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endoII exam2 > Martin pharm DM > Flashcards

Martin pharm DM Flashcards

1
Q

What are the rapidly acting insulin preparations

A

insulin lispro
insulin aspart
insulin glulisine

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2
Q

what are the short acting insulin preparations

A

regular R- human

“humilin R and Novolin R”

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3
Q

what are the intermediate acting insulin preparations

A

NPH (N) isophane insulin suspension

“humilin N and novolin N”

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4
Q

what are the long acting insulin preparations

A

insulin glargine “lantus”

insulin detemir “levemir”

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5
Q

what are the mixed insulins

A

NPH/regular mixture
NPL/humalog mixture
NPA (Aspart protamine) / aspart

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6
Q

what are biguanides used for and name of drug

A

antihyperglycemic

metformin

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7
Q

what are sulfonylureas used for and drug names

A

stimulate insulin secretion
glimepiride
glipizide
glyburide

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8
Q

what are the non-sulfonylurea secretagogues used for and drug names

A

stimulate insulin secretion
repaglinide
nataglinide

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9
Q

what are the thiazolininediones used for and drug names

A

insulin sensitizers

piolitazone

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10
Q

what are the alpha glucosidase inhibitors used for and drug names

A

preven complex carbohydrate hydrolysis and delay carbohydrate absorrption
acarbose
miglitol

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11
Q

what are the glucagon like peptide 1 agonists used for and drug names

A

potentiate glucose dependent insulin secretion, suppress glucagon secretion, gastric emptying and promote satiety
exenatide

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12
Q

what drugs do we have that mimic amylin

A

pramlintide

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13
Q

what happens to proinsulin in golgi

A

packaged in secretory granules along with the enzymes that remove the connecting peptide to form insulin

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14
Q

what is important about the various crystallizations of insulin

A

determines how fast the crystals dissolved after subcutaneous injection

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15
Q

what form of insulin is absorbed

A

insulin free in solution

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16
Q

what determines rate of onset and duration of insulin preparations

A

the rate of dissolution of insulin crystals with local blood flow

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17
Q

principal stimulus of insulin secretion

A

glucose

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18
Q

what senses the plasma [ ] of glucose

A

langerhans B cells

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19
Q

what sympathetic Receptors control insulin secretion

A

alpha2 inhibit insulin secretion

beta 2 and vagal nerve stimulate insulin secretion

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20
Q

what allows for release of insulin into the blood

A

Ca

21
Q

what occurs in a healthy patient with constant infusion of glucose

A

2 phases of insulin secretion

22
Q

what occurs to the phases of insulin release in DM I? DM II?

A

both phases are missing in type I

the first phase is missing in DM II

23
Q

where does degradation of insulin occur

A

liver and kidney

24
Q

how long does insulin last in the blood

A

half life 5-8 minutes

25
Q

target tissues for glucose homeostasis

A

liver, muscle, fat

26
Q

insulin inhibits what processes

A

breakdown of glycogen, fat and protein

27
Q

describe timing of each of the actions of insulin

A

phosphorylation-dephosphorylation of enzymes is sec- minutes
transcription translation effects- hours
changes in cellular proliferation and differentiation- days

28
Q

what type of R is insulin

A

tyrosine kinase

29
Q

how does glucose enter cells

A

GLUT R

30
Q

how does insulin stimulate glucose transport

A

promotes energy dependent translocation of intracellular vesicles that contain GLUT4 to the plasma membrane

31
Q

what transporter may contribute to DM II

A

GLUT2

32
Q

how is pancreatic function in DM II

A

low or normal or high levels insulin.

33
Q

Family Hx DM I? DM II

A

DM I not strong

DM II strong

34
Q

Tx DM I

A

insulin

diet and exercise

35
Q

how is subcut insulin different than physiologic

A

1- kinetics do not match response to ingestion of nutrients

2- diffuses into peripheral circulation, not portal

36
Q

indications fo insulin therapy

A

all types I DM
DM II not controlled by diet and/or oral hypoglycemic agents
patients after pancreatectomy or gestational DM
management diabetic ketoacidosis
Tx hyperglycemic, nonketotic coma
perioperative management Type I and II patients

37
Q

time of onset aciton, peak effect and duration of action of insulin depends on what

A

dose, anatomic site of injection, method Sq or IV, local blood flow, body temp, level of physical activity and degree of R

38
Q

what insulin preparations can be used as IV infusions or subcutaneous infusion pumps

A

regular, aspart, glulisine, lispro

39
Q

variability of insulin kinetics is mostly due to what

A

rates of SQ absorption and SQ blood flow

40
Q

what is exubera

A

inhaled insulin

41
Q

what is a single daily dose regimen

A

single daily dose of an intermediate acting insulin

42
Q

what is split-mixed regimen

A

pre breakfast and pre supper injection of mixture of regular and intermidiate acting insulin

43
Q

what is split mixed regimen with delayed evening dose

A

evening dose of NPH insulin is delayed until bedtime to increase amount of insulin available until the next morning

44
Q

What is the intensive insulin therapy

A

1:1 basal:bolus ratio SQ
basal is glargine or detemir
bolus is rapid acting insulin or regular before each meal

45
Q

What is split mix insulin therapy dosing

A

1- 2/3 total dose before breakfast (2/3 NPH 1/3 regular)
2- 1/3 total dose later in day: (1/3 regular before dinner
2/3 NPH at bedtime)

46
Q

what makes evening dose of insulin so importnat

A

normal and diabetic patients have increased requirement o finsulin the the early morning

47
Q

what insulin is used to meet postprandial demand

A

rapid acting insulin

48
Q

What factors affect insulin absorption

A

site of injeciton, type of insulin, SQ blood flow
regional muscle activity at injections site, colume and concentration of injected insulin
depth of injection, mixing of regular insulin with NPH or NPL can slow absorbtion

endoII exam2 (18 decks)

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