Insulin Analogues and Anti-Obesity Agents Flashcards

1
Q

What are the five main insulin categories?

A
Short acting
Rapid acting
Intermediate acting
Long acting 
Very long acting
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2
Q

Give time scale of short acting insulin

  • when it starts to work
  • when to inject
  • peak
  • duration of action
A
Works in 30-60 minutes
Inject 15-30 minutes before eating
Peaks at 2-3 hours
Duration of 8-10 hours 
Injected several times a day to cover meals
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3
Q

Give time scale of rapid acting insulin

  • onset of action
  • when to inject
  • peak
  • duration
A

Onset within 5-15 minutes
Inject just before eating
Peaks at 30-90 minutes
Duration of 4-6 hours

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4
Q

Give timings of intermediate acting insulin

  • onset
  • peak
  • duration
  • when to inject
A

Onset of 2-4 hours
Peaks at 4-8 hours
Duration of 12-20 hours
Twice a day, before breakfast and dinner

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5
Q

Give time scale of long and very long acting

  • onset
  • duration
A

Onset of 2-6 hours (slow)

Duration of up to 24 hours

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6
Q

Give benefits of long and very long acting insulin

A

Keeps blood glucose at a more steady state
Reduced chance of nocturnal hypos
Less need for snacking between meals and before bed because there is less of a peak of insulin concentration

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7
Q

Adverse effects of insulin?

A

Hypoglycaemia
Hyperglycaemia
Lipodystrophy from injecting in the same spot (hypertrophy or atrophy)
Painful injections due to acidic solutions
Insulin allergies due to preservatives

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8
Q

What are the different types of insulin?

A

Porcine and bovine

Recombinant DNA technology

  • human short-acting
  • human rapid-acting
  • isophane intermediate acting
  • long-acting basal analogue insulins
  • very long-acting basal analogue insulins
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9
Q

What causes elevation of HbA1c?

A

Glucose non-enzymatically irreversibly glycosylates haemoglobin - rate is proportional to glucose

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10
Q

What is the normal baseline HbA1c?

A

6%

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11
Q

What damage can a HbA1c above 7% cause?

A
Damage of function to 
-renal
-hepatic
-CVS
-neurological 
Due to onset of microvascular disease
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12
Q

Name the two main anti-obesity agents

A

Orlistat

Sibutramine

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13
Q

How does orlistat work?

A

A gastric and pancreatic lipase inhibitor

-reduces dietary fat conversion to fatty acids and glycerol

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14
Q

Major limitations of orlistat?

A

GI disturbance

-includes fatty stools increasing risk of flatus with unpleasant discharge or faecal incontinence

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15
Q

How does sibutramine work?

A

Noradrenaline and serotonin re-uptake inhibitor

  • suppresses appetite
  • reduces hyperglycaemia
  • reduces rate of glucose metabolism
  • may increase thermogenesis
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16
Q

ADRs of sertraline?

A

Increased heart rate

Increased blood pressure