Martin pharm DM Flashcards by Amanda Beach

What are the rapidly acting insulin preparations

insulin lispro
insulin aspart
insulin glulisine

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what are the short acting insulin preparations

regular R- human

“humilin R and Novolin R”

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what are the intermediate acting insulin preparations

NPH (N) isophane insulin suspension

“humilin N and novolin N”

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what are the long acting insulin preparations

insulin glargine “lantus”

insulin detemir “levemir”

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what are the mixed insulins

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

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what are biguanides used for and name of drug

antihyperglycemic

metformin

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what are sulfonylureas used for and drug names

stimulate insulin secretion
glimepiride
glipizide
glyburide

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

stimulate insulin secretion
repaglinide
nataglinide

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what are the thiazolininediones used for and drug names

insulin sensitizers

piolitazone

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what are the alpha glucosidase inhibitors used for and drug names

preven complex carbohydrate hydrolysis and delay carbohydrate absorrption
acarbose
miglitol

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

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

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what drugs do we have that mimic amylin

pramlintide

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what happens to proinsulin in golgi

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

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what is important about the various crystallizations of insulin

determines how fast the crystals dissolved after subcutaneous injection

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what form of insulin is absorbed

insulin free in solution

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what determines rate of onset and duration of insulin preparations

the rate of dissolution of insulin crystals with local blood flow

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principal stimulus of insulin secretion

glucose

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what senses the plasma [ ] of glucose

langerhans B cells

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what sympathetic Receptors control insulin secretion

alpha2 inhibit insulin secretion

beta 2 and vagal nerve stimulate insulin secretion

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what allows for release of insulin into the blood

what occurs in a healthy patient with constant infusion of glucose

2 phases of insulin secretion

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

both phases are missing in type I

the first phase is missing in DM II

where does degradation of insulin occur

liver and kidney

how long does insulin last in the blood

half life 5-8 minutes

target tissues for glucose homeostasis

liver, muscle, fat

insulin inhibits what processes

breakdown of glycogen, fat and protein

describe timing of each of the actions of insulin

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

what type of R is insulin

tyrosine kinase

how does glucose enter cells

GLUT R

how does insulin stimulate glucose transport

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

what transporter may contribute to DM II

GLUT2

how is pancreatic function in DM II

low or normal or high levels insulin.

Family Hx DM I? DM II

DM I not strong | DM II strong

Tx DM I

insulin | diet and exercise

how is subcut insulin different than physiologic

1- kinetics do not match response to ingestion of nutrients | 2- diffuses into peripheral circulation, not portal

indications fo insulin therapy

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

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

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

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

regular, aspart, glulisine, lispro

variability of insulin kinetics is mostly due to what

rates of SQ absorption and SQ blood flow

what is exubera

inhaled insulin

what is a single daily dose regimen

single daily dose of an intermediate acting insulin

what is split-mixed regimen

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

what is split mixed regimen with delayed evening dose

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

What is the intensive insulin therapy

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

What is split mix insulin therapy dosing

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)

what makes evening dose of insulin so importnat

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

what insulin is used to meet postprandial demand

rapid acting insulin

What factors affect insulin absorption

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