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ARCHIVED: Pharmacology for Nurse Anesthesia > Exam 4: Diabetes Pharmacology > Flashcards

Exam 4: Diabetes Pharmacology Flashcards

(86 cards)

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1
Q

Two reasons for hyperglycemia in DMII:

A

Lack of insulin production once β cells fail

Cells resistant to insulin action

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2
Q

Insulin produced by:

A

β cells in islets of Langerhans

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3
Q

β cells secrete insulin in response to:

A

↑ circulating glucose

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4
Q

Insulin released as:

A

Proinsulin (precursor)

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5
Q

Structure of insulin:

A

Small protein chain of 21 amino acids linked by two disulfide bridges to a β chain of 30 amino acids

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6
Q

Effects of insulin:

A 
Glucose into cells
Glycogen creation
Uptake of amino acids, Phos, K, Mg
Protein synthesis/inhibited proteolysis
Fatty acid/TG synthesis
↓ lipolysis
DNA/gene regulation
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7
Q

Portal circulation receives basal insulin rate of:

A

1U/hr

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8
Q

With meals, insulin secretion increases:

A

5-10x

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9
Q

Average daily requirement of insulin:

A

40U

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10
Q

ANS influence on insulin secretion:

A

α stimulation ↓ insulin

β and PSNS stimulation ↑ insulin

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11
Q

History of making insulin:

A

Stage 1: insulin extracted from pigs/cows
Stage 2: replaced one ‘wrong’ amino acid to make it identical to human
Stage 3: Make yeast or e.coli produce it instead

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12
Q

Rapid-acting forms of insulin:

A

Lispro (Humalog)
Aspart (Novalog)
Glulisine (Apidra)

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13
Q

Short-acting form of insulin:

A

Regular (Humulin R/Novolin R)

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14
Q

Intermediate-acting form of insulin:

A

NPH (Humulin N/Novolin N)

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15
Q

Long-acting forms of insulin:

A

Glargine (Lantus)
Detemir (Levemir)
Ultralente

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16
Q

Delivery forms for insulin:

A

SQ
IV
Inhaled

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17
Q

Insulin mixtures available:

A

R/NPH

Rapid/NPH

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18
Q

Long-acting insulin used to mimic:

A

Basal insulin rate

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19
Q

Insulin mixture incompatibilities:

A

Do not mix glargine with others

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20
Q

PK of IV regular insulin:

A

E1/2t of IV bolus: 5-10 min
Duration: 30-60 minutes
Metabolized in liver/kidneys by proteolytic enzyme

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21
Q

Insulin’s relatively long duration is due to:

A

Tightly binding to receptors

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22
Q

Formulation to use IV:

A

U-100 (100 units/ml)

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23
Q

Onset/peak/duration of rapid-acting insulin (lispro):

A

Onset: 10-15 min
Peak: 30-60 min
Duration: 3-5 hrs

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24
Q

Onset/peak/duration of short-acting insulin (regular):

A

Onset: 30-60 min
Peak: 1-5 hrs
Duration: 5-8 hrs

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25
Onset/peak/duration of intermediate-acting insulin (NPH):
Onset: 1-2 hrs Peak: 6-10 hrs Duration: 16-20 hrs
26
Onset/peak/duration of long-acting insulin (glargine):
Onset: 2-6 hrs Peak: none Duration: 24 hrs
27
Delivery methods for insulin:
Syringe Pens Jet injectors Insulin pumps
28
A/E of insulin injection:
``` Site rxns Lipodystrophy at site Protamine allergy Weight gain Hypoglycemia!! ```
29
S/s of hypoglycemia:
``` Diaphoresis Tachycardia HTN CNS agitation Seizures Coma ```
30
Drugs that oppose the hypoglycemic effects of insulin:
ACTH Glugacon Estrogens
31
Drug that decreases insulin release/mobilizes glucose:
Epinephrine
32
Drugs that prolong insulin duration:
Tetracycline Chloramphenicol Salicylates
33
Drugs that increase hypoglycemic effects of insulin:
MAOIs
34
In a type I diabetic 1 U will ↓ BG by:
40-50 mg/dL
35
In a type II diabetic 1 U will ↓ BG by:
30-40 mg/dL
36
Advantages of tight periop BG control:
↑ healing | ↓ infection, diuresis, DKA
37
Disadvantages of tight periop BG control:
Hypoglycemia risk without labor intensive monitoring/adjustments
38
Nontight periop managment of diabetes:
D5W @ 100-125cc/hr in 2nd IV 30-50% of normal AM intermediate insulin Check BG q1-2hr, adjust D5W SS insulin for BG > 200-250
39
Tight periop management of diabetes:
D5W @ 100-150cc/hr in 2nd IV 50U regular insulin in 250cc NS piggybacked Insulin rate: (last BG/150)/hr ** BG/100 for steroids, obese, infection Add 20mEq K+ for each liter of glucose infused
40
Tx of hyperkalemia:
10U regular insulin IV 25g glucose 1 amp D50 Over 5 minutes
41
Tx of hypoglycemia:
Conscious: Fast acting oral sugar Anesthetized: 25-50ml D50
42
MoA of sulfonylureas:
Stimulates release of insulin from β cells (binds to ATP sensitive K+ channels that allow depolarization) Enhances β cell sensitivity to glucose Enhances tissue sensitivity to insulin Normalizes hepatic glucose production
43
FBG, A1c reduction with sulfonylureas:
60-70 mg/dL | Up to 2%
44
1st generation sulfonylureas:
Tolbutamide | Chlorpropamide
45
2nd generation sulfonylureas:
Glipizide Glyburide Glimepiride
46
1st vs 2nd generation sulfonylureas:
1st has more drug interactions/SE than 2nd 2nd 100x more potent but no more effective
47
PK of sulfonylureas:
90-98% protein bound | Hepatic metabolism
48
Renal impairment best served by these sulfonylureas:
Glipizide or tolbutamide
49
A/E of sulfonylureas:
GI: nausea, fullness, cholestasis, LFTs, appetite stim GU: ADH-like effect Derm: pruritis, rash Hypoglycemia
50
Pre-op mgmt of sulfonylureas:
Hold 24-48 hrs preop
51
MoA of sulfonylureas:
**Stimulates release of insulin from β cells (binds to ATP sensitive K+ channels that allow depolarization)** Enhances β cell sensitivity to glucose Enhances tissue sensitivity to insulin Normalizes hepatic glucose production
52
Class and MoA of metformin:
Biguanide **Decreases hepatic and renal glucose production** Enhances insulin receptor binding Increases glucose utilization, decreases insulin resistance Requires insulin to work!
53
Clearance of metformin:
Excreted unchanged by kidneys
54
FPG change from metformin:
60 mg/dL | More with sulfonylureas
55
Benefits of metformin:
No weight gain May ↑ HDL, ↓ LDL/TG Hypoglycemia rare
56
A/E of metformin:
GI: diarrhea, metallic taste, nausea Lactic acidosis Rash
57
Contraindications for metformin:
ESRD: ♀ Cr > 1.4, ♂ Cr > 1.5 Hepatic dysfunction CHF, shock, hypoxic pulm disease
58
Examples of thiazolidinediones:
Pioglitazone (Actos) | Rosglitazone (Avandia)
59
MoA of thiazolidinediones:
**Improves insulin sensitivity/decreases insulin resistance** Reduces hepatic glucose production
60
FBG/A1c changes with thiazolidinediones:
FBG ↓ 50 mg/dL | A1c ↓ 1-2%
61
Clearance of thiazolidinediones:
Hepatic metabolism
62
Unique advantage of thiazolidinediones:
Will restore ovulation in women who had stopped due to insulin resistance
63
A/E of thiazolidinediones:
Edema Weight gain Hepatotoxicity
64
Black box warnings for thiazolidinediones:
CHF - cause or exacerbate | Possible MI with rosiglitazone
65
Examples of alpha-glucosidase inhibitors:
Acarbose (Precose) | Miglitol (Glyset)
66
MoA of alpha-glucosidase inhibitors:
Antagonizes enzymes in brush border that digest complex carbs to delay glucose absorption and lower post-prandial hyperglycemia
67
FBG/PPG/A1c changes with alpha-glucosidase inhibitors:
FBG ↓ 25-30 PPG ↓ 60-70 A1c ↓ 0.7 - 0.9%
68
Clearance of alpha-glucosidase inhibitors:
Excreted in stool
69
A/E of alpha-glucosidase inhibitors:
Abdominal pain/distention Diarrhea Flatulence
70
Considerations with alpha-glucosidase inhibitors:
Take with first bite of meal | Caution with IBD, colon ulceration, obstruction
71
Examples of meglitinides:
Repaglinide (Prandin) | Nateglinide (Starlix)
72
MoA of meglitinides:
Stimulates insulin secretion from β cells
73
PK of meglitinides:
Onset and peak: 1 hr | Duration: 4 hrs
74
Administration of meglitinides:
Take 15-30 min before meals Skip meal - skip dose Add meal - add dose
75
A/E of meglitinides:
Hypoglycemia N/V/C/D, heartburn Headache
76
MoA of gliptins:
Inhibit DPP-4, which stimulates GLP-1, which enhances glucose-dependent insulin secretion
77
Example of gliptins:
Sitagliptan (Januvia)
78
PK of sitagliptan:
E1/2t: 12 hours
79
Efficacy of gliptins:
Modest; third-line drug
80
A/E of gliptins:
Rare fatal pancreatitis, anaphylaxis
81
MoA of exenatide:
GLP-1 analog; identical MoA to gliptins
82
A/E of exenatide:
``` N/V Antibody development Pancreatitis (can be fatal) Transplant-requiring renal failure Hypersensitivity Delayed gastric emptying ```
83
MoA of pramlintide:
Analog of amylin that ↓ gastric emptying, glucagon secretion, and ↑ feeling of satiety
84
PK of pramlintide:
Peak: 20 min post-SC injection E1/2t: 49 minutes Metabolized in kidneys
85
Indications for pramlintide:
Enhance insulin effects in DM I/II patients who cannot control well with insulin
86
A/E of pramlintide:
Hypoglycemia Nausea Site rxns Decreased absorption of drugs

ARCHIVED: Pharmacology for Nurse Anesthesia (20 decks)

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