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Endocrine > Week 1 Drugs and Insulin Analogs > Flashcards

Week 1 Drugs and Insulin Analogs Flashcards

1
Q

What is always the first choice for T2DM treatment after lifestyle changes?

A

Metformin

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2
Q

For T2DM what time period should you plan to reach your goal for HbA(1c) levels in?

A

3 - 6 months.

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3
Q

What amino acid is substituted or modified in insulin analogs?

A

B29

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4
Q

Metformin is a(n)?

A

Insulin sensitizer.

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5
Q

What are the three rapid acting insulin analogs?

A

Lispro (Humalog)Aspart (Novorapid)Glulisine (Apidra)

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6
Q

What are the two long acting insulin analogs?

A

Detemir and Glargine

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7
Q

What are the two intermediate acting insulin analogs?

A

Humulin-NPHNovolin-NPH

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8
Q

Which type of insulin analogs are cloudy?

A

The intermediate analogs (Humulin-NPH and Novolin-NPH).

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9
Q

What are some complications of insulin therapy?

A
  • Weight gain- Hypoglycemia- Lipohypertrophy- Insulin allergies
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10
Q

Name two insulin sensitizers.

A

Metformin & the Thiazolidinediones {TZDs} {Pioglitazone}.

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11
Q

What are some of the properties of Metformin?

A
  • Safe & Cheap- Weight loss- Can be combined with insulin.- Excreted unchanged by the kidney.- Reduces hepatic glucose production.- Enhances insulin stimulated glucose uptake.
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12
Q

Metformin blocks to conversion of lactate to glucose but allows lactate to be oxidized providing there is?

A

Oxygen; Phenformin blocks both the conversion to glucose and oxidation of lactate.

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13
Q

Metformin may cause CKD (Chronic Kidney Disease). Patients should stop taking metformin if:

A
  • Diarrhea/vomiting/dehydration occurs.- Become bed sick.- Admitted to hospital.
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14
Q

What are some properties of Thiazolidinediones (TZDs)?

A
  • Expensive but effective.- No hypoglycemia- Lower blood pressure- Should NOT be combined with insulin.- Weight gain.
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15
Q

Name two types of insulin secretagogues.

A
  • Sulphonylureas- Meglitnides
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16
Q

What do secretagogues act on?

A

Potassium ATP channels.

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17
Q

What are some properties of secretagogues?

A
  • Relatively safe.- Prices range from cheap to expensive.- Can be combined with insulin.- May cause hypoglycemia and weight gain.
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18
Q

Name four secretagogues.

A

Glyburide, Gliclazide, Glimepiride, and Repaglinide.

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19
Q

Name a alpha glucosidase inhibitor.

A

Acarbose

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20
Q

List some of the properties of acarbose.

A
  • Slows the digestion of oligosaccharides to monosaccharides.- Safe- Poorly tolerated and results in gastrointestinal gas.
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21
Q

What do incretins do?

A

Incretins are gut hormones which increase insulin secretion.

22
Q

Name two incretins.

A

GLP-1 (Glucagon like peptide 1)GIP (Glucose-dependant insulinotropic peptide)

23
Q

What three primary effects does GLP-1 have on the body?

A
  • Lowers glucose levels.- Increases insulin secretion.***- Lowers glucagon.
24
Q

Incretin therapies may?

A

Inhibit GLP-1 breakdown or act as GLP-1 mimetics that are resistant to breakdown.

25
Q

What are some of the effects of incretin therapies?

A
  • Reduce blood glucose levels.- Low risk of hypoglycemia.- Weight loss- Increase/preservation of beta cell function.- Nausea and vomiting.
26
Q

What are the effects of an SGLT2 inhibitor?

A
  • Lower blood glucose.- No hypoglycemia.- Weight loss.- Lower blood pressure.- Risk of UTI / Genital infections.
27
Q

What T2DM antihyperglycemic agent causes flatulence?

A

The Alpha Glucosidase Inhibitor Acarbose.

28
Q

What T2DM antihyperglycemic agent precipitates to form microcrystals after injection?

A

Glargine (Lantus) - a long lasting insulin analog.

29
Q

What drug has an acylated at B29 to increase self association?

A

Detemir (Levamir) - a long lasting insulin analog.

30
Q

Which insulins act faster? Rapid analogs or short-acting analogs?

A

Rapid analogs.

31
Q

What are the only cloudy insulin analogs?

A

The intermediate analogs: Humulin-NPH & Novolin-NPH.

32
Q

Name the three rapid insulin analogs.

A

AspartLisproGlulisine

33
Q

How long is the onset of the rapid analog insulins?

A

10 - 15 minutes.

34
Q

After what time do the rapid analog insulins peak?

A

~1.5 hours.

35
Q

Over what duration do the rapid analog insulins act?

A

3 - 5 hours.

36
Q

Name two short-acting insulin analogs.

A

Humulin-RNovolin Toronto

37
Q

How long is the onset of the short-acting insulin analogs?

A

30 minutes.

38
Q

After what time do the short-acting insulin analogs peak?

A

2 - 3 hours.

39
Q

What is the duration of the short-acting insulin analogs?

A

6 - 7 hours.

40
Q

Name two intermediate insulin analogs.

A

Humulin-NPHNovolin-NPH

41
Q

What is the onset of the intermediate insulin analogs?

A

1 - 3 hours.

42
Q

When do the intermediate insulin analogs peak?

A

5 - 8 hours.

43
Q

What duration do the intermediate insulin analogs act over?

A

10 - 18 hours.

44
Q

What is a defining characteristic of the intermediate insulin analogs?

A

They are cloudy.

45
Q

What would intermediate insulin analogs be used for?

A

Maintaining basal insulin levels.

46
Q

Name two long-acting insulin analogs.

A

DetemirGlargine

47
Q

What is the onset of the long-acting insulin analogs?

A

90 minutes.***Note that this is shorter than the intermediate insulin analogs.

48
Q

When do the long-acting insulin analogs “peak”?

A

6 - 8 hours; the peak is very small, if present at all.

49
Q

What is the duration of the long-acting insulin analogs?

A

20 - 24 hours. {Detemir is 16 - 24 hours}

50
Q

What would the long-acting insulin analogs be used for?

A

Maintaining basal insulin levels.

51
Q

What would the rapid insulin analogs be used for?

A

Bolus dose insulin.

52
Q

What would the short-acting insulin analogs be used for?

A

Bolus dose insulin.

Endocrine (2 decks)

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