Insulin and other drugs

Question 1

drugs for type 1 (3)

Answer 1

1. insulin
2. insulin analogs
3. insulin formulaitons

Question 2

drugs for type 2 (8)

Answer 2

1. biguanides
2. sulfonylureas
3. meglitinides
4. thiazolidinediones
5. incretins
6. gliptins
7. glucosindase inhibs
8. SGLT2 inhibs

Question 3

when is normal insulin peak

Answer 3

2-3 hours

Question 4

what is stucture of insulin

Answer 4

2 chains - A chain of 21AA and B chain of 30AA

Question 5

3 insulin analogs

Answer 5

1. lispro
2. aspart
3. glulisine

Question 6

what is advantage of analogs (2)

Answer 6

1. fast acting

2. short life- less hypoglycemia

Question 7

how are analogs made to work faster

Answer 7

don’t aggregate the same way, so pass into blood sooner

Question 8

what is intermediate acting insulin

Answer 8

NPH insulin - regular with protamine attached

Question 9

what are 2 long acting insulins

Answer 9

1. detemir 12hr- binds to albumin

2. glargine 24hr- preciptates at injection site

Question 10

when are insulins used

Answer 10

type1 and seomtimes type 2

Question 11

how does insulin funciton (3)

Answer 11

1. GLUT transported
2. glucose metabolism
3. gene expression
4. glycogen synthesis

Question 12

what happens normally when feeding

Answer 12

insulin up > fuel deposition and utilization

Question 13

what happens normally when fasting

Answer 13

epi, glucagon, glucocort up > fuel mobilization

Question 14

what are insuling requirments for peak and basal levels

Answer 14

1. peak - handle calories after meal

2. basal - promote utilization of glucose to prevent excessive fuel

Question 15

5 potential adverse reactions to insulin

Answer 15

1. hypoglycemia
2. allergy
3. local lipodistrophy - due to site of injection
4. presbyopia - visual disturbances due to osmotic changes
5. edema - Na retention at kidney

Question 16

what are biguanides (metformin)

Answer 16

acts on AMP protein kinase to cause lower glucose production in liver and in creased muscle uptake

Question 17

adv and disadv. of biguanides

Answer 17

adv - no hypoglycemia

dis -GI and lactic acidosis

Question 18

how do sulfonylureas and meglitinides work

Answer 18

1. block K channels so get less polar membrane potential
2. cell depolarizes
3. Ca comes in
4. secretes insulin

Question 19

what is major side effect of sulfonylureas and meglitinides

Answer 19

hypoglycemia - esp sulfonylureas

Question 20

3 potentiating drug of sulfonylureas and meglitinides

Answer 20

1. proprnalol
2. sulfonamides
3. anti-coagulants

Question 21

how do thiazolidinediones work

Answer 21

act at PPAR receptors on small fat cells to redistribute fatty acids and improve glucose utilization

Question 22

SEs of thiazolidinediones (3)

Answer 22

1. weight gain
2. water retention
3. increase risk of MI

Question 23

how do incretins work (3)

Answer 23

similar to GLP-1 -

1. slow gastic emptying
2. improve insulin production in B-cells
3. decrease glucagon

Question 24

how do SGLT-2 inhibs work

Answer 24

inhibs. Na-glucose transporter so pee out more glucose

Question 25

SE of SGLT-2

Answer 25

yeast and UTIs because of all the sugar pee

Question 26

how do glucosidase inhibs work (2)

Answer 26

1. inhibs carb digestion in gut

2. delay glucose uptake in gut