Insulin Flashcards
Aspart
Insulin
Rapid
detemir
Insulin
Long acting
Modded C-terminal thr B chain deleted and myristic acid added to increase self aggregation and binding to albumin
glargine
Insulin
Long acting
Modded A21 from Asn to Gly and two Arg residues at B31 and B32
Makes insulin soluble at acidic pH but precipitates in neutral pH slowing the absorption
glulisine
Insulin
Rapid
lispro
Insulin
Rapid
NPH
Insulin
Intermediate acting
regular crystalline insulin
Insulin
Short Acting, wild type insulin
exenatide
incretin-like drugs
Incretin agonist
SQ
SE:
- Nausea
- Anorexia
- Headaches
- Diarrhea
- Pancreatitis
sitagliptin
incretin-like drugs
Inhibit incretin degradation
Oral (sit and eat)
Incretin stimulates insulin release from B cells and reduces glucagon from A cells
SE:
- Headache
- Increased rate of infections
- Pancreatitis
Lowers postprandial glucose
pramlintide
amylin analogs
Amylin hormone made by B cells that inhibit glucagon secretion by A cells
CNS anorectic Effect
SQ
W/insulin useful in type I diabetics
SE:
- hypoglycemia
- nausea
- vomiting
- anorexia
chlorpropamide
sulfonylureas:
First Gen
60 h
They
glipizide
sulfonylureas
Second Gen
More potent and available
10-24 h
They
glyburide
sulfonylureas
2nd Gen
10-24h
They
glimepiride
sulfonylureas
2nd gen
10-24h
They
tolbutamide
sulfonylureas
1st Gen
6-12h
They
repaglinide
meglitinides:
Similiar to sulfonylureas prevent K efflux from B cells increasing insulin production
Chemically unrelated
Binding affinity to K channels higher than sulfonylureas
More potent than sulfonylureas but shorter acting 4-5h
Side effects:
Hypoglycemia
Cautiously use in patients with renal or hepatic insufficiency
nateglinide
phenylalanine analogs
Stimulates insulin production by preventing the efflux of K in B cells
Faster response but less sustained
Side Effects:
Hypoglycemia but less pronounced
Safer in reduced renal function patients
metformin
biguanides
Oldest insulin drug
Inactivate mito gylcerophosphate dehydrogenase
Antagonize the action of glucagon and/or activate AMP-activated protein kinase
Occur in Liver
Reduce gluconeogenesis and hepatic glucose output
First line therapy in type 2 diabetes
SE:
- GI discomfort
- Lactic acidosis
- Does not induce weight gain or hypoglycemia
rosiglitazone
thiazolidinediones
Agonist of PPARy
Increase insulin sensitivity in target tissues
SE:
- weight gain
- fluid retention
- liver toxicity
pioglitazone
thiazolidinediones
Agonist of PPARy
Increase insulin sensitivity in target tissues
SE:
- weight gain
- fluid retention
- liver toxicity
acarbose
a-glucosidase inhibitors
Reduce intestinal absorption of carbs by inhibiting alpha glucosidases
SE:
- Flatulence
- Diarrhea
- Abd pain
miglitol
a-glucosidase inhibitors
Reduce intestinal absorption of carbs by inhibiting alpha glucosidases
SE:
- Flatulence
- Diarrhea
- Abd pain
bromocriptine
dopaminergic agents
Stimulates insulin secretion through adrenergic stimulation
canagliflozin
inhibitors of glucose reabsorption
Inhibits SGLT2 in Kidney
Inhibit reabsorption promoting glucose excretion of kidney
ORAL
SE:
- UTIs
- Increased Urination
Adverse Reaction to Insulin
Hypoglycemia
- Cause overdose or failure to eat
- Treatment: oral glucose, IV glucose, SQ or IM glucagon
Lipodystrophy at site of injection
Insulin allergy and resistance
Adverse Reactions to Sulfonylrueas
Hypoglycemia
Resistance
Tachyphylaxis
