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Pharmacology I - CP > Insulins > Flashcards

Insulins Flashcards

1
Q

Islet of Langerhans secrete

A

insulin, glucagon, somatostatin, pancreatic polypeptide

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2
Q

Beta cells in islet of langerhans synthesize and secrete

A

insulin

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3
Q

alpha cells in islet of langerhans secrete

A

glucagon

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4
Q

glucagon

A

regulates carbs, fats, and protein metabolism

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5
Q

insulin

A

regulates carbs, fats, and protein metabolism

promotes storage of glucose, fatty acids, and amino acids

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6
Q

activation of Na/K ATPase in cell membranes by insulin moves ___

A

K+ into cells and decreases concentration of K+ in plasma

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7
Q

Which organ is primary source of endogenous glucose production following glycogenolysis and gluconeogenesis?

A

liver

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8
Q

What does glucagon stimulate and inhibit?

A

stimulates: glycogenolysis and gluconeogenesis
inhibits: glycolysis

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9
Q

Glycogenolysis

A

glycogen breakdown

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10
Q

blood glucose level range that can be regulated

A

50-300 (narrow)

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11
Q

insulin is released in response to ___

A

beta-adrenergic stimulation or acetylcholine

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12
Q

insulin release is inhibited in response to ___

A

alpha adrenergic stimulation or beta-blockade

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13
Q

insulin resistance

A

impaired intracellular signal decreases the recruitment of proteins that transport glucose to plasma membrane for glucose intake

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14
Q

what inhibits insulin secretion?

A

hypoglycemia, beta adrenergic antagonists, alpha adrenergic agonists, somatostatin, diazoxide, thiazide diuretics, volatile anesthetics, insulin

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15
Q

principle stimulation for glucagon secretion

A

hypoglycemia

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16
Q

glucagon

A

increases blood glucose by stimulating glycogenolysis in liver, activates adenylate cyclase for cAMP formation

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17
Q

type 1 diabetes mellitus

A

autoimmune mediated destruction of pancreatic beta cells, depend on exogenous insulin to regulate metabolism

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18
Q

type 2 diabetes mellitus

A

peripheral insulin resistance with failure to secrete insulin because of pancreatic beta cell dysfunction

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19
Q

elevated blood glucose levels and hypoinsulinemia leads to

A

diabetic myopathy, inhibition of lipase enzyme system, unopposed mobilization of fatty acids, formation of ketones, ketoacidosis, depletion of K

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20
Q

diabetics can have impaired vasodilation that leads to

A

chronic proinflammatory, prothrombotic, and proatherogenic state and vascular complications

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21
Q

diagnosis of diabetes

A

elevated fasting glucose > 126 or HbA1c of 6.5% or higher

for T1DM: glucose >200 and HbA1C>7%

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22
Q

long term complications of diabetes

A

retinopathy, kidney disease, HTN, CAD, peripheral/cerebral vascular disease, neuropathy

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23
Q

treatment for Type 1 DM

A

insulin
basal supplementation + short acting before food absorption
need at least 2 daily SQ injections of intermediate or long acting + rapid acting following meals

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24
Q

Intermediate acting basal insulins

A

NPH, lente, lispro protamine, aspart protamine

twice daily administration

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25
Q

long acting basal insulins

A

ultra lente, glargine, detemir

once daily

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26
Q

short acting insulin

A

regular

meal time

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27
Q

rapid acting insulin

A

lispro, aspart, glulisine

meal time

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28
Q

what is the most commonly used commercial preparation of inuslin?

A

Insulin U-100 (100u/mL)

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29
Q

typical daily exogenous dose of insulin for T1DM

A

0.5-1 u/kg/day (40-80units/day)

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30
Q

onset, peak, duration of rapid acting insulin

A

onset: 5-15 minutes
peak: 45-75 minutes
duration: 2-4 hours

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31
Q

onset, peak, duration of short acting insulin

A

onset: 30 minutes
peak: 2-4 hours
duration: 6-8 hours

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32
Q

onset, peak, duration of intermediate acting insulin

A

onset: 2 hours
peak: 4-12 hours
duration: 18-28 hours

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33
Q

onset, peak, duration of long acting insulin

A

onset: 1.5-2 hours
peak: 3-9 hours, none
duration: 6->24 hours

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34
Q

what preparations are used for continuous insulin pumps?

A

short acting (regular) and rapid acting (lispro, aspart, glulisine)

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35
Q

lispro onset, peak, duration

A

onset: 15 minutes
peak: 45-75 minutes
duration: 2-4hours

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36
Q

administration of regular insulin

A

IV or SQ

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37
Q

five main side effects of insulin

A

hypoglycemia, allergic reactions, lipodystrophy, insulin resistance, drug interactions

38
Q

first symptoms of hypoglycemia are compensensatory effects of ___

A

increased epinephrine secretion

39
Q

first symptoms of hypoglycemia include

A

diaphoresis, tachycardia, HTN, rebound hyperglycemia from SNS activation, mental confusion, seizures, coma

40
Q

prolonged hypoglycemia can lead to

A

irreversible brain damage because the brain depends on glucose for oxidative metabolism

41
Q

severe hypoglycemia treatment

A

50-100mL of 50% glucose IV

0.5-1.0mg IV/SQ glucagon

42
Q

chronic protamine exposure in NPH may stimulate production of antibodies against __

A

protamine (worry aboutin CABG)

43
Q

hormones that counter hypoglycemic effects of insulin

A

adrenocorticotrophic hormone, estrogen and glucagon

44
Q

epinephrine ____ insulin secretion and ____ glycogenolysis

A

inhibits; stimulates

45
Q

which drugs increase duration of action of insulin?

A

tetracycline, salicylates, phenylbutazone

46
Q

four major classes of oral antidiabetic drugs

A

secretagogues, biguanides, thiazolidinediones or glitazones, alpha-glucosidase inhibitors

47
Q

how do sulfonylureas work?

A

stimulate insulin secretion

48
Q

how do biguanides (metformin) work?

A

inhibit glucose production by the liver by activating adenosine monophosphate activated protein kinase

49
Q

contraindications for metformin

A

lactic acidosis, AKI, GI intolerance, acute hepatic disease

50
Q

metformin

A

does not undergo metabolism, not bound to plasma proteins

51
Q

elimination half time of metformin

A

2-4 hours

52
Q

dose of metformin

A

500-1000mg TID with meals

53
Q

when should patients discontinue metformin before surgery?

A

48 hours before surgery

54
Q

do not give metformin to patients with:

A

hepatic dysfunction, renal insufficiency, IV contrast dye, acute MI, CHF, arterial hypoxemia, sepsis

55
Q

in order for sulfonylureas to be successful patients need to have

A

some beta cell function

56
Q

do not administer sulfonylureas if the patient has

A

a sulfa allergy

57
Q

MOA of sulfonylureas (glyburide, glipizide, glimepride)

A

act on sulfonylurea receptors on pancreatic and cardiac cells, inhibit adenosine triphosphate sensitive K+ channels on pancreatic beta cells = Ca2+ influx and stimulation of insulin release

58
Q

glyburide

A

dose: 2.5- 20mg daily
peak: 3 hours
DOA: 18-24 hours
elimination half time: 4.5-12 hours

59
Q

glipizide

A

dose: 5-40mg daily
peak: 1 hour after PO
DOA: 12-24 hours
elimination half time: 4-7 hours

60
Q

glimepiride

A

dose: 2-4 mg daily
DOA: 24+ hours
elimination half time: 5-8 hours

61
Q

meglitinides exert effects on

A

beta cells

62
Q

meglitinides MOA

A

lowers blood glucose by stimulating release of insulin from beta cells

63
Q

nateflinide (starlix) unique characteristic

A

accumulation of active metabolites may cause hypoglycemia

64
Q

difference between repaglinide and nateflinide

A

repaglinide - nateglinide-

minimal kidney excretion excreted by kidney

65
Q

alpha glucosidase inhibitors MOA

A

decrease carbs digestion and absorption of disaccharides by interfering with intestinal glucosidase activity

66
Q

thiazolidinediones MOA

A

act at skeletal muscle, liver, and adipose tissue via peroxisome proliferator activator receptor-gamma to decrease insulin resistance and hepatic glucose production, and to increase use of glucose by liver

67
Q

which patients are thiazolidinediones more effective?

A

obese patients

68
Q

how long does it take to reach clinical effect for thiazolidinediones

A

4-12 weeks

69
Q

when are thiazolidinediones contraindicated?

A

CHF, liver failure

70
Q

glucagon like peptide 1 receptor agonists MOA

A

increase insulin secretion from beta cells, decrease glucagon production from alpha cells and reduce gastric emptying

71
Q

dipeptidyl peptidase 4 inhibitors MOA

A

increase insulin secretion from alpha cells and reduce pancreatic alpha cell secretion of glucagon

72
Q

pramlintide (amylin agonist) MOA

A

suppress gastric emptying, inhibit glucagon release and reduce HbA1C but does not alter insulin levels!

73
Q

goal of combination therapy

A

target two or more causes of hyperglycemia simultaneously

74
Q

primary and secondary aim of combination therapy

A

primary: decrease HbA1c, secondary: decrease in daily insulin dose

75
Q

example of combo therapy

A

metformin (decrease insulin resistance in liver) + sulfonylurea (increased insulin secretion)

76
Q

DM + HTN =

A

50% likelihood of diabetic autonomic neuropathy

77
Q

incidence of periop CV instability is increased by concomitant use of ___

A

angiotensin-converting enzyme inhibitors or angiotensin receptor blockers

78
Q

most T1DM have kidney disease by age

A

30

79
Q

how can you assess diabetic patients for risk of difficult intubation?

A

praying hands, TMJ joint assessement, cervical spine mobility

80
Q

percentage of T1DM that are difficult intubations

A

30%

81
Q

keep glucose level in periop period

A

<180 mg/dL

82
Q

hyperglycemia is associated with

A

hyperosmolarity, infection, poor wound healing, increased mortality

83
Q

“time honored approach”

A

patient takes 2/3 nighttime insulin (NPH/regular) and 1/2 total morning insulin dose intermediate (NPH)

84
Q

on day of surgery what should the patient do about their regular insulin?

A

hold AM dose of regular insulin

85
Q

what should patients do with their continuous pump before surgery?

A

decrease overnight rate by 30% and keep at basal rate for day of surgery

86
Q

if patient takes glargine and lispro/aspart daily

A

take 2/3 glargine dose and entire lispro/aspart night before, hold AM dose

87
Q

insulin infusion

A

add regular insulin to NS ( 1 unit/mL)

start at 0.02 -0.1 unit/kg/hr

88
Q

one unit of regular insulin should lower plasma glucose by __

A

25-30 mg/dL

89
Q

when can patients restart their diabetic meds postop?

A

when resumes PO intake

90
Q

how often should you measure plasma glucose levels when patient is on an infusion vs PO

A

infusion - q30mins-1hour

po - before surgery and after surgery

91
Q

do you shut a continuous pump off for surgery?

A

no

Pharmacology I - CP (8 decks)

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