Exam 3: Diabetes pharmacology Flashcards
1
Q
Insulin is produced in the
A
Islets of Langerhans in the pancreas, in the ß cells
2
Q
Insulin structure
A
a polypeptide hormone; 2 amino acid chains connected by 2 disulfide bridges
3
Q
What results in insulins with different characteristics (ex: rapid acting insulins)
A
Modifying the amino acid sequence
4
Q
Secretion of insulin regulated by
A
- glucose levels
2. sympathetic NS & parasympathetic NS activation will influence glucose leve
5
Q
human insulin
A
identical in structure to insulin produced in the pancreas
6
Q
Insulin analogs
A
modified human insulin (altered amino acid sequence)
7
Q
With the exception of NPH insulin, all insulin made in the US are
A
Clear and Colorless solutions
8
Q
Standard concentration of insulin is
A
U-100
9
Q
Standard insulin syringe measures up to
A
50-100 units of insulin
10
Q
Insulin pens
A
A dial is used to select the desired dose of insulin
11
Q
external insulin pumps
A
continuous subcutaneous delivery of insulin
12
Q
Implantable insulin pumps:
A
surgically implanted and can be programmed to deliver a basal dose continuously and bolus doses when needed
13
Q
Jet injectors
A
send a fine spray of insulin through the skin by a high-pressure air mechanism instead of a needle
14
Q
Devices for insulin administration
A
External insulin pumps
Implantable insulin pumps
Jet injectores
Insulin Inalers
15
Q
Repetitive SC injections into the same injection site can cause disturbances in fat metabolism:
A
Lipodystrophy
16
Q
lipoatrophy:
A
SC fat breaks down, causing a depression in the skin
17
Q
lipohypertrophy:
A
lipid deposits that make the area spongy
18
Q
Both forms of lipodystrophy can delay
A
insulin absorption
19
Q
Unopened insulin should be stored
A
under refrigeration until the expiration date
20
Q
Once insulin vial is opened, it may be kept at room temperature for up to
A
1 month
21
Q
What should you never do with insulin
A
Freeze
Expose insulin to direct sunlight or heat
22
Q
For ALL insulin preparations:
A
High alert medication!!
23
Q
Due to a number insulin preparations, it is essential to
A
Identify and clarify the type of insulin to be used
24
Q
Regular insulin examples
A
HumuLIN R, novoLin, R
25
Regular insulin is
Short acting
26
Regular insulin administration
SQ inj, SQ inf, IV, INH
27
regular insulin is used for
emergency treatment of hyperglycemic states
28
Regular insulin is for _____ treatment of DM
routine treatment for type 1 and 2
29
Insulin should be given
- given before meals to control postprandial rise in blood glucose
- Infused SQ to provide basal glycemic control
- often combined with longer-acting insulins
30
Onset for regular insulin
30-60 minutes
31
Peak for regular insulin
1-5 hours
32
Duration of regular insulin
6-10 hours
33
Adverse effects of regular insulin
hypoglycemia, hypokalemia
34
Insulin lispro examples
HumaLOG
35
insulin lispro is a
RAPID acting analog of regular insulin
36
insulin lispro s given in
association with meals to control postprandial rise in blood glucose
37
Insulin lispro si combined with
Longer acting insulins to provide basal glycemic control between meals and at night
38
Insulin lispro onset
15-30 min
39
Peak of insulin lispro
30 - 2.5 hours
40
Duration insulin lispro
3-6 hours
41
Other rapid acting insulins
insulin aspart
| Insulin glulisine
42
Regular human insulin
Hexamers break up slowly into monomers and dimers; monomers enter circulation
43
Rapid acting insulin analogs
Hexamers break up more rapidly; more monomers and dimers present; monomers enter circulation more rapidly.
44
NPH insulin examples
Humulin N, Novolin N, Isophane suspension
45
NPH insulin is an
intermediate acting
46
NPH insulin a conjugated with a large protein causing
onset of action is delayed
| duration of action is extended
47
Lengthy peak action time of NPH insulin produces additional risk for
hypoglycemia
48
NPH insulin look
cloudy suspension, must be gently agitated before administration
49
NPH administration time
Cannot be administered at mealtimes to control postprandial rise in blood glucose
50
NPH insulin is usually injected
twice/day to provide glycemic control between meals and during the night
51
NPH insulin onset
1-2 hours
52
NPH insulin peak
6-14 hours
53
NPH insulin duration
16-24 hours
54
other intermediate acting insulin
insulin detemir (Levemir)
55
Insulin glargine is a
Long acting insulin
56
for insulin glargine, glucose blood levels are relatively
stable during 24 hour period
57
Insulin glargine is given
once daily injection (usually at bedtime)
58
What should you never do with insulin glargine
Never mix with other insulins
59
Insulin glargine onset
70 minutes
60
Insulin glargine peak
NONE
61
Insulin glargine duration
24 hour
62
Oral antidiabetics (hypoglycemics) indication
Indicated for type 2 diabetes
63
oral anti diabetics are employed
after a program of diet modification & exercise to control glucose levels: used as an adjunct to non-drug therapy, NOT as a substitute
64
For ALL oral anti diabetic drugs
High alert medication !
65
Oral hypoglycemic drugs may be associated with
Increased cardiovascular mortality (metformin seems to be the only exception)
66
Oral anti diabetics stress related states
it may be necessary to discontinue oral therapy & administer insulin if patient is exposed to stress (trauma, infection, surgery)
67
Metformin drug class
Oral anti diabetic, Biguanide
68
Metformin MOA
- Lowers BG by decrease hepatic gluconeogenesis
- Sensitizes insulin receptor in target tissues
- Also lowers TG levels
69
Does metformin stimulate insulin release from pancreas?
NO!
70
Does metformin induce hypoglycemia
NO! (except if caloric intake is not adequate or if combined with other oral antidiabetic drugs)
71
Metformin can be used in patients
whose beta cells no longer function
72
what can cause accumulation of metformin to toxic levels
Renal impairment
73
Do not use metoformin if serum creatinine is
> 1.5 mg/dl
74
#1 drug choice for treatment of Type 2 diabetes
Metformin
75
Metformin was also found to delay the development of
type 2 diabetes in high risk individuals
76
Adverse effects of metformin
in patients undergoing radiologic contrast studies (e.g. angiograms, CT w/contrast), metformin therapy should be d/c’d prior to administration of contrast & continued only when renal function has returned to normal
77
When should metformin be discontinued
prior to administration of contrast and continued only when renal function has returned to normal
78
Black box warning for metformin
Lactic acidosis!
| D/C in clinical situations predisposing to hypoxemia
79
Metformin risk of accumulation and lactic acidosis increased with the degree of
impairment of renal function
80
Sulfonylureas indication
Type 2 DM treatment
81
Sulfonylureas MoA
Binds to potassium channels on pancreatic beta cells to stimulate insulin secretion
82
Sulfonylureas may ...
- Improve insulin binding to receptors
| - `increase number of insulin receptors
83
To use Sulfonylureas individual MUST have a functioning
beta cell
84
Sulfonylureas adverse effects
hyperinsulinemia
hypoglycemia
weight gain
85
Sulfonylureas examples
```
chlorproPAMIDE
gliclazide
glimepiride
glipiZIDE
glyBURIDE
TOLAZamide
TOLBUTamide
```
86
what drugs are combined to make glucovance
glyBURIDE + metformin
87
glyBURIDE is a
second generation sulfonylurea
88
All 2nd generation sulfonylureas have less
drug interactions than 1st generation
89
glyBURIDE moA
stimulates insulin release from pancreatic β-cells (must have functioning β-cells) leading to
- DECREASE
glucose output from liver
- INCREASE insulin sensitivity at peripheral target sites
90
Glyburide can sometimes be used in
combination with insulin in type 2 DM
91
Adverse effects of glyburide
hyperinsulinemia
hypoglycemia
propensity for weight gain
92
Sulfonamide allergy:
chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, & loop diuretics
93
Glinides/Meglitinide derivatives
nateglinide (Starlix)
| repaglinide (Prandin)
94
Drug combination to make PrandiMet
repaglinide + metformin
95
Repaglinide drug class
Glinide/meglitinide derivative
96
Repaglinide moA
binds to potassium channels on pancreatic beta cells which stimulates the release of insulin from pancreatic β-cells (must have functioning β-cells)
97
Major adverse effects of repaglinide
- Hypoglycemia
| - Rapid hepatic metabolism & biliary excretion: caution in patients with liver dysfunction
98
Repaglinide should be caution in patients with
liver dysfunction
99
Patient education of repaglinide
- Take repaglinide immediately before eating (wait no more than 30 minutes); rapid absorption, onset, peak, & duration
- If a meal is skipped, omit corresponding dose of repaglinide
- If an extra meal is added, add a dose to cover the meal
- `Avoid alcohol
100
Glitazones examples
pioglitazone (Actos)
| rosiglitazone (Avandia) [used only rarely today due to risk of MI & sudden cardiac death]
101
Drug combination of octopus met
pioglitazone+ metformin
102
Pioglitazone drug class
Thiazolidinedione (glitazone), TZD
103
pioglitazone moA
Decrease insulin resistance in muscle and adipose tissue
104
pioglitazone advert effects
- Weight gain
- Hepatic damage
- Increase incidence of fractures in female patients treated with rosiglitazone
- Increase risk of bladder cancer
105
Black box warning for rosiglitazone
May cause or exacerbate heart failure
106
Do not give rosiglitazone to patients with
- exacerbate ischemic heart disease
| - increased risk of angina and MI
107
Use pioglitazone cautiously In patients with
pre-existing diabetic retinopathy
108
Examples of alpha glucosidase inhibitors
acarbose (Precose)
| miglitol (Glyset)
109
Acarbose drug class
Alpha-glucosidase Inhibitor
110
Acarbose moA
Delays absorption of dietary CHO which decreases postprandial rise in blood glucose
111
Acarbose acts
locally in the gut, only 2% of drug is absorbed , so systemic effects are minimal
112
Instruct patient to take acarbose with
first bite of each meal
113
Do not take medications with to within _____ of taking acarbose
2 hours
114
Acarbose adverse effects
Frequently causes flatulence, cramps, abdominal distention, borborygmus, diarrhea (secondary to bacterial fermentation of unabsorbed CHO in the colon; may diminish over time)
115
Does acarbose cause hypoglycemia?
No! Unless its combined with other anti diabetic agents
116
Long term, high dose therapy of acarbose may cause
liver dysfunction; monitor liver function tests every 3 months for 1st year
117
Alpha-glycoside inhibitors niether
Stimulate nor increase insulin release/action on target tissue
118
Hypoglycemia is only a concern for alpha glucoside inhibitors if
Combined with insulin or router oral anti diabetic agents
119
Gliptins examples
alogliptin (Nesina)
linagliptin (Tradjenta)
saxagliptin (Onglza)
sitaGLIPtin (Januvia)
120
Drug combination for Janumet
sitaGLIPtin + metformin
121
SitaGLIPtin drug class
Antidiabetic agent; glisten
122
Sitagliptin moA
Inhibits DDP-IV thereby enhancing the effects of incretin hormones which
- DECREASE glucose levels
123
DD-IV is an enzyme that
Inactivated incretin
124
Incretin hormones are released from
the intestines after a meal
125
Incretin hormones stimulate
Please of insulin
126
Incretin hormones suppress
glucagon release
127
Sitagliptin adverse effects
- Pancreatitis: cases of acute pancreatitis (including hemorrhagic & necrotizing with some fatalities) have been reported; patient should report severe & persistent abdominal pain
- Rare hypersensitivity reactions, including anaphylaxis or severe dermatologic reactions (Stevens-Johnson syndrome)
128
Incretin mimetics Adverse effects
GI distress
Injection site irritation
Cases of acute pancreatitis (including hemorrhagic & necrotizing with some fatalities) have been reported; severe & persistent abdominal pain
129
Incretin mimetics boxed warning
dose & duration dependent thyroid tumors have developed in animal studies; relevance in humans unknown
130
Pramlintide drug class
Amylin mimetic
131
pramlintide indications
Adjunctive treatment with mealtime insulin in BOTH type 2 and type 1 diabetics who have not achieved optimal glucose control
132
pramlintide administration
SQ
133
pramlintide moA
synthetic analog of human amylin (cosecreted w/ insulin by pancreatic beta cells); reduces postprandial glucose levels via the following mechanisms:
1. prolongation of gastric emptying time
2. reduction of postprandial glucagon secretion
3. reduction of caloric intake via centrally-mediated appetite suppression
134
Pramlintide boxed warning
- Co-administration with insulin may induce severe hypoglycemia
- - requires an initial dosage reduction of insulin & frequent pre- & post-blood glucose monitoring to reduce risk of sever hypoglycemia
-concurrent use of other glucose-lowering agents may increase risk of hypoglycemia
135
Glucagon moA
increase glucose levels by stimulating glycogenolysis
136
How much glucagon is give to unconscious patients to reverse hypoglycemiaa due to insulin overdose
0.5 - 1
137
Glucagon administration
SC, IM, IV
138
Maximum glycemic response for glucagon is within
30 minutes
