Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia Pharmacology > Insulin and Oral Hypoglycemics > Flashcards

Insulin and Oral Hypoglycemics Flashcards

1
Q

Where is insulin made?

In what form is it made and what are the steps to become insulin?

A

made in the beta cells of Islets of Langerhans

Preproinsulin->proinsulin->insulin+C-peptide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Insulin leads to increased synthesis of _________, _________., and ___________

A

glycogen, protein and fatty acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Insulin decreases glucose phosphorylation in cells. t/f

A

F, it enhances phosphorylation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name 5 metabolic processes insulin decreases

A 
Glycogenolysis
gluconeogenesis
ketogenesis
lipolysis
protein catabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the main function of insulin?

A

carry glucose across cell membrane?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Aside from monitoring glucose during an insulin infusion, what other lab is important to consider?

A

potassium

insulin drive K intracellular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Insulin is made of 2_________, joined by 3 ___________.

A

amino acid chains

disulfide bonds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Endogenous insulin is metabolized by kidney and liver, and ____% first pass

A

50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the duration of action of endogenous insulin

A

30-60 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the basal rate of insulin production

A

1 u/hour

up to 40 u/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is onset, peak, and duration of Fast acting insulin?

What’s an example?

A

Lispro
Onset 5-15 min
peak 1 hour
Duration: 4-5 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is onset, peak, and duration of regular insulin?

A

Onset: 30 min
Peak 2-3 hours
Duration 6-10 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is onset and duration of NPHt’s an example?

A

Isophane
Onset 2-5 hours
Duration 10-20 hours
Variable peak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is onset and duration of Long acting insulin?

What’s an example?

A

Ultralente
Onset: slow
duration prolonged: 16-20 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are guidelines for insulin preoperatively?

A

cut A.M. insulin in half or cut all of it
DM pts should be first case of the day
or start an IV and check glucose as soon as they come in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the real long acting insulin that doesn’t have much of a peak

A

glargine/lantus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

give 3 examples of bolus insulins and 4 basal insulins

A

Bolus: regular, humalog/lispro, Novolog/aspart (Apidra/glulisine)
Basal; NPH, Lente, Ultralenta, lantus/glargin (Levemir/detemir)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

________ (Bolus/Basal) insulin more accurately reflects endogenous insulin

A

Bolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are uses of regular insulin?

A

Abrupt onset of hyperglycemia
Ketoacidosis
Hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does NPH stand for?

A

Neutral protamine hagedorn

Hagedorn was a danish guy who created NPH insulin

21
Q

How does protamine affect subQ insulin?

A

slows subQ absorption

22
Q

How much protamine in is nph insulin?

A

0.005 mg/u

23
Q

What is the calculation for basal dose or infusion of insulin?

A

(glucose-100)/40

24
Q

What is the calculation for a bolus dose of insulin?

A

glucose/150

25
Q

1 U of insulin lows blood glucose ___________mg/dL

A

25-30

26
Q

What are the side effects of insulin?

A 
Hypoglycemia!!!!!
Allergic rxn
Lipodystrophy 
resistance 
drug interactions
27
Q

What are initial symptoms of hypoglycemia?

A

Diaphoresis
tachycardia
hypertension

28
Q

What is the allergic reaction to insulin etiology?

A

Immune reactions are rare, it is usually a local allergy

protamine

29
Q

What is lipodystrophy?

A

Loss of fat from one area
Lump or small dent in the skin that forms when a person performs injections repeatedly in the same spot.
Can cause rejection or slowed absorption of injected medication
Rotate injection sites

30
Q

What drugs do insulin interact with?

A 
Epinephrine-inhibits insulin release
MAO Inhibitors-inhibits pancreatic islets
Antibiotics
-tetracycline-inhibits insulin release
Salicylates-increase insulin release
31
Q

HOw do sulfonylureas work?

A

Stimulate insulin secretion

hypoglycemia is a risk

32
Q

How do meglitinides work?

A

stimulate insulin secretion

hypoglycemia is a risk

33
Q

How do biguanides work?

A

Inhibit glucose production by liver

metformin

34
Q

What are the alph-glucosidase inhibitors?

A

Slows digestion and absorption of carbohydrates

acarbose

35
Q

Which group of pts would you want you want to avoid sulfonylurea?

A

sulfa allergy

They will be ineffective in type 1 dm

36
Q

Waht is mechanism and site of action of sulfonylurea?

A

Binds to ATP dependent channel on b cells in islets of longerhans
causes an increase in intracellular Ca which results in increased fusion of insulin granulae with the cell membrane

37
Q

What is primary and secondary failure of sulfonylurea?

A

primary-pt never achieve satisfactory response

secondary- pts become resistant

38
Q

______% of sulfonylurea are protein bound

A

90-95% bound to albumen

39
Q

where is sulfonylurea metabolized?

A

liver metabolism

renal excretion

40
Q

Tolbutamide (orinase), Acetohexamide and chlorpropamide are examples of?

A

first gen sulfonylureas

41
Q

Glyburide and glipizide are examples of ?

A

second gen sulfonylureas

42
Q

What drug class does metformin belong to? HOw does it work?

A

biguanide

inhibits gluconeogenesis

43
Q

What is the side effect of metformin?

A

Lactic acidosis

44
Q

Metformin should be held at least _____ hours before surgery

A

12

45
Q

Too much acarbose can induce hypoglycemia. T/F

A

F

46
Q

IN a pt with type II diabetes, what is a strong independent predictor of cardiomyopathy?

A

Hgb A1C levels

47
Q

What is prediabetes range of A1C?

A

5.7-6.4%, whcih corresponds to fasting plasma glucose test 100-125

48
Q

The goal for A1C is less than _____% which is estimated average glucose of ____

A

7%

154

49
Q

A1C measures glucose over the last ____ months

A

3

Anesthesia Pharmacology (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions