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316 Pharmacology > Exam 3: Diabetes pharmacology > Flashcards

Exam 3: Diabetes pharmacology Flashcards

1
Q

Insulin is produced in the

A

Islets of Langerhans in the pancreas, in the ß cells

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2
Q

Insulin structure

A

a polypeptide hormone; 2 amino acid chains connected by 2 disulfide bridges

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3
Q

What results in insulins with different characteristics (ex: rapid acting insulins)

A

Modifying the amino acid sequence

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4
Q

Secretion of insulin regulated by

A
  1. glucose levels

2. sympathetic NS & parasympathetic NS activation will influence glucose leve

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5
Q

human insulin

A

identical in structure to insulin produced in the pancreas

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6
Q

Insulin analogs

A

modified human insulin (altered amino acid sequence)

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7
Q

With the exception of NPH insulin, all insulin made in the US are

A

Clear and Colorless solutions

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8
Q

Standard concentration of insulin is

A

U-100

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9
Q

Standard insulin syringe measures up to

A

50-100 units of insulin

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10
Q

Insulin pens

A

A dial is used to select the desired dose of insulin

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11
Q

external insulin pumps

A

continuous subcutaneous delivery of insulin

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12
Q

Implantable insulin pumps:

A

surgically implanted and can be programmed to deliver a basal dose continuously and bolus doses when needed

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13
Q

Jet injectors

A

send a fine spray of insulin through the skin by a high-pressure air mechanism instead of a needle

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14
Q

Devices for insulin administration

A

External insulin pumps
Implantable insulin pumps
Jet injectores
Insulin Inalers

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15
Q

Repetitive SC injections into the same injection site can cause disturbances in fat metabolism:

A

Lipodystrophy

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16
Q

lipoatrophy:

A

SC fat breaks down, causing a depression in the skin

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17
Q

lipohypertrophy:

A

lipid deposits that make the area spongy

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18
Q

Both forms of lipodystrophy can delay

A

insulin absorption

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19
Q

Unopened insulin should be stored

A

under refrigeration until the expiration date

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20
Q

Once insulin vial is opened, it may be kept at room temperature for up to

A

1 month

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21
Q

What should you never do with insulin

A

Freeze

Expose insulin to direct sunlight or heat

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22
Q

For ALL insulin preparations:

A

High alert medication!!

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23
Q

Due to a number insulin preparations, it is essential to

A

Identify and clarify the type of insulin to be used

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24
Q

Regular insulin examples

A

HumuLIN R, novoLin, R

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25
Q

Regular insulin is

A

Short acting

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26
Q

Regular insulin administration

A

SQ inj, SQ inf, IV, INH

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27
Q

regular insulin is used for

A

emergency treatment of hyperglycemic states

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28
Q

Regular insulin is for _____ treatment of DM

A

routine treatment for type 1 and 2

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29
Q

Insulin should be given

A
  • given before meals to control postprandial rise in blood glucose
  • Infused SQ to provide basal glycemic control
  • often combined with longer-acting insulins
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30
Q

Onset for regular insulin

A

30-60 minutes

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31
Q

Peak for regular insulin

A

1-5 hours

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32
Q

Duration of regular insulin

A

6-10 hours

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33
Q

Adverse effects of regular insulin

A

hypoglycemia, hypokalemia

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34
Q

Insulin lispro examples

A

HumaLOG

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35
Q

insulin lispro is a

A

RAPID acting analog of regular insulin

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36
Q

insulin lispro s given in

A

association with meals to control postprandial rise in blood glucose

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37
Q

Insulin lispro si combined with

A

Longer acting insulins to provide basal glycemic control between meals and at night

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38
Q

Insulin lispro onset

A

15-30 min

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39
Q

Peak of insulin lispro

A

30 - 2.5 hours

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40
Q

Duration insulin lispro

A

3-6 hours

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41
Q

Other rapid acting insulins

A

insulin aspart

Insulin glulisine

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42
Q

Regular human insulin

A

Hexamers break up slowly into monomers and dimers; monomers enter circulation

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43
Q

Rapid acting insulin analogs

A

Hexamers break up more rapidly; more monomers and dimers present; monomers enter circulation more rapidly.

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44
Q

NPH insulin examples

A

Humulin N, Novolin N, Isophane suspension

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45
Q

NPH insulin is an

A

intermediate acting

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46
Q

NPH insulin a conjugated with a large protein causing

A

onset of action is delayed

duration of action is extended

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47
Q

Lengthy peak action time of NPH insulin produces additional risk for

A

hypoglycemia

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48
Q

NPH insulin look

A

cloudy suspension, must be gently agitated before administration

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49
Q

NPH administration time

A

Cannot be administered at mealtimes to control postprandial rise in blood glucose

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50
Q

NPH insulin is usually injected

A

twice/day to provide glycemic control between meals and during the night

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51
Q

NPH insulin onset

A

1-2 hours

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52
Q

NPH insulin peak

A

6-14 hours

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53
Q

NPH insulin duration

A

16-24 hours

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54
Q

other intermediate acting insulin

A

insulin detemir (Levemir)

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55
Q

Insulin glargine is a

A

Long acting insulin

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56
Q

for insulin glargine, glucose blood levels are relatively

A

stable during 24 hour period

57
Q

Insulin glargine is given

A

once daily injection (usually at bedtime)

58
Q

What should you never do with insulin glargine

A

Never mix with other insulins

59
Q

Insulin glargine onset

A

70 minutes

60
Q

Insulin glargine peak

A

NONE

61
Q

Insulin glargine duration

A

24 hour

62
Q

Oral antidiabetics (hypoglycemics) indication

A

Indicated for type 2 diabetes

63
Q

oral anti diabetics are employed

A

after a program of diet modification & exercise to control glucose levels: used as an adjunct to non-drug therapy, NOT as a substitute

64
Q

For ALL oral anti diabetic drugs

A

High alert medication !

65
Q

Oral hypoglycemic drugs may be associated with

A

Increased cardiovascular mortality (metformin seems to be the only exception)

66
Q

Oral anti diabetics stress related states

A

it may be necessary to discontinue oral therapy & administer insulin if patient is exposed to stress (trauma, infection, surgery)

67
Q

Metformin drug class

A

Oral anti diabetic, Biguanide

68
Q

Metformin MOA

A
  • Lowers BG by decrease hepatic gluconeogenesis
  • Sensitizes insulin receptor in target tissues
  • Also lowers TG levels
69
Q

Does metformin stimulate insulin release from pancreas?

A

NO!

70
Q

Does metformin induce hypoglycemia

A

NO! (except if caloric intake is not adequate or if combined with other oral antidiabetic drugs)

71
Q

Metformin can be used in patients

A

whose beta cells no longer function

72
Q

what can cause accumulation of metformin to toxic levels

A

Renal impairment

73
Q

Do not use metoformin if serum creatinine is

A

> 1.5 mg/dl

74
Q

1 drug choice for treatment of Type 2 diabetes

A

Metformin

75
Q

Metformin was also found to delay the development of

A

type 2 diabetes in high risk individuals

76
Q

Adverse effects of metformin

A

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
Q

When should metformin be discontinued

A

prior to administration of contrast and continued only when renal function has returned to normal

78
Q

Black box warning for metformin

A

Lactic acidosis!

D/C in clinical situations predisposing to hypoxemia

79
Q

Metformin risk of accumulation and lactic acidosis increased with the degree of

A

impairment of renal function

80
Q

Sulfonylureas indication

A

Type 2 DM treatment

81
Q

Sulfonylureas MoA

A

Binds to potassium channels on pancreatic beta cells to stimulate insulin secretion

82
Q

Sulfonylureas may …

A
  • Improve insulin binding to receptors

- `increase number of insulin receptors

83
Q

To use Sulfonylureas individual MUST have a functioning

A

beta cell

84
Q

Sulfonylureas adverse effects

A

hyperinsulinemia
hypoglycemia
weight gain

85
Q

Sulfonylureas examples

A 
chlorproPAMIDE
gliclazide
glimepiride
glipiZIDE
glyBURIDE
TOLAZamide
TOLBUTamide
86
Q

what drugs are combined to make glucovance

A

glyBURIDE + metformin

87
Q

glyBURIDE is a

A

second generation sulfonylurea

88
Q

All 2nd generation sulfonylureas have less

A

drug interactions than 1st generation

89
Q

glyBURIDE moA

A

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
Q

Glyburide can sometimes be used in

A

combination with insulin in type 2 DM

91
Q

Adverse effects of glyburide

A

hyperinsulinemia
hypoglycemia
propensity for weight gain

92
Q

Sulfonamide allergy:

A

chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, & loop diuretics

93
Q

Glinides/Meglitinide derivatives

A

nateglinide (Starlix)

repaglinide (Prandin)

94
Q

Drug combination to make PrandiMet

A

repaglinide + metformin

95
Q

Repaglinide drug class

A

Glinide/meglitinide derivative

96
Q

Repaglinide moA

A

binds to potassium channels on pancreatic beta cells which stimulates the release of insulin from pancreatic β-cells (must have functioning β-cells)

97
Q

Major adverse effects of repaglinide

A
  • Hypoglycemia

- Rapid hepatic metabolism & biliary excretion: caution in patients with liver dysfunction

98
Q

Repaglinide should be caution in patients with

A

liver dysfunction

99
Q

Patient education of repaglinide

A
  • 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
Q

Glitazones examples

A

pioglitazone (Actos)

rosiglitazone (Avandia) [used only rarely today due to  risk of MI & sudden cardiac death]

101
Q

Drug combination of octopus met

A

pioglitazone+ metformin

102
Q

Pioglitazone drug class

A

Thiazolidinedione (glitazone), TZD

103
Q

pioglitazone moA

A

Decrease insulin resistance in muscle and adipose tissue

104
Q

pioglitazone advert effects

A
  • Weight gain
  • Hepatic damage
  • Increase incidence of fractures in female patients treated with rosiglitazone
  • Increase risk of bladder cancer
105
Q

Black box warning for rosiglitazone

A

May cause or exacerbate heart failure

106
Q

Do not give rosiglitazone to patients with

A
  • exacerbate ischemic heart disease

- increased risk of angina and MI

107
Q

Use pioglitazone cautiously In patients with

A

pre-existing diabetic retinopathy

108
Q

Examples of alpha glucosidase inhibitors

A

acarbose (Precose)

miglitol (Glyset)

109
Q

Acarbose drug class

A

Alpha-glucosidase Inhibitor

110
Q

Acarbose moA

A

Delays absorption of dietary CHO which decreases postprandial rise in blood glucose

111
Q

Acarbose acts

A

locally in the gut, only 2% of drug is absorbed , so systemic effects are minimal

112
Q

Instruct patient to take acarbose with

A

first bite of each meal

113
Q

Do not take medications with to within _____ of taking acarbose

A

2 hours

114
Q

Acarbose adverse effects

A

Frequently causes flatulence, cramps, abdominal distention, borborygmus, diarrhea (secondary to bacterial fermentation of unabsorbed CHO in the colon; may diminish over time)

115
Q

Does acarbose cause hypoglycemia?

A

No! Unless its combined with other anti diabetic agents

116
Q

Long term, high dose therapy of acarbose may cause

A

liver dysfunction; monitor liver function tests every 3 months for 1st year

117
Q

Alpha-glycoside inhibitors niether

A

Stimulate nor increase insulin release/action on target tissue

118
Q

Hypoglycemia is only a concern for alpha glucoside inhibitors if

A

Combined with insulin or router oral anti diabetic agents

119
Q

Gliptins examples

A

alogliptin (Nesina)
linagliptin (Tradjenta)
saxagliptin (Onglza)
sitaGLIPtin (Januvia)

120
Q

Drug combination for Janumet

A

sitaGLIPtin + metformin

121
Q

SitaGLIPtin drug class

A

Antidiabetic agent; glisten

122
Q

Sitagliptin moA

A

Inhibits DDP-IV thereby enhancing the effects of incretin hormones which
- DECREASE glucose levels

123
Q

DD-IV is an enzyme that

A

Inactivated incretin

124
Q

Incretin hormones are released from

A

the intestines after a meal

125
Q

Incretin hormones stimulate

A

Please of insulin

126
Q

Incretin hormones suppress

A

glucagon release

127
Q

Sitagliptin adverse effects

A
  • 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
Q

Incretin mimetics Adverse effects

A

GI distress
Injection site irritation
Cases of acute pancreatitis (including hemorrhagic & necrotizing with some fatalities) have been reported; severe & persistent abdominal pain

129
Q

Incretin mimetics boxed warning

A

dose & duration dependent thyroid tumors have developed in animal studies; relevance in humans unknown

130
Q

Pramlintide drug class

A

Amylin mimetic

131
Q

pramlintide indications

A

Adjunctive treatment with mealtime insulin in BOTH type 2 and type 1 diabetics who have not achieved optimal glucose control

132
Q

pramlintide administration

A

SQ

133
Q

pramlintide moA

A

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
Q

Pramlintide boxed warning

A
  • 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
Q

Glucagon moA

A

increase glucose levels by stimulating glycogenolysis

136
Q

How much glucagon is give to unconscious patients to reverse hypoglycemiaa due to insulin overdose

A

0.5 - 1

137
Q

Glucagon administration

A

SC, IM, IV

138
Q

Maximum glycemic response for glucagon is within

A

30 minutes

316 Pharmacology (19 decks)

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