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Pharmacology > Diabetic pharmacology > Flashcards

Diabetic pharmacology Flashcards

1
Q

Name the insulin analogues

A

Lispro
Aspart
Glulisine

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2
Q

What is the onset of Lispro, Aspart and Glulisine

A

15 min

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3
Q

What is the Peak of Lispro, Aspart and Glulisine

A

0.5- 1.5 hrs

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4
Q

What is the Duration of Lispro, Aspart and Glulisine

A

3-5 hrs.

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5
Q

What is the onset of human insulin

A

0.5-1 hr

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6
Q

What is the Peak of human insulin

A

2-3 hrs

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7
Q

What is the duration of human insulin

A

5-8 hrs

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8
Q

What is the onset human NPH/Lente

A

1-3 hrs

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9
Q

What is the peak of human NPH/Lente

A

4-8 hrs

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10
Q

What is the duration of human NPH/Lente

A

8-20 hrs

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11
Q

What is the onset of human ultralente

A

4-8 hrs

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12
Q

What is the Peak of ultralente

A

8-12 hrs

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13
Q

What is the duration of ultralente

A

18-36 hrs

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14
Q

What is the onset of glargine, determir

A

1-2 hrs

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15
Q

What is the peak of glargine, determir

A

Flat

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16
Q

What is the duration of glargine, determir

A

24 hrs

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17
Q

Name the 2nd generation sulfonylureas

A

Glyburide
Glipizide
Glimepiride

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18
Q

What is the MOA of the sulfonylureas

A

stimulates insulin secretion from pancreatic islet beta cells

  • Inhibits SUR1 ATP-sensitive potassium channels on beta cells
  • Does NOT decrease insulin resistance
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19
Q

Thiazide diuretics have what effect on sulfonylureas

A

excretes it from blood

*Must increase the dose of sulfonylurea

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20
Q

Renal disease has what effect on sulfonylureas

A

decreases elimination

21
Q

Meglitinides are the newer oral diabetic agents and include which drugs

A

“NIDEs”
Repaglinide
Netaglinide
Miglitinide

22
Q

What is the MOA of Meglitinides

A

Stimulates insulin secretion from beta cell

*Same MOA as sulfonylurea but peaks in 1 hour and shorter DOA of 4 hours

23
Q

Meglitinides are active ONLY

A

in the presence of glucose

*less risk of hypoglycemic episodes

24
Q

What is the major Biguanides

A

Metformin

25
Q

What is the MOA of metformin

A

Decrease hepatic glucose production
Decreases absorption from gut
Increases insulin sensitivity in skeletal muscles and adipose tissue

*Does NOT stimulate insulin secretion

26
Q

What are the adverse effects associated with metformin

A

Hypoglycemia (rare)
Diarrhea (20%)
Lactic acidosis

27
Q

Why does metformin cause lactic acidosis

A

Blocks mitochondrial membranes preventing mitochondria from converting pyruvate to acetyl-CoA and oxidation

28
Q

What are alpha glucosidase

A

enzymes that breakdown starch and dissacharides into glucose

29
Q

What are the a-Glucosidase inhibitors

A

Acarbose
Miglitol
Voglibose

30
Q

Where do a-Glucosidase inhibitors exert their effects in the body

A

On the enzymes in intestinal brush border

31
Q

What are a-glucosidase inhibitors used for

A

to prevent post-prandial hyperglycemia

32
Q

What are the PPAR gama-agonists

A

“litazones”

33
Q

Why were the PPAR gama-agonists pulled off the market

A

Cause CHF, MI

34
Q

What is amylin

A

a polypeptide cosecreted with insulin from the pancreatic beta cells responsible for slowing gastric emptying, suppressing glucagon, and promoting satiety

35
Q

What drug mimics amylin

A

Pramlintide

36
Q

Amylin is —— in diabetics

A

deficient

37
Q

What are incretins

A

a group of GI hormones that stimulate insulin release and inhibits glucagon release with net effect of lowering blood glucose

*Glucagon-like polypeptide-1 (GLP-1)

38
Q

What inactivates incretins

A

DPP-4

39
Q

What are the drugs designed to MIMIC incretins

A

Liraglutide
Exenatide
Taspoglutide

40
Q

GLP-1 activity is similar to amylin activity in what three ways

A

Suppresses glucagon secretion from pancreatic alpha cells

slows gastric emptying

Promotes satiety

41
Q

What are the two additional MOA of GLP-1 that distinguishes it from the amylins

A

Improves insulin sensitivity

Stimulates insulin secretion from pancreatic beta cells

42
Q

Exenatide does what to the hemoglobin A1c levels

A

decreases it by 1%

43
Q

Exenatide does what for weight

A

decreases by 2.5 kg or 5 lbs

44
Q

exenatide is associated with what disease

A

acute pancreatitis

*don’t give to patients with severe abdominal pain radiating to back and vomiting

45
Q

What is DPP-4

A

The enzyme that inactivates incretins

46
Q

What are the DPP-4 inhibitors

A

“…gliptins”

47
Q

What are the concerns with Vildagliptin

A

Skin lesions
Bowel CA
Lung CA

48
Q

What is Sodium Glucose Transporter 2 (SGLT-2)

A

Receptors found on proximal kidney tubules that reabsorb glucose from ultrafiltrate regardless of hyperglycemia

49
Q

What are the SGLT-2 inhibitors

A

“…liflozin”

Pharmacology (27 decks)

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