Insulin and other drugs Flashcards
drugs for type 1 (3)
- insulin
- insulin analogs
- insulin formulaitons
drugs for type 2 (8)
- biguanides
- sulfonylureas
- meglitinides
- thiazolidinediones
- incretins
- gliptins
- glucosindase inhibs
- SGLT2 inhibs
when is normal insulin peak
2-3 hours
what is stucture of insulin
2 chains - A chain of 21AA and B chain of 30AA
3 insulin analogs
- lispro
- aspart
- glulisine
what is advantage of analogs (2)
- fast acting
2. short life- less hypoglycemia
how are analogs made to work faster
don’t aggregate the same way, so pass into blood sooner
what is intermediate acting insulin
NPH insulin - regular with protamine attached
what are 2 long acting insulins
- detemir 12hr- binds to albumin
2. glargine 24hr- preciptates at injection site
when are insulins used
type1 and seomtimes type 2
how does insulin funciton (3)
- GLUT transported
- glucose metabolism
- gene expression
- glycogen synthesis
what happens normally when feeding
insulin up > fuel deposition and utilization
what happens normally when fasting
epi, glucagon, glucocort up > fuel mobilization
what are insuling requirments for peak and basal levels
- peak - handle calories after meal
2. basal - promote utilization of glucose to prevent excessive fuel
5 potential adverse reactions to insulin
- hypoglycemia
- allergy
- local lipodistrophy - due to site of injection
- presbyopia - visual disturbances due to osmotic changes
- edema - Na retention at kidney
what are biguanides (metformin)
acts on AMP protein kinase to cause lower glucose production in liver and in creased muscle uptake
adv and disadv. of biguanides
adv - no hypoglycemia
dis -GI and lactic acidosis
how do sulfonylureas and meglitinides work
- block K channels so get less polar membrane potential
- cell depolarizes
- Ca comes in
- secretes insulin
what is major side effect of sulfonylureas and meglitinides
hypoglycemia - esp sulfonylureas
3 potentiating drug of sulfonylureas and meglitinides
- proprnalol
- sulfonamides
- anti-coagulants
how do thiazolidinediones work
act at PPAR receptors on small fat cells to redistribute fatty acids and improve glucose utilization
SEs of thiazolidinediones (3)
- weight gain
- water retention
- increase risk of MI
how do incretins work (3)
similar to GLP-1 -
- slow gastic emptying
- improve insulin production in B-cells
- decrease glucagon
how do SGLT-2 inhibs work
inhibs. Na-glucose transporter so pee out more glucose
SE of SGLT-2
yeast and UTIs because of all the sugar pee
how do glucosidase inhibs work (2)
- inhibs carb digestion in gut
2. delay glucose uptake in gut
