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Pharmacology > Endocrine 1 > Flashcards

Endocrine 1 Flashcards

1
Q

Insulin MOA

A

Glucose diffusion into cells, gluc storage (glycogen), uptake (AA, K, Mg), protein synthesis/inhib proteolysis, inc FA and TG synthesis (dec lipolysis), reg DNA gene expression

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2
Q

What ANS does to insulin secretion

A

Alpha decreases it. Beta and PNS increase it. Under stress- release more insulin.

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3
Q

Ultra rapid insulin 3

A

Lispro (humalog)
Aspart (novolog)
Glulisine (apidra)

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4
Q

Short acting insulin

A

Regular

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5
Q

Intermediate acting insulin

A

NPH, sensitive to protamine

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6
Q

Long acting insulin

A

Glargine (Lantus)
Detemir (levemir)
Ultralente

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7
Q

Which insulin doesn’t have a peak

A

Long acting

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8
Q

Peaks for
Short- fastest
Short- slower

A

1-2 hrs

4-5 hrs

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9
Q

Peak for intermediate acting

A

6-8 hrs

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10
Q

Dont mix what with any other insulin

A

Glargine, not compatible

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11
Q

IV regular insulin
E 1/2 t
Duration

A

5-10 min

30-60 min

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12
Q

Only regular insulin we should use iv

A

U 100

100 u per ml

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13
Q

Lispro insulin
Onset
Peak
Duration

A

10-15 min
30 min-1 hr
3-5 hrs

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14
Q

Regular insulin
Onset
Peak
Duration

A

30-60 min
1-5 hrs
5-9 hrs

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15
Q 
NPH 
Onset 
Peak 
Duration 
Use
A

1-2 hrs
6-10 hrs
16-20 hrs
Basal insulin, overnight

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16
Q 
Glargine 
Onset 
Peak 
Duration 
Use
A

2-6 hrs
No peak
24 hrs
Basal, overnight

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17
Q

Danger if hypoglycemia from inadequate carb intake w insulin symptoms

A

Sweaty, tachycardia, htn, cns agitation, seizures, coma

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18
Q

Which drugs oppose hypoglycemic effects of insulin 3

A

Acth, glucagon, and estrogens

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19
Q

Which drug decreases release of insulin and stim mobilization of glucose

A

Epi

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20
Q

DOA of insulin prolonged by which 3 drugs

A

Tetracycline, chloramphenicol, salicylates

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21
Q

MAOIs do what to insulin

A

Can increase hypoglycemic effects

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22
Q

Type 1 dm

1 u insulin drops bg by what

A

40-50 mg

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23
Q

Type 2 dm 1 u insulin drops bg by what

A

30-40 mg

24
Q

Normal bg in diabetic periop has which 4 effects

A

Inc healing, dec infection, dec osmotic diuresis, and dec DKA incidence

25
Q

Hyperkalemia tx

A

10 u reg iv 25g glucose 1 amp of 50% dextrose over 5 min

26
Q

Tx hypoglucemia: 2

A

Conscious- oral fast acting sugar

Anesthesia: 25-50 ml 50% dextrose solution

27
Q

Type 2 antidiabetic meds that can cause hypoglycemia

A

Sulfonylureas, meglitinides, GLP 1

28
Q

Type 2 dm drugs that wont cause hypoglycemia alone

A

Biguanides, thiazolidediones, alpha glucosidase inhibitors

29
Q

Sulfonylureas primary MOA

A

Stim insulin release from pancreatic beta cells. Binds to atp sensitive k channels- depolarization- ca influx- insulin release

30
Q

Sulfonylureas reduce fbg by what and a1c by what

A

60-70

2%

31
Q

DOA 1st gen sulf

How long we generally hold

A

Tolbutamide 6-12 hrs
Chlorpropamide 36-72 hrs
48-72 hrs

32
Q

2nd gen sulfonylureas DOA

A

Glipizide 12-24
Glyburide 18-24
Glimepridie

33
Q

1st gen vs 2nd gen sulfonylureas

A

1st gen more drug interactions and SE. 2nd 100x more potent but not more effective

34
Q

Sulfonylureas
Avoid in what
If renal impairment

A

Hepatic disease

Use glipizide or tolbutamide

35
Q

Sulfonylureas

Most common AE

A

Hypoglycemia, nausea, heartburn, cholestasis, alt LFT, stim appetite, ADH like effect, rash

36
Q

Hold sulfonylureas how long pre op

A

24-48 hrs
24 2nd gen
48 1st gen

37
Q

Biguanides
Drug in this class
MOA

A

Metformin

Dec hepatic and renal glucose production

38
Q

Metformin
AE
Benefit
Hypoglycemia

A

Lactic acidosis, gi distress, rash
May have wt loss
Rare if used alone

39
Q

Metformin contraindications

A

Cr women >1.4, 1.5 men
Hepatic failure
CHF, shock, hypoxic pulm disease

40
Q

TZDs
Drugs
MOA
Requires what to work

A

Actos, avandia
Improves insulin sensitivity and decreases resistance
Insulin presence

41
Q

TZDs

Metabolism

A

Hepatic

42
Q

TZDS
AE
Warnings

A

Edema, wt gain, hepatotoxic (LFT monitor)

Black box: CHF, mi

43
Q

Alpha glucosidase inhib
Drugs
MOA

A

Precose and glyset

Antag enzymes in brush border that break down complex carbs, delays absorption, lowers post prandial bg

44
Q

Alpha glucosidase inhib
Dec fbg
Dec ppl
AE

A

25-30
60-70
Abd pain, diarrhea, gas

45
Q

Alpha glucosidase
Consid
Caution in who

A

Take w 1st bite of meal

Ibd, ulcers, obstruction

46
Q

Meglitinides
Drugs
MOA
Onset and duration

A

Prandin, starlix
Stim insulin secretion from beta cells
1 hr, 4 hrs

47
Q

Meglitinides
Dosing do what
AE

A

Skip a meal skip the dose
Add a meal add a dose
Hypoglycemia, nvd, heartburn, ha

48
Q

Glp 1

MOA

A

Enhances glucose dependent insulin secretion, decrease glucagon secretion. Slows gastric emptying

49
Q

Glp 1
Anesthesia consid
Drug, 1/2 t

A

May do rapid sequence induction if not held for 24 hrs before
Januvia, 12 hrs

50
Q

AE januvia

A

Pancreatitis (rare) anaphylaxis

51
Q

Exenatide

How its rx

A

Glp 1 analog, sq, added to metformin or sulfonylureas

52
Q

Exenatide AE

A

Nv, antibodies against drug, pancreatitis, renal failure*, delayed gastric emptying (dec bc and abx abs- take an hr before taking this)

53
Q

Amylin mimetic
Drug
MOA

A

Pramintide
Dec gastric emptying, dec glucagon sec, inc satiety
Reduces post prandial bg

54
Q

Pramlintide
Peak
1/2 t
Metab

A

20 min after injection
49 min
Kidneys

55
Q

Pramlintide

Interactions

A

Dec absorption of abx and bc, take 1 hr before or 2 hrs post injection

Pharmacology (19 decks)

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