DM/ Insulin drugs

Question 1

Lispro Insulin

Answer 1

Type I DM
Insulin Analog (Short & Rapid Acting)…
prevents self-aggregation, thus immediately absorbed

Uses: Prior to meal (guard against postprandial hyperglycemia) & currently in insulin pumps

Primarily pump, but can be pen or injection

Question 2

Regular Insulin

Subcutaneous or IV (possibly inhaled)

Answer 2

Type I DM
Human Insulin (short & relatively rapid acting)
aDsorbed ( meaning attached to outside of zinc crystal)

Uses: Diabetic Ketoacidosis/ Perioperative Management(surgery)/ Inhaled insulin (resp malfxn will effect its absorption)

Adverse Effect: Cough/ contra. in smoker & patients with chronic lung disease

Question 3

Neutral Protamine Hagedorn (NPH)/ Isophane Insulin

Subcutaneous Injection

Answer 3

Type I DM

Digestion of protamine to release insulin (slow release … long acting)

Question 4

Glargine Insulin (ex. Lantus)

Subcutaneous Injection

Answer 4

Type I DM
injected in neutral pH (soluble at ph4) / aggregates after injection
Provides a dependable, sustained release

Question 5

Metformin (First drug used)

Answer 5

Type 2 DM
Biguanides (Insulin Sensitizer)

Activate AMPK (AMP-activated protein kinase) to decrease hepatic gluconeogenesis & glycogenolysis

GOOD Adverse effects: decreases serum triglycerides

Question 6

Rosiglitazone

Answer 6

Type 2 DM
Thiazolidinediones (Insulin Sensitizer)

PPAR agonist-heterodimerizes w/RXR receptor activating insulin responsive genes … decreasing insulin resistance

Primarily acts on fat …

Question 7

Glimepiride

Glyburide

Answer 7

Type 2 DM
Sulfonylureas (Insulin Releasers)/
Glucose INDEPENDENT

Binds & Inactivates SUR1 (sulfonyurea receptors)- increasing efflux of K->depolarization-> increasing release of insulin

Adverse Effect: Hypoglycemia

Question 8

Exenatide (Original-short lasting)

Injected

Answer 8

*Type 2 DM*
Incretin Mimic (Insulin Releaser)/ glucose DEPENDENT

GLP-1 receptor agonist increase insulin (suppress glucagon, slows gastric emptying, decrease appetite)

Uses: Monotherapy with diet & exercise or combination

Adverse effects: NONE b/c glucose dependent

Question 9

Liraglutide (Analog- last longer)

injection

Answer 9

*Type 2 DM*
Incretin Mimic (Insulin Releaser)

GLP-1 receptor agonist to increase insulin (bound to albumin until released)

Slow release, longer half life

Question 10

Acarbose

Answer 10

Type 2 DM
Alpha-Glucosidase

Blunt postprandial rise in plasma glucose by Inhibiting alpha glucosidase thus inhibits breakdown of starch or oligosaccharides (slows down intestional carb absorption)

Adverse effects: not used much due to MAJOR GI effects