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ESA 5 - Pharmacology > The Pharmacology of Insulin > Flashcards

The Pharmacology of Insulin Flashcards

1
Q

What is the physiological role of insulin?

A
  • Stimulates uptake of glucose into the liver, muscle, and adipose tissue
  • Decreases hepatic glucose output via inhibition of gluconeogenesis
  • Inhibits glycogenolysis
  • Promotes uptake of fats
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2
Q

What would an ideal insulin treatment be able to do?

A

Reinstate the normal daily insulin profile to prevent both hyperglycaemia and hypoglycaemia

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3
Q

What are the types of insulin available?

A
  • Animal porcine and bovine
  • Recombinant DNA technology
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4
Q

What are the types of insulin produced by recombinant DNA technology?

A
  • Human short acting insulins
  • Human rapid acting insulin analogues
  • Isophane intermediate acting insulin
  • Long acting basal analogue insulins
  • Very long acting basal analouge insulins
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5
Q

What has recombinant DNA technology allowed for?

A

The development and production of analogues

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6
Q

What happens to the insulin molecule analogue when it is produced by recombinant DNA technology?

A

Its molecular structure is modified to alter the pharmacokinetic properties, primarily affecting the absorption of the drug from subcutaneous tissue

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7
Q

What region of the insulin molecule is altered in recombinant DNA technology?

A

B26-30 region

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8
Q

Describe the steps in the genetic engineering to produce insulin

A
  1. Plasmid from a bacterium is cut using an enzyme
  2. Human insulin gene is inserted into the plasmic
  3. The engineered plasmid is inserted into the new bacterium
  4. The bacterium divides and starts producing insulin
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9
Q

How do the different types of insulin vary?

A

They exist in various strengths and forms

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10
Q

Give 3 examples of forms that insulin can be

A
  • Vials
  • Cartridges
  • Disposable pens
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11
Q

What is the problem with there being lots of different types of insulin?

A

Very confusimng and liable to prescription errors

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12
Q

What is meant by u100, when considering insulin?

A

100 units of insulin per ml

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13
Q

What is the problem with Humulin R U500 (a form of insulin)?

A
  • It can lead to catastrophic prescription errors if people don’t realise its U500, not U100
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14
Q

How are prescription errors prevented with U200 and U300 insulins?

A

They are now produced with pen delivery systems

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15
Q

What are the main insulin categories?

A
  • Ultrafast acting
  • Rapid acting
  • Short acting
  • Intermediate acting
  • Long acting
  • Very long acting
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16
Q

What is the difference between the main insulin categories?

A

The rate of insulin absorption after injection

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17
Q

How does absorption of insulin into the blood stream occur?

A

Via subcutaneous injection

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18
Q

When did ultra-fast acting insulin gain a UK license?

A

In January

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19
Q

How does the pricing of ultra-fast acting insulin compare to rapid acting insulins?

A

It is the same

20
Q

Give three examples of rapid acting insulins

A
  • Humalog
  • Novorapid
  • Apidra
21
Q

How long does the onset of action take with rapid acting insulins?

A

5-15 minutes

22
Q

When should rapid acting insulins be injected?

A

Just before eating

23
Q

When does the action of rapid acting insulins peak?

A

About 60 minutes after administration

24
Q

What is the duration of action of fast acting insulins?

A

4 to 6 hours

25
Q

Give 4 examples of short acting insulins

A
  • Actrapid
  • Humulin S
  • Hypurin Bovine
  • Porcine Neutral
26
Q

How long does short acting insulin take to work?

A

30 to 60 minutes

27
Q

When does short acting insulin need to be injected?

A

At least 15 to 20 minutes before eating

28
Q

When does the action of short acting insulin peak?

A

2 to 3 hours after taking it

29
Q

What is the problem with the timing of the peak of short acting insulin compared to the administration time?

A

You will get a very high glucose reading after meal, which can increase in the risk of complications over time

30
Q

What is the duration of action of short acting insulin?

A

8 to 10 hours

31
Q

How often does short acting insulin need to be injected?

A

Several times daily, to cover meals

32
Q

Give 3 examples of intermediate acting insulins

A
  • Insulatard
  • Humulin I and Insuman Basal
  • Hypurin Bovine and Porcine Isophane
33
Q

When is the onset of intermediate acting insulin?

A

2 to 4 hours

34
Q

When does the action of intermediate acting insulin peak?

A

4 to 8 hours

35
Q

What is the duration of action of intermediate acting insulin?

A

12 to 20 hours

36
Q

Give two examples of long acting insulins

A
  • Glargine
  • Determir
37
Q

What is the onset of long acting insulins?

A

2 to 6 hours

38
Q

What is the duration of action of long acting insulins?

A

Up to 24 hours

39
Q

Give an example of very long acting insulin

A

Degludec

40
Q

What is the duration of very long acting insulin?

A

50 hours

41
Q

What is an insulin pump therapy?

A

A sensor augmented pump therapy with threshold suspend

42
Q

What are the adverse effects of insulin?

A
  • Hypoglycaemia
  • Hyperglycaemia
  • Lipodystrohy
  • Painful injections
  • Insulin allergies
43
Q

What % of the UK population has diabetes?

A

4-5%

44
Q

What % of those in the UK with diabetes are treated with insulin?

A

30 to 40%

45
Q

How common are insulin errors in the UK?

A

Very common, with prescribing errors in approx. 20% of cases

46
Q

Why are insulin prescribing errors problematic?

A

Too much will lead to hypoglycaemia, and too little will lead to hyperglycaemia

ESA 5 - Pharmacology (28 decks)

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