Brainscape's Knowledge GenomeTM

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


See full index

PHCY 310 > L 34.2 > Flashcards

L 34.2 Flashcards

1
Q

What is the goal of all insulin treatment?

A

To mimic the healthy pancreas’ way of secreting insulin to the bloodstream

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

Insulin consists of … amino acids that form … polypeptide chains, and these … chains are linked by … bridges

A

Insulin consists of 51 amino acids that form 2 polypeptide chains, and these 2 chains are linked by disulfide bridges

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

What are 5 examples of therapeutic insulins?

A

Beef, pork, human, human analogues, human recombinants

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

What is the Quick overview of insulin production by recombinant DNA tech?

A

Gene is cloned into the plasmid and then transfected

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

What is the standard route for the administration of insulin?

A

Subcutaneous as the diffusional barrier provides a delayed release and sustained release as the insulin has to partition or diffuse across the tissue to get to the vascular system.

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

Why not the oral, IV or IM route?

A

Oral: peptide will get broken down in stomach
IV: Good spike but cleared quickly from blood - not sustained
IM: close to blood vessels so are getting responses between IV and SC. Not as long lasting as SC
The best route of administration of insulin is SC

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

What are the 3 examples of insulin delivery devices?

A

Needle and Syringe, injectable pen, insulin pump (continuous delivery)

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

How does insulin form a stable structure?

A

Insulin forms a hexamer structure around Zn2+

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

When insulin enters into the human SC tissue, it ………?

A

When insulin enters into the tissue, it dissociates into dimers and then into monomers.

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

Can insulin monomers or dimers diffuse into the capillaries?

Can monomers reassociate? Can dimers?

A

Both insulin and monomers can dissolve into the capillary, but dimers have limited diffusion compared to monomers which have rapid diffusion.
Dissociation/reassociation: Hexamer Dimer Monomer

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

What are the Limitations of regular human insulin?

A
  • Injections required 30-45 mins before meals = patient inconvenience (coordination required), safety concerns (hypo/hyper) if meal not eaten when scheduled.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are examples of rapid acting insulin?

A 
Insulin lispro (Humalog)
Insulin aspart (Novolog)
Insulin glulisine (Apidra)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is an example of short acting insulin?

A

Regular insulin

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

What is an example of intermediate acting insulin?

A

Neutral Protamine Hagedorn Insulin (NPH) aka isophane insulin.

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

What is an example of long acting insulin?

A

Insulin glargine (Lantus)

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

How are insulins categorized?

A

First by length of action

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

Factors influencing the insulin effect x4. How do they affect it?

A

Temperature - increased heat (e.g shower, sauna) = inc BF = faster absorption absorption
Injection site - Rate = Abdominal > buttocks > thigh because … has higher vasculature
Massaging injection site - increased BF = increased absorption
SC fat thickness - thicker fat layer = slower absorption

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

Rapid fast acting insulin profile

A
  • Onset 15 mins
  • Peak 1 hour
  • Lasts 2-4 hours
  • Taken directly prior to a meal with long acting insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Short-regular acting insulin profile

A
  • Onset 0.5-1 hour
  • Peak 2-3h
  • Lasts 6-8h
  • Given before a meal with long acting insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Intermediate acting insulin profile

A
  • Onset 2-4h
  • Peak 4-8h
  • Lasts 12-18h
  • Taken 2x a day + short/rapid acting insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Long acting insulin profile

A
  • Onset several hours
  • No ‘peak’ as such, but steady effect
  • Lasts 24h
  • Often given in combo with rapid/short acting insulin.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the brand names for these generics:

A 
Insulin Aspart
Insulin Glulisine
Insulin Lispro
Insulin aspart - novorapid
Insulin glulisine - apidra
Insulin lispro - humalog
23
Q

Onset of most rapid acting insulins
Duration of action
When to take rapid acting insulins

A

15 mins (10-20 mins)
Up to 5 hours
Take immediately before a meal or w/in 20 mins of starting a meal

24
Q

Why does rapid lispro (humalog) work quicker than soluble human insulin?

A

What changes were made?
It blocks the reformation of insulin dimer and hexamers.
Recombinant DNA tech reverses the final lysine and proline.

25
Q

Rapid insulin lispro is only absorbed as…?

A

Rapid insulin lispro is only absorbed as monomers

Why does Insulin apart (rapid novolog) work quicker than human insulin?

26
Q

What changes were made?

A

It works quicker by having a reduced tendency to form hexamers.
Changed by exchanging proline for aspartic acid (changing 1 amino acid)

27
Q

Rapid insulin MoA

What does this make the absorption curve look like?

A

Prevent self association of the monomers into dimers and dimers into hexamer forms.
Faster onset, faster peak, shorter duration

28
Q

Components of insulin aspart?

A

Zinc ion, buffer, preservatives (phenol), isotonicity agents

29
Q

Short acting insulin reaches the bloodstream … after injection, peaks …. after injection and is effective for …. after injection?

A

Short acting insulin reaches the bloodstream 0.5-1 hour after injection, peaks 2-3h after injection and is effective for 6-8h after injection

30
Q

What is the generic and 2 brand names for short acting insulin?

A

Short acting insulin = human neutral insulin.
2 brands = actrapid and humulin R
Onset of action for short acting insulin

31
Q

What is the Duration of action of short acting insulin?

A

When to take short acting insulin
Onset: 30 mins
Duration: 6-8h
When to take: 30 mins before a meal

32
Q

MoA of short acting insulin?

A

Same as regular human insulin: hexamer dimer monomer —> blood vessel.
Dimer can also be absorbed.

33
Q

Intermediate acting insulin reaches the bloodstream… after injection, peaks …. after injection and is effective for … after injection?

A

Intermediate acting insulin reaches the bloodstream 2-4h after injection, peaks 4-8 hours after injection and is effective for 12-18h after injection

34
Q

What is the generic and 2x brand names for intermediate acting insulin?

A

Intermediate acting insulin = Insulin isophane human

Brand names: Humulin NPH and Protaphane

35
Q

What is the onset of action for intermediate acting insulin?

Is NPH or protaphane longer?

A

60 - 90 mins

Protaphane = 90 mins. NPH = 60 mins

36
Q

What is the duration of action for intermediate acting insulin?
When do you take it?

A

Duration: 16-24 hours

Take it at the same time every day

37
Q

What does NPH insulin stand for?

A

Neutral protamine Hagedorn.
Neutral = pH 7
Protamine (suspension)
H = Hans Hagedorn (researcher)

38
Q

What changes to NPH have been made?
What does the solution look like?
What do you need to do before drawing from the vial?

A

NPH is made by mixing regular insulin and fish protein (protamine) reduces absorption and increases duration of action.
Hazy solution (suspension)
Need to roll a vial between pals to thoroughly mix before drawing from it.

39
Q

Delayed release due to insulin being negatively charged at 7.4 so the insulin hexamers form a protamine-insulin complex. These particles make up the suspension and have a slow dissociation back into hexamers then into dimers and monomers.

A

What is the mechanism of action for intermediate acting insulin?

40
Q

Long acting insulin starts working … after injection and works for approximately …

A

Long acting insulin starts working 2-4 hours after injection and works for approximately 24 hours.

41
Q

What are some generic names for long acting insulin and their matching brand name?

A

Insulin degludec - Tresibla
Insulin detemir -levemir
Insulin glargine - lantus

42
Q

When is steady state reached for long acting insulin?

A

Duration of action

43
Q

When to take?

A

Steady state reached after 2-4 hours.
Duration: up to 24h
Take same time daily (tresiba = od, levemir and lantus bd)

44
Q

Is lantus a human insulin analogue?

What is MoA?

A

Yes, lantus is a human insulin analogue.

MoA: Lantus uses pH to form micro-precipitates under the skin, so the micro-crystals slowly release insulin for ~24h

45
Q

How does insulin glargine differ from human insulin?

A

Human insulin has replaced asparagine with glycine. This change shifts the isoelectric point and makes the insulin more soluble at an acidic pH, and less soluble @ 7.4.

46
Q

What does the isoelectric shift also allow for?

A

Allows for the subcutaneous injection of a clear solution.

47
Q

What impact does change the isoelectric shift have on the injection profile?

A

Injecting the acidic insulin solution under the skin (pH 7.4) means there will be a precipitation of crystals. This causes a slow dissociation from crystals into hexamers, dimers, and monomers, therefore, achieving a long-acting insulin profile.

48
Q

What is an insulin mixture called?

A

Biphasic insulins

49
Q

What are the generic names (and corresponding brand names) for biphasic insulins?

A

Biphasic insulin lispro (Humalog Mix25, Humalog Mix50)
Biphasic isophane insulin (Humulin 30/70, Mixtard, Penmix)
Biphasic insulin apart (NovoMix30)

50
Q

What is the general onset time for insulin mixtures?

A

10-30 minutes

Biphasic isophane insulin = 30 minutes

51
Q

What is the duration of action for biphasic insulins?

When do you take biphasic insulin lispro/biphasic insulin apart and biphasic isophane insulin?

A

Up to 24 hours
Biphasic insulin lispro and biphasic insulin apart: Same time each day, immediately before a meal.
Biphasic isophane insulin: 30 mins before a meal

52
Q

Premix insulin analogs mimic…..

A

Premix insulin analogs mimic physiological insulin secretion

53
Q

Mixture-insulins can vary in the … of the …

A

Mixture-insulins can vary in the fraction of the two types of insulin used

54
Q

The use of premixed pens is viewed … by patients.

However, they are … common

A

The use of premixed pens is viewed positively by patients. However, they are less common.

PHCY 310 (65 decks)

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