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Pharmacology > Exam 3 - Diabetes > Flashcards

Exam 3 - Diabetes Flashcards

1
Q

What are the rapid acting insulins?

A
  • insulin lispro (Humalog)
  • insulin aspart (Novolog)
  • Insulin glulisine (Apidra)
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2
Q

What is the onset and duration of rapid acting insulins (homolog, novolog)?

A
  • very rapid onset (4-15min)
  • peak (30-90min)
  • short duration (3-5hr)
  • Taken immediately before a meal
  • onset of action similar to insulin release from pancreas
  • monomeric insulin - aa subs have been made so the insulin molecules don’t dimerize and form aggregates
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3
Q

What is a short acting insulin?

A

-Humalin R
-Novolin R
“normal insulin”

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4
Q

What is the onset and duration of short acting insulin (humalin)?

A
  • rapid onset (30-45 min)
  • peak (2-3hr)
  • short duration (4-6hr)
  • only insulin prep used IV, can be IM
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5
Q

What is an intermediate acting insulin?

A

-NPH

Neutral protamine hagedon or insulin isophane

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6
Q

What is the onset and duration of NPH(int acting)?

A
  • onset 2-5hrs

- duration 4-12hrs

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7
Q

What are 2 long acting insulins?

A
  • insulin glargine (lantus)

- insulin detemir (levemir)

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8
Q

What is the onset and duration of long acting insulins (lantus and levemir)?

A
  • insulin glargine (lantus)
  • –onset 1-1.5 hr
  • –duration 11-24hr
  • –can be injected once or twice a day
  • –soluble at acid pH
  • –aggregates at phys pH after inj
  • insulin detemir (levemir)
  • –onset 1-2hr
  • –duration >12hr
  • –very reproducible kinetics
  • –myristic a res promotes self aggregation at phys pH
  • *These 2 cannot be used in the same syringe as other preparations since they will aggregate at physiological pH
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9
Q

What is an ultra long acting insulin?

A

insulin degludec (tresiba)

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10
Q

What is the onset and duration of tresiba (ultra long acting insulin)?

A
  • onset 30-90min
  • 25hr half life
  • duration >24hr
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11
Q

When are insulin combos used? (NPH/reg insulin)

A

d/t lack of flexibility in dosing and meals

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12
Q

What are routes of admin of insulin?

A
  • SC (MC) in abdomen, butt, ant thigh, dorsal arm
  • IM - faster onset than SC
  • IV - ER situations
    • Reg insulin is only form IV
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13
Q

What are some side effects of insulin?

A
  • hypoglycemia
  • immunopathology > allergies, immune resistance
  • lipodystrophy at inj site
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14
Q

What are 6 classes of oral anti diabetic agents?

A
  1. biguanindes
  2. sulfonylureas
  3. meglitinides
  4. D-phenylalanine derivative
  5. thiazolidinediones
  6. alpha-glucosidase inhibitors
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15
Q

Metformin

A

-biguanide
MOA: decrease hepatic glucose production > decreases fasting and postprandial hyperglycemia
*1st line for T2DM
SE: GI distress, high doses=lactic acidosis
Contra: pts with renal/hepatic/pulmonary dz, alcoholism, and uncompensated heart failure d/t risk of lactic acidosis

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16
Q

Sulfonylureas

Insulin secretagogue

A

MOA: inhibition of the ATP-sensitive K channels > increases release of insulin > decreases glucagon secretion
SE: hypoglycemia rarely, n/v, jaundice, anemias, hypersensitivity

17
Q

What are the 1st generation sulfonylureas?

A

-tolbutamide > short half life (T 4-5hr)
-chlorpropamide > long duration (T 32hr)
SE: Contra in elderly d/t risk of hypoglycemia. Also jaundice and alcohol induced flush similar to disulfram
-tolazamide - int duration (T 7hr)

18
Q

What are 2nd gen sulfonylureas?

A
  • glyburide > SE: hypoglycemia, Contra in pts w/ hepatic/renal dz
  • glipizide > short half life (2-4hr) Contra in pts with hepatic/renal dz
  • glimepride - longer duration (T 5hr) mono therapy or combo with insulin
19
Q

Meglitinides (Repaglinide)

Insulin secretagogue

A

MOA: inhibition of ATP sensitive K channels

  • fast onset, peak 1hr, duration 4-7hr
  • used for postprandial glucose control
  • should be taken before meal
20
Q

D-phenylalanine derivatives (Nateglinide)

Insulin secretagogue

A

MOA: inhibition of ATP-sensitive K channels > suppression of glucagon secretion and decreases hepatic production

  • rapid onset and peak 1hr
  • stimulates insulins secretion under glucose load, but not during normoglycemia
  • lowest incidence of hypoglycemia of secretagogue drugs
21
Q

Thiazolodinediones

(pioglitazone, rosiglitazone)

(insulin sensitizer)

A

MOA: increase sensitivity to insulin, agonist for the peroxisome proliferation activated receptor gamma (PPAR-y)
Effects of carb met: increase insulin stimulated uptake of glucose, hepatic uptake, reduce hepatic gluconeogenesis
Effects of lipid met: reduce plasma FA by increasing clearance and reducing lypolosis, increases differentiation of adipocytes, shifts fat deposits from visceral stores to SC deposits, weight gain
SE: wt gain, edema, increased risk of HF, demineralization of bone and increased risk of bone fractures in women

22
Q

pioglitazone (

A

-thiazolidinedione
-reduces plasma triglycerides and raises HDL
increase risk for bladder cancer

23
Q

rosiglitazone

A

-thiazolidinedione
“Black box warning”
-CV risks
-removed from shelves

Pharmacology (15 decks)

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