Test 2 - L11/12 Diabetics Flashcards
Rapid Insulin: Compare/contrast to endogenous Insulin
and Regular insulin
(do not need to know specifics just know RAPID)
- Rapid insulin readily form monomers in solution V.S Regular Insulin although still classified as a Rapid therapy needs more time to break down into monomers from its hexameric state
-given preprandial/ prior to meal to mimic insulin stimulation via nutrient intake
What is the route of admin for DPP4 inhibitors
A) slow IV infusion
B) syringe
C) Butt chug
D) oral
D) oral
The 2 drugs which were used by celebrities for weight loss (not lizzo tho)
Semaglutide was the main one
tirzepatide also mentioned
A) which of the 3 DPP4 inhib drugs are eliminated through biliary excretion
B) why is this beneficial for diabetic patients
A) Linagliptin eliminated via biliary secretion,
B) Beneficial in diabetic patients since it’s not being eliminated in kidneys. So no dose adjustment is required
(remember that CKD is common in diabetic patients)
Regular Insulin (Intravenous Injection)
Compare/contrast to endogenous Insulin:
- Rate
- Mech
- Regular Insulin is slower than endogenous Insulin but is still considered RAPID
- Delay is caused by Regular insulin forming NON-COVALENT HEXAMERS in solution. (requires time to break into monomers; active form)
*Regular Insulin is only suitable for intravenous use and given preprandial/ prior to meal to mimic insulin stimulation via nutrient intake
1) What was a severe side of DPP4 inhibitors
2) what was a possible side effect of DPP4 and GLP1 drugs but has not yet shown in human data
1) Increased risk of pancreatitis (severe)
2) Pancreatic cancer seen in animals but not in humans so far
Intermediate Insulin:
- Name
- Composition
- cause of time delay
*other concerns about absorption
- NPH Insulin :
- is a suspension of human sequence insulin aggregated with protamine and zinc
- protamine and Zinc are aggregates causing delayed activity
-Intermediate and Long acting insulin mimic 24hr basal insulin secretion
** NPH action is unpredictable bc of variable rate of absorption. You can also find drugs which come as a mix of regular and NPH insulin
1) what is the usual 1st line treatment in T2DM IF the patient does not suffer from any renal deficiencies.
2) what happens if the person suffers from renal impairment and cannot eliminate the drug from their body
****
(This is Black box I forgot to mention on the main card)
1) Metformin
2) Metabolic acidosis
Long Insulin (3)
- names
- Why does it take longer/ Administration
(2 act similar, 1 has its own mechanism)
- purpose
Insulin: Glargine, Detemir, Degludec
A) Glargine soluble at pH 4 but poorly soluble at pH7
making it take longer to solubilize staying in system longer.When injected SUBCUTANEOUSLY forms fine precipitant in interstitial fluid.
B) Both Detemir and Degludec are insulin administrations prolonged by binding to albumin in the blood. (normal insulin is never bound)
C) Intermediate and Long acting insulin mimic 24hr basal insulin secretion
Metformin
A) class
B) mechanism
C) use
D) Sides/metabolism
A) Biguanide drug
B) Inhibits Gluconeogenesis in Liver
-* Unlike insulin does not cause Hypoglycemia or Weight Gain (Sulfonylureas/Insulin = fat)
C) **most common 1st LINE THERAPY for T2DM
D) Bc Metformin is 100% excreted by Kidneys as active compound it should be used with caution in patients with decrease GFR/CKD why?
** BC improper elimination of Metformin can lead to increased metabolic acidoses
** Since Metformin acts locally on liver it affects hepatic metabolism of lactic acid = accumulation
(do not confuse this with drug being metabolize by liver. it is not)
** GI side effects of nausea, diarrhea
Aside from controlling/lowering blood glucose through stimulation of B cells and inhibiting gluconeogenesis what were the other 2 unique positive benefits (1 of is tech a side effect)
DRUG: GLP1-agonist
2) 1) benefit is that is cardio protective
2) Unique side is its effect on CNS for feeling of satiety
Glyburide, Glimepiride, Glipizide
A) class
B) use/requirements
C) MECH
A) Sulfonylurea drugs; But also Insulin Secretagogues
B) Used in early T2DM If Metformin alone cannot control blood Glucose and require functioning B cells
(useless in T1D)
C) Blocks K+ channelse making inside of cell more positive leading to Ca+ Channel depolarization. Ca+ leads to B- Cell depolarization and INSULIN secretion
These 2 drugs are both responsible for side effects of Nausea/ vomiting , Diarrhea and GI effects
Metformin and GLP-1 ( glp1 only nausea/vomit)
Sulfonylureas:
Glizipide: 1/2 life; admin when
+ general side effects (including the other sulfur drugs)
Glizipide -Shortest half life and administered pre-prandial
Sulfonyl Side Effects:
- weight gain -> increased appetite **
- Hypoglycemia
- Sulfer allergy
- increased CV mortality **
Repaglanide
A) class (alt drug)
B) mechanism
C) use
D) side
A) Alternative to Sulfonylurea drugs
(which also enhance B-cell insulin release; secretagogue)
B) They inhibit K ATP channels in B cells for insulin release via depolarization through ca+ mech
C) They can be used as an alternative T2DM drug in patients who may have Sulfer allergy
D) Hypoglycemia