Endocrine 1 Flashcards by Hailey Haas

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

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What ANS does to insulin secretion

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

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Ultra rapid insulin 3

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

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Short acting insulin

Regular

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Intermediate acting insulin

NPH, sensitive to protamine

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Long acting insulin

Glargine (Lantus)
Detemir (levemir)
Ultralente

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Which insulin doesn’t have a peak

Long acting

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Peaks for
Short- fastest
Short- slower

1-2 hrs

4-5 hrs

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Peak for intermediate acting

6-8 hrs

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Dont mix what with any other insulin

Glargine, not compatible

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IV regular insulin
E 1/2 t
Duration

5-10 min

30-60 min

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Only regular insulin we should use iv

U 100

100 u per ml

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Lispro insulin
Onset
Peak
Duration

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

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Regular insulin
Onset
Peak
Duration

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

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NPH 
Onset 
Peak 
Duration 
Use

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

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Glargine 
Onset 
Peak 
Duration 
Use

2-6 hrs
No peak
24 hrs
Basal, overnight

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Danger if hypoglycemia from inadequate carb intake w insulin symptoms

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

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Which drugs oppose hypoglycemic effects of insulin 3

Acth, glucagon, and estrogens

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Which drug decreases release of insulin and stim mobilization of glucose

Epi

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DOA of insulin prolonged by which 3 drugs

Tetracycline, chloramphenicol, salicylates

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MAOIs do what to insulin

Can increase hypoglycemic effects

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Type 1 dm

1 u insulin drops bg by what

40-50 mg

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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