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Endocrine Drugs Flashcards

1
Q

What type of insulin is Lispro

A

Short acting insulin

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2
Q

Onset of Lispro

A

within 15 minutes

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3
Q

Peak of Action of Lispro

A

30-90 minutes

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4
Q

Duration of Lispro

A

3-5 hours

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5
Q

Benefit of Lispro

A

decrease in postprandial hyperglycemia and less risk of hypoglycemia

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6
Q

Class of Insulin Aspart and Glulisine

A

synthetic rapid acting analogues

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7
Q

Onset of Insulin Aspart and Glulisine

A

10-15 minutes

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8
Q

Peak of Aspart and Glulisine

A

45-75 minutes

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9
Q

Duration of Apart and Glulisine

A

2-4hours

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10
Q

Types of Regular Insulin

A

Humulin R, Novolin R, ReliOn R

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11
Q

Regular Insulin is

A

fast acting preparation and crystalline zinc insulin

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12
Q

Route regular insulin can be administered

A

IV and SQ

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13
Q

Can you mix Regular insulin with other insulins

A

yes if pH is simliar

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14
Q

Periop dose of insulin

A

Single (1-5U) or infusion of 0.5-2u/hr)

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15
Q

Onset of Regular Insulin

A

30 minutes

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16
Q

Peak effect of Regular Insulin

A

2-4 hours after SQ injections because of insulin hexamers

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17
Q

Duration of Regular Insulin

A

6-8 hours

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18
Q

Neutral Protamine Hagedorn is

A

intermediate acting insulin

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19
Q

Onset of NPH

A

2 hours

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20
Q

Peak of NPH

A

4-12 hours

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21
Q

Duration of NPH

A

18-24 hours

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22
Q

Preparation and absorption of NPH

A

SQ delay due to conjugation with protamine

prep contains 0.005mg protamine/U of insulin

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23
Q

Long Acting Insulins

A

Detemir (Levemir)
Glargine (Lantus)
Degludec (Tresiba)

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24
Q

Mixed Insulins

A

First is long acting then second is short/rapid acting

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25
Five Side effects of insulin
``` hypoglycemia allergic reactions lipodystrophy insulin resistance drug interactions ```
26
Symptoms of Hypoglycemia
increased epinpehrine secretion diaphoresis, tachycardia, HTN, rebound hyperglycomia caused by SNS activation may mask diagnosis mental confusion, seizures, coma
27
Brain depends on glucose as a
selective substrate for oxidative metabolism
28
treatment of hypoglycemia
50-100 mg of 50% glucose IV will increase 2mg/dl
29
What insulin will you see allergic reaction?
NPH chronic protamine exposure in NPH may stimulate production of antibodies against protamine, if large doses of protamine is adminstered IV to antagonize anticoagulant effects of heparin, allergy to protamine
30
what drugs increase the DOA of insulin
tetracycline, salicylates, phenylbutazone | may have hypoglycemic effect
31
Four Classes of Anti-diabetic Drugs
secretagogues biguanides thiazolidinediones or glitazones alpha-glucosidase inhibitors
32
Secretagogues
sulfonylureas and meglitindines | increase insulin availability
33
Biguanides
metformin | suppress excessive hepatic glucose release
34
Thiazolidinediones or glitazones
rosiglitazone, pioglitazone | improve insulin sensitivity
35
alpha-glucosidase inhibitors
acarose, miglitol | delay GI glucose absorption (used to maintain glucose control)
36
Metformin is an
oral biguanide
37
metformin rarely
causes hypoglycemia
38
Metformin is contraindicated in
lactic acidosis, AKI, GI intolerance and acute hepatic disease
39
Metformin does not
undergo metabolize
40
Metformin is eliminated
in the kidneys
41
Elimination 1/2 life of metformin
2-4 hours
42
How do you prescribe metformin
TID 500-1000mg with meals
43
Use metformin cautiously in
patients with renal dysfunction
44
MOA of metaformin
activated AMP protein kinase to suppress hepatic glucose production by decreasing gluconeogenesis and glycogenolysis and to enhance postprandial insulin suppression of hepatic glucose production
45
Metformin needs to be discontinued
48 hours prior to surgery
46
Metformin is not for patients
with hepatic dysfunction, renal insufficiency IV contrast acute MI CHF, arterial hypoxemia, sepsis
47
sulfonylureas are not administered
to patients with sulfa allergy
48
Examples of Sulfonylurea
``` glyburide glipizide glimepride tolbutamide tolazamide acetohexamide chlorpropamide ```
49
MOA Sulfonylurea
act on sulfonylurea receptors on pancreatic and cardiac cells; inhibit ATP sensitive K channels on pancreatic beta cells resulting in Ca2 influx and stimulation of insulin release
50
Meglitinide
stimulates release of insulin from beta islet cells of pancreas
51
MOA of acarbose and miglitol
decrease carbohydrate digestion and absorption o f disaccharides by interfering with intestinal glucosidase activity
52
Thiazolidinesdiones
act on skeletal muscle, liver and adipose tissue via peroxisome proliferator activator receptor gamma to decrease insulin resisstance and hepatic glucose production and to increase use of glucose by liver
53
DM+ HTN
50% likelihood of diabetic autonomic neuropathy
54
Autonomic dysfunction -> delayed gastric emptying
gastroparesis | premed nonparticulate antacid and metoclopramide
55
one unit of regular insulin usually lowers plasma glucose by
25-30mg/dl
56
Patients with insulin Pump prior to surgery
decrease overnight rate by 30% and keep at basal rate for DOS
57
AM dose of regular insulin
should be held
58
Time Honored approach
pt takes 2/3 nighttime insulin (NPH/Regular) and 1/2 total morning insulin dose in form of intermediate-acting insulin (NPH)
59
If patient takes glargine and lispro daily,
take 2/3 glargine dose and entire lispro/aspart the night before; hold all AM doses
60
Oral medications for diabetes can be
continued til DOS
61
Sulfolnylureas and metformin on DOS
have to be stopped due to long half lives

Pharmacology (14 decks)

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