Endocrine 1 Flashcards
Insulin MOA
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
What ANS does to insulin secretion
Alpha decreases it. Beta and PNS increase it. Under stress- release more insulin.
Ultra rapid insulin 3
Lispro (humalog)
Aspart (novolog)
Glulisine (apidra)
Short acting insulin
Regular
Intermediate acting insulin
NPH, sensitive to protamine
Long acting insulin
Glargine (Lantus)
Detemir (levemir)
Ultralente
Which insulin doesn’t have a peak
Long acting
Peaks for
Short- fastest
Short- slower
1-2 hrs
4-5 hrs
Peak for intermediate acting
6-8 hrs
Dont mix what with any other insulin
Glargine, not compatible
IV regular insulin
E 1/2 t
Duration
5-10 min
30-60 min
Only regular insulin we should use iv
U 100
100 u per ml
Lispro insulin
Onset
Peak
Duration
10-15 min
30 min-1 hr
3-5 hrs
Regular insulin
Onset
Peak
Duration
30-60 min
1-5 hrs
5-9 hrs
NPH Onset Peak Duration Use
1-2 hrs
6-10 hrs
16-20 hrs
Basal insulin, overnight
Glargine Onset Peak Duration Use
2-6 hrs
No peak
24 hrs
Basal, overnight
Danger if hypoglycemia from inadequate carb intake w insulin symptoms
Sweaty, tachycardia, htn, cns agitation, seizures, coma
Which drugs oppose hypoglycemic effects of insulin 3
Acth, glucagon, and estrogens
Which drug decreases release of insulin and stim mobilization of glucose
Epi
DOA of insulin prolonged by which 3 drugs
Tetracycline, chloramphenicol, salicylates
MAOIs do what to insulin
Can increase hypoglycemic effects
Type 1 dm
1 u insulin drops bg by what
40-50 mg
Type 2 dm 1 u insulin drops bg by what
30-40 mg
Normal bg in diabetic periop has which 4 effects
Inc healing, dec infection, dec osmotic diuresis, and dec DKA incidence
Hyperkalemia tx
10 u reg iv 25g glucose 1 amp of 50% dextrose over 5 min
Tx hypoglucemia: 2
Conscious- oral fast acting sugar
Anesthesia: 25-50 ml 50% dextrose solution
Type 2 antidiabetic meds that can cause hypoglycemia
Sulfonylureas, meglitinides, GLP 1
Type 2 dm drugs that wont cause hypoglycemia alone
Biguanides, thiazolidediones, alpha glucosidase inhibitors
Sulfonylureas primary MOA
Stim insulin release from pancreatic beta cells. Binds to atp sensitive k channels- depolarization- ca influx- insulin release
Sulfonylureas reduce fbg by what and a1c by what
60-70
2%
DOA 1st gen sulf
How long we generally hold
Tolbutamide 6-12 hrs
Chlorpropamide 36-72 hrs
48-72 hrs
2nd gen sulfonylureas DOA
Glipizide 12-24
Glyburide 18-24
Glimepridie
1st gen vs 2nd gen sulfonylureas
1st gen more drug interactions and SE. 2nd 100x more potent but not more effective
Sulfonylureas
Avoid in what
If renal impairment
Hepatic disease
Use glipizide or tolbutamide
Sulfonylureas
Most common AE
Hypoglycemia, nausea, heartburn, cholestasis, alt LFT, stim appetite, ADH like effect, rash
Hold sulfonylureas how long pre op
24-48 hrs
24 2nd gen
48 1st gen
Biguanides
Drug in this class
MOA
Metformin
Dec hepatic and renal glucose production
Metformin
AE
Benefit
Hypoglycemia
Lactic acidosis, gi distress, rash
May have wt loss
Rare if used alone
Metformin contraindications
Cr women >1.4, 1.5 men
Hepatic failure
CHF, shock, hypoxic pulm disease
TZDs
Drugs
MOA
Requires what to work
Actos, avandia
Improves insulin sensitivity and decreases resistance
Insulin presence
TZDs
Metabolism
Hepatic
TZDS
AE
Warnings
Edema, wt gain, hepatotoxic (LFT monitor)
Black box: CHF, mi
Alpha glucosidase inhib
Drugs
MOA
Precose and glyset
Antag enzymes in brush border that break down complex carbs, delays absorption, lowers post prandial bg
Alpha glucosidase inhib
Dec fbg
Dec ppl
AE
25-30
60-70
Abd pain, diarrhea, gas
Alpha glucosidase
Consid
Caution in who
Take w 1st bite of meal
Ibd, ulcers, obstruction
Meglitinides
Drugs
MOA
Onset and duration
Prandin, starlix
Stim insulin secretion from beta cells
1 hr, 4 hrs
Meglitinides
Dosing do what
AE
Skip a meal skip the dose
Add a meal add a dose
Hypoglycemia, nvd, heartburn, ha
Glp 1
MOA
Enhances glucose dependent insulin secretion, decrease glucagon secretion. Slows gastric emptying
Glp 1
Anesthesia consid
Drug, 1/2 t
May do rapid sequence induction if not held for 24 hrs before
Januvia, 12 hrs
AE januvia
Pancreatitis (rare) anaphylaxis
Exenatide
How its rx
Glp 1 analog, sq, added to metformin or sulfonylureas
Exenatide AE
Nv, antibodies against drug, pancreatitis, renal failure*, delayed gastric emptying (dec bc and abx abs- take an hr before taking this)
Amylin mimetic
Drug
MOA
Pramintide
Dec gastric emptying, dec glucagon sec, inc satiety
Reduces post prandial bg
Pramlintide
Peak
1/2 t
Metab
20 min after injection
49 min
Kidneys
Pramlintide
Interactions
Dec absorption of abx and bc, take 1 hr before or 2 hrs post injection
