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Pharmacology > Endocrine Drugs > Flashcards

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
Q

Five Side effects of insulin

A 
hypoglycemia
allergic reactions
lipodystrophy
insulin resistance
drug interactions
26
Q

Symptoms of Hypoglycemia

A

increased epinpehrine secretion
diaphoresis, tachycardia, HTN, rebound hyperglycomia caused by SNS activation may mask diagnosis
mental confusion, seizures, coma

27
Q

Brain depends on glucose as a

A

selective substrate for oxidative metabolism

28
Q

treatment of hypoglycemia

A

50-100 mg of 50% glucose IV will increase 2mg/dl

29
Q

What insulin will you see allergic reaction?

A

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
Q

what drugs increase the DOA of insulin

A

tetracycline, salicylates, phenylbutazone

may have hypoglycemic effect

31
Q

Four Classes of Anti-diabetic Drugs

A

secretagogues
biguanides
thiazolidinediones or glitazones
alpha-glucosidase inhibitors

32
Q

Secretagogues

A

sulfonylureas and meglitindines

increase insulin availability

33
Q

Biguanides

A

metformin

suppress excessive hepatic glucose release

34
Q

Thiazolidinediones or glitazones

A

rosiglitazone, pioglitazone

improve insulin sensitivity

35
Q

alpha-glucosidase inhibitors

A

acarose, miglitol

delay GI glucose absorption (used to maintain glucose control)

36
Q

Metformin is an

A

oral biguanide

37
Q

metformin rarely

A

causes hypoglycemia

38
Q

Metformin is contraindicated in

A

lactic acidosis, AKI, GI intolerance and acute hepatic disease

39
Q

Metformin does not

A

undergo metabolize

40
Q

Metformin is eliminated

A

in the kidneys

41
Q

Elimination 1/2 life of metformin

A

2-4 hours

42
Q

How do you prescribe metformin

A

TID 500-1000mg with meals

43
Q

Use metformin cautiously in

A

patients with renal dysfunction

44
Q

MOA of metaformin

A

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
Q

Metformin needs to be discontinued

A

48 hours prior to surgery

46
Q

Metformin is not for patients

A

with hepatic dysfunction, renal insufficiency IV contrast acute MI CHF, arterial hypoxemia, sepsis

47
Q

sulfonylureas are not administered

A

to patients with sulfa allergy

48
Q

Examples of Sulfonylurea

A 
glyburide
glipizide
glimepride
tolbutamide
tolazamide
acetohexamide
chlorpropamide
49
Q

MOA Sulfonylurea

A

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
Q

Meglitinide

A

stimulates release of insulin from beta islet cells of pancreas

51
Q

MOA of acarbose and miglitol

A

decrease carbohydrate digestion and absorption o f disaccharides by interfering with intestinal glucosidase activity

52
Q

Thiazolidinesdiones

A

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
Q

DM+ HTN

A

50% likelihood of diabetic autonomic neuropathy

54
Q

Autonomic dysfunction -> delayed gastric emptying

A

gastroparesis

premed nonparticulate antacid and metoclopramide

55
Q

one unit of regular insulin usually lowers plasma glucose by

A

25-30mg/dl

56
Q

Patients with insulin Pump prior to surgery

A

decrease overnight rate by 30% and keep at basal rate for DOS

57
Q

AM dose of regular insulin

A

should be held

58
Q

Time Honored approach

A

pt takes 2/3 nighttime insulin (NPH/Regular) and 1/2 total morning insulin dose in form of intermediate-acting insulin (NPH)

59
Q

If patient takes glargine and lispro daily,

A

take 2/3 glargine dose and entire lispro/aspart the night before; hold all AM doses

60
Q

Oral medications for diabetes can be

A

continued til DOS

61
Q

Sulfolnylureas and metformin on DOS

A

have to be stopped due to long half lives

Pharmacology (14 decks)

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