DM

Question 1

Lispro/Humalog

Answer 1

ultra short acting. only one approved for pump use. onset of axn: 15-30 min, give w/in 15 min or right after meals. peak axn: 30 min-2.5 hr. duration of axn: 3-6.5 hrs.

Question 2

Aspart/Novolog

Answer 2

short-acting, rapid onset of axn. onset of axn: 10-20 min, give 5-10 min before meals. peak: 1-3 hrs. DOA: 3-5 hrs.

Question 3

Insulin glulisine/Apidra

Answer 3

short-acting. rapid onset of axn. onset of axn: 10-15 min, give w/in 15 min or right after meals. peak: 1-1.5 hrs. DOA: 3-5 hrs.

Question 4

Regular Insulin/ Humulin R/ Novolin R

Answer 4

short-acting. onset: 30 min-1hr. peak: 2-3 hrs. DOA: 4-6 hrs. only insulin that can be admin’d IV.

Question 5

NPH/ Novolin N/ Humulin N

Answer 5

intermediate acting. onset: 1-2 hrs. peak: 6-14 hrs. DOA: 16-24 hrs.

Question 6

Insulin glargine/ Lantus

Answer 6

long-acting. onset: clinical effect ~1hr after inj. peak: none. DOA: >/= 24hrs.

Question 7

Insulin determir/ Levemir

Answer 7

long-acting. onset: unkn, but appears to be ~ 1-2hrs from PK graphics. peak: 6-8 hrs. DOA: dose dependent.

Question 8

sulfonylureas 1st generation.

Answer 8

chlorpropamide (diabinese), tolazamide (tolinase), tolbutamide (orinase).

Question 9

sulfonylureas 2nd generation.

Answer 9

glipizide (glucatrol), glyburide (diabeta, micronase, prestabs), glimepiride (amaryl).

Question 10

non-sulfonylurea beta cell stimulator

Answer 10

meglitinide (prandin)

Question 11

sulfonylurea & non-sulfonylurea drugs

Answer 11

beta cell stimulator. insulin secretagogue. effective only in pt’s w/ fxning pancreas (insulin resistance). Primary AE: hypoglycemia esp in impaired renal fxn or hepatic fxn. use w/ caution in pt’s w/ sulfa all.

Question 12

biguanides= metformin (glucophage)

Answer 12

insulin sensitizer via inc’d peripheral glucose uptake & utilization. 1st line tx. reduces hepatic glucose production & intestinal glucose absorption. contraind. in impaired renal fxn. hypoglycemia not an issue. monitor Cr- do NOT initiate or cont w/ impaired renal fxn (general >1.5males, >1.4females). avoid use in HF. AE: GI in nature (n/v, diarrhea, abd bloating, metallic taste)- effects usually transient & resolve w/ cont’d use. rare risk of lactic acidosis.

Question 13

Alpha-glucosidase inhibitors

Answer 13

Acarbose (Precose), Miglitol (Glyset)

Question 14

alpha-glucosidase inhibitors

Answer 14

delays intestinal carb absorption by reducing post prandial* digestion of starches & disaccharides via enzyme axn inhibition. inhibits enzyme ___ in GI tract. ‘starch blockers.’ cause wt loss to a degree. indicated for obese diabetics but contraind. in pt nl wt. AE: diarrhea, abd pain, & gas. taken w/ 1st bite of meal. avoid use in IBD & impaired renal fxn.

Question 15

Thiazolidinediones (TZDs or glitazones)

Answer 15

Pioglitazone (Actos), Rosiglitazone (Avandia)

Question 16

TZDs or glitazones

Answer 16

inc insulin sensitivity by inching # of receptor sites, inc’d receptor sensitivity, & enhance glucose uptake. axn at PPAR-y receptors found in muscle, adipose, & other tissue. makes you use insulin better- hypoglycemia not an issue. onset: up to 12 wks for full effect. favorable lipid axn- inc’s HDL, dec triglycerides. edema risk inc’s when use w/ insulin or SU. monitor liver fxn- if ALT rises >3x upper limit, d/c.

Question 17

Incretin Mimetic/ Glucagon-like peptide (GLP)-1 agonist

Answer 17

Exenatide (Byetta, Bydureon), Liraglutide (Victoza). inj only

Question 18

incretin mimetic/ GLP-1 agonist

Answer 18

stim insulin production in response to inc in plasma glucose. dec’s post meal glucose output (by dec’ing glucagon secretion), inc’s satiety, regulates gastric emptying (inhibits glucagon release postprandial). slows gastric emptying, often leading to appetite suppression & wt loss. peaks 2 hrs after SC admin. hypoglycemia when given w/ sulfonylurea but not alone or w/ other hypoglycemics. SE: GI (n/v, diarrhea). excreted renally- contraind. in renal impairment. admin’d SC before 2 lg’est meals of day.

Question 19

Dipeptidyl peptidase-4 (DPP-4) inhibitor

Answer 19

Sitagliptin (Januvia), saxagliptin (onglyza), linagliptin (tradjenta)

Question 20

DPP-4 inhibitor

Answer 20

inc’s levels of incretin, inc’ing synthesis & release of insulin from pancreatic beta cells & dec’ing release of glucagon from pancreatic alpha cells. inhibits inactivation of incretin in the stomach (incretin stim insulin production, dec’s hepatic glucose production. axn is glucose depending. AE: nasopharyngitis, HA. excreted renally- monitor kidney fan, contraind in renal failure. monitor for pancreatitis.