usually diagnosed in early childhood to early adulthood

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5
Q

What is the cause of Type I DM?

A

Caused by autoimmune destruction of the B cells of the pancreas, absolute deficiency of insulin (B islet cells)

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6
Q

What HgbA1c is diagnostic for diabetes?

A

> 6.5

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7
Q

What are some complications associated with DM?

A

Retinopathy
Nephropathy
Neuropathy
CV complications
Gastroparesis, Autonomic insufficiency

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8
Q

What are the therapeutic goals of giving insulin?

A
  • To replicate normal physiologic insulin secretion
  • To replace basal insulin (overnight, fasting and between meals)
  • To provide bolus at meal time
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9
Q

What are the rapid acting insulins?

A
  • Insulin aspart (Novolog)
  • Insulin lispro (Humalog)
  • Insulin glulisine (Adidra)
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10
Q

What is the MOA of rapid acting insulins?

A
  • Acts as natural insulin: facilitates glucose transport into cells, inhibit glycogenolysis and gluconeogensis, regulate fat and protein metabolism, increase K+ uptake in cells
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11
Q

What is the PK of rapid acting insulins?

A
  • SubQ w/in 15 minute of a meal, or IV administration
  • Onset 10-30 minutes, peak effects seen 30-90 minutes, effective up to 1-5 hours
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12
Q

What are the uses of rapid acting insulins?

A
  • Rapid-acting insulins
  • Admin to mimic mealtime release of insulin and to control postprandial glucose
  • Fast correction of elv glucose
  • Usually used in combo with longer acting insulin
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13
Q

What are the side effects of insulin?

A

Weight gain, Somogyi effect, Dawn phenomenon, hypogycemia

HA, tachycardia, vertigo, anxiety, confusion, diaphoresis, lipodystrophy, hypersensitivity

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14
Q

What are the regular short acting insulins?

A

Humulin R and Novolin R

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15
Q

What is the use of regular short acting insulin?

A
  • Short acting insulin
  • Admin to mimic mealtime release of insulin and to control postprandial glucose
  • Fast correction of elevated glucose
  • Usually used in combo with longer acting insulin
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16
Q

What is the Somogyi effect?

A

If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning.

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17
Q

What is the MOA of regular short acting insulin?

A

Acts as a natural insulin: facilitates glucose transport into cells, inhibits glycogenolysis and gluconeogensis, regulate fat and protein metabolism, increase K+ uptake in cells

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18
Q

What is the PK of regular short acting insulin?

A
  • SubQ, 30 minutes before meal, or IV admin (emergency)
  • Onset, 30 minutes- 5 hours, peak 2-3 hours, effective up to 8-12 hours
19
Q

What type of insulin is NPH Insulin Isophane (Humulin N)?

A

An intermediate acting insulin

20
Q

What are the uses for NPH Insulin Isophane (Humulin N)?

A
  • Intermediate acting insulin
  • Basal (fasting) control in type 1 or 2 diabetes
  • Usually given along with rapid or short acting insulin for mealtime control
  • DO NOT use when rapid glucose lowering is needed
21
Q

What is the MOA of NPH Insulin Isophane (Humulin N)?

A

Acts as a natural insulin: facilitates glucose transport into cells, inhibits glycogenolysis and gluconeogenesis, regulate fat and protein metabolism, increase K+ uptake in cells

22
Q

What is the PK of NPH Insulin Isophane (Humulin N)?

A
  • SubQ admin only
  • Onset 4-12 hours, peak 5.5 hours, effective up to 18-24 hours
23
Q

What are the long-acting insulins?

A

Insulin detemir (Levemir) and Insulin Glargine (Lantus)

24
Q

What are the uses of Insulin Determir and Insulin Glargine (long-acting insulins)?

A
  • Long acting insulin
  • Basal (fasting) control in type 1 and 2 diabetes
25
Q

What is the MOA of long-acting insulins?

A

Acts as a natural insulin: facilitates glucose transport into cells, inhibits glycogenolysis and gluconeogenesis, regulate fat and protein metabolism, increase K+ uptake in cells

26
Q

What is the PK for Insulin detemir (Levemir)?

A
  • SubQ admin ONLY, twice daily dosing
  • Onset 1-2 hours, peak 6-8 hours, effective up to 24 hours
27
Q

What is the PK for Insulin glargine (Lantus)?

A
  • SubQ admin ONLY, once daily dosing
  • Onset 1-1.5 hours, peak 4 hours, effective up to 24 hours
28
Q

What is the MOA of GLP-1 agonists?

A

GLP-1 receptor agonists –> promote insulin secretion, enhance satiety, decrease postprandial glucagon secretion, promote beta cell proliferation

29
Q

What drugs are GLP-1 agonists?

A

Exenatide
Liraglutide
Dulaglutide

30
Q

What is the PK of the GLP-1 agonists?

A

SubQ admin
Liraglutide: long half-life, once daily dosing
Exenatide: shorter half-life, twice daily dosing, eliminated by glomerular filtration

31
Q

What are the side effects of GLP-1 agonists?

A

N/V, diarrhea, constipation, possible pancreatitis

Exenatide: contra in severe renal impairment

32
Q

What are the Sulfonylureas?

A

Glyburide
Glipizide
Glimepiride

33
Q

What are the use of Sulfonylureas?

A

Treatment of patients who have type 2 DM that is not controlled with diet

34
Q

What is the MOA of Sulfonylureas?

A

Block ATP-sensitive K+ channels –> depolorization, Ca2+ influx, and insulin release
- Increase insulin sensitivity

35
Q

What is the PK of Sulfonylureas?

A
  • Oral admin
  • 18-24 hours DOA
  • Hepatic metabolism
36
Q

What are the side effects of Sulfonylureas?

A

Weight gain, hyperinsulinemia, hypoglycemia

37
Q

Sulfonylureas are contraindicated in who?

A

Sulfa allergy
Pregnancy

38
Q

Sulfonylureas should be used in caution in whom?

A

Hepatic and renal insufficiency, geriatric patients

39
Q

What are the meglitinides?

A

Repaglinide
Natelinide

40
Q

What are the uses of meglitinides?

A
  • Postprandial glucose regulators
  • Used infrequently
  • Should not be used with Sulfonylureas
41
Q

What is the MOA of the meglitinides?

A

Bind to distinct sites on B cells, closing ATP-sensitive K+ channels and causing insulin release

42
Q

What is the PK of meglitinidenes?

A

Oral admin prior to a meal

43
Q

What are the side effects of meglitinedenes?

A

Lower incidence of weight gain and hypoglycemia than sulfonylureas

44
Q

Meglitinedenes should be used in caution in what cohort?

A

Hepatic impairment

Pharmacology III Exam I: Endocrine (3 decks)

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