Insulins & Antidiabetics

Question 1

Very Rapid-Acting Insulin

Answer 1

Lispro
Insulin aspart
Glulisine

Question 2

Very Rapid-Acting ONSET

Answer 2

5-15min

Question 3

Very Rapid-Acting PEAK

Answer 3

45-75min

Question 4

Very Rapid-Acting DURATION

Answer 4

2-4hr

Question 5

Rapid-Acting Insulin

Answer 5

Regular

Question 6

Rapid-Acting ONSET

Answer 6

30min

Question 7

Rapid-Acting PEAK

Answer 7

2-4hr

Question 8

Rapid-Acting DURATION

Answer 8

6-8hr

Question 9

Intermediate-Acting Insulin

Answer 9

NPH

Question 10

Intermediate-Acting ONSET

Answer 10

2hr

Question 11

Intermediate-Acting PEAK

Answer 11

4-12hr

Question 12

Intermediate-Acting DURATION

Answer 12

18-28hr

Question 13

Long-Acting Insulin

Answer 13

Detemir

Glargine

Question 14

Long-Acting ONSET

Answer 14

Detemir 2hr

Glargine 1.5hr

Question 15

Long-Acting PEAK

Answer 15

Detemir 3-9hr

Glargine NONE

Question 16

Long-Acting DURATION

Answer 16

Detemir 6-24hr

Glargine 20-24+hr

Question 17

Ultra Long-Acting Insulin

Answer 17

Degludec

Question 18

Ultra Long-Acting ONSET

Answer 18

2hr

Question 19

Ultra Long-Acting PEAK

Answer 19

NONE

Question 20

Ultra Long-Acting DURATION

Answer 20

> 40hr

Question 21

Metformin MOA

Answer 21

Biguanide
Inhibits glucose production by the liver
↓GI glucose absorption
↑insulin sensitivity

Question 22

Metformin Anesthesia Implications

Answer 22

Discontinue 48hr prior to surgery

Monitor for lactic acidosis

Question 23

Sulfonylureas MOA

Answer 23

Stimulate insulin secretion & ↓insulin resistance ↑sensitivity
Sulfonylurea receptors on pancreatic & cardiac cells
Requires some β cell function

Glyburide, Glipizide, Glimepiride

Question 24

Sulfonylureas SE

Answer 24

Hypoglycemia more prolonged & dangerous than d/t insulin

Question 25

Sulfonylureas Anesthesia Implications

Answer 25

Discontinue 24-48hr preop

Question 26

Meglitinide MOA

Answer 26

Stimulate insulin secretion from β cells

Repaglinide & Nateglinide

Question 27

Meglitinide SE

Answer 27

Hypoglycemia risk

Question 28

α Glucosidase Inhibitors

Answer 28

Slow carbohydrate digestion & absorption

Interfere w/ glucosidase activity

Question 29

Thiazolidinedione(TZDs)

Answer 29

Increase sensitivity to insulin for glucose uptake by skeletal muscles & adipose tissue
↓insulin resistance

Question 30

Intraop Blood Glucose Management

Answer 30

Goal <180mg/dL

Question 31

Insulin Infusion

Answer 31

0.02-0.1u/kg/hr

Question 32

1unit Regular Insulin

Answer 32

↓plasma glucose by 25-30mg/dL

Monitor Q 30min-1hr