Week 1 Drugs and Insulin Analogs Flashcards
What is always the first choice for T2DM treatment after lifestyle changes?
Metformin
For T2DM what time period should you plan to reach your goal for HbA(1c) levels in?
3 - 6 months.
What amino acid is substituted or modified in insulin analogs?
B29
Metformin is a(n)?
Insulin sensitizer.
What are the three rapid acting insulin analogs?
Lispro (Humalog)Aspart (Novorapid)Glulisine (Apidra)
What are the two long acting insulin analogs?
Detemir and Glargine
What are the two intermediate acting insulin analogs?
Humulin-NPHNovolin-NPH
Which type of insulin analogs are cloudy?
The intermediate analogs (Humulin-NPH and Novolin-NPH).
What are some complications of insulin therapy?
- Weight gain- Hypoglycemia- Lipohypertrophy- Insulin allergies
Name two insulin sensitizers.
Metformin & the Thiazolidinediones {TZDs} {Pioglitazone}.
What are some of the properties of Metformin?
- Safe & Cheap- Weight loss- Can be combined with insulin.- Excreted unchanged by the kidney.- Reduces hepatic glucose production.- Enhances insulin stimulated glucose uptake.
Metformin blocks to conversion of lactate to glucose but allows lactate to be oxidized providing there is?
Oxygen; Phenformin blocks both the conversion to glucose and oxidation of lactate.
Metformin may cause CKD (Chronic Kidney Disease). Patients should stop taking metformin if:
- Diarrhea/vomiting/dehydration occurs.- Become bed sick.- Admitted to hospital.
What are some properties of Thiazolidinediones (TZDs)?
- Expensive but effective.- No hypoglycemia- Lower blood pressure- Should NOT be combined with insulin.- Weight gain.
Name two types of insulin secretagogues.
- Sulphonylureas- Meglitnides
What do secretagogues act on?
Potassium ATP channels.
What are some properties of secretagogues?
- Relatively safe.- Prices range from cheap to expensive.- Can be combined with insulin.- May cause hypoglycemia and weight gain.
Name four secretagogues.
Glyburide, Gliclazide, Glimepiride, and Repaglinide.
Name a alpha glucosidase inhibitor.
Acarbose
List some of the properties of acarbose.
- Slows the digestion of oligosaccharides to monosaccharides.- Safe- Poorly tolerated and results in gastrointestinal gas.
What do incretins do?
Incretins are gut hormones which increase insulin secretion.
Name two incretins.
GLP-1 (Glucagon like peptide 1)GIP (Glucose-dependant insulinotropic peptide)
What three primary effects does GLP-1 have on the body?
- Lowers glucose levels.- Increases insulin secretion.***- Lowers glucagon.
Incretin therapies may?
Inhibit GLP-1 breakdown or act as GLP-1 mimetics that are resistant to breakdown.
What are some of the effects of incretin therapies?
- Reduce blood glucose levels.- Low risk of hypoglycemia.- Weight loss- Increase/preservation of beta cell function.- Nausea and vomiting.
What are the effects of an SGLT2 inhibitor?
- Lower blood glucose.- No hypoglycemia.- Weight loss.- Lower blood pressure.- Risk of UTI / Genital infections.
What T2DM antihyperglycemic agent causes flatulence?
The Alpha Glucosidase Inhibitor Acarbose.
What T2DM antihyperglycemic agent precipitates to form microcrystals after injection?
Glargine (Lantus) - a long lasting insulin analog.
What drug has an acylated at B29 to increase self association?
Detemir (Levamir) - a long lasting insulin analog.
Which insulins act faster? Rapid analogs or short-acting analogs?
Rapid analogs.
What are the only cloudy insulin analogs?
The intermediate analogs: Humulin-NPH & Novolin-NPH.
Name the three rapid insulin analogs.
AspartLisproGlulisine
How long is the onset of the rapid analog insulins?
10 - 15 minutes.
After what time do the rapid analog insulins peak?
~1.5 hours.
Over what duration do the rapid analog insulins act?
3 - 5 hours.
Name two short-acting insulin analogs.
Humulin-RNovolin Toronto
How long is the onset of the short-acting insulin analogs?
30 minutes.
After what time do the short-acting insulin analogs peak?
2 - 3 hours.
What is the duration of the short-acting insulin analogs?
6 - 7 hours.
Name two intermediate insulin analogs.
Humulin-NPHNovolin-NPH
What is the onset of the intermediate insulin analogs?
1 - 3 hours.
When do the intermediate insulin analogs peak?
5 - 8 hours.
What duration do the intermediate insulin analogs act over?
10 - 18 hours.
What is a defining characteristic of the intermediate insulin analogs?
They are cloudy.
What would intermediate insulin analogs be used for?
Maintaining basal insulin levels.
Name two long-acting insulin analogs.
DetemirGlargine
What is the onset of the long-acting insulin analogs?
90 minutes.***Note that this is shorter than the intermediate insulin analogs.
When do the long-acting insulin analogs “peak”?
6 - 8 hours; the peak is very small, if present at all.
What is the duration of the long-acting insulin analogs?
20 - 24 hours. {Detemir is 16 - 24 hours}
What would the long-acting insulin analogs be used for?
Maintaining basal insulin levels.
What would the rapid insulin analogs be used for?
Bolus dose insulin.
What would the short-acting insulin analogs be used for?
Bolus dose insulin.
