AX Presentation (Antidiabetic)

Question 1

what is the mechanism of action for Glipizide(2)?

Answer 1

• stimulates pancreatic islet cells which causes them to create more insulin
• increases sensitivity to insulin at receptor sites

Question 2

describe absorption of Glipizide

Answer 2

1) rapidly and completely absorbed in the GI tract

2) absorption unaffected by food but causes it to be delayed by 40 minutes

Question 2

describe metabolism of glipizide

Answer 2

may be slowed in patients with renal impairment and renal failure

Question 3

describe excretion of glipizide

Answer 3

may be slowed in patients with renal impairment and renal failure

Question 4

what are the indications for glipizide?

Answer 4

type 2 diabetes mellitus

Question 5

what are the contraindications associated with glipizide?

Answer 5

1) diabetic ketoacidosis
2) sulfonamide sensitivity

Question 6

what is the drug class/action of glipizide?

Answer 6

• antidiabetic agent; blood glucose lowering agent
• alimentary tract and metabolism

Question 7

what is the class/action of NPH/isophane insulin(3)?

Answer 7

• antidiabetic agent (insulin and analogs)
• alimentary tract and metabolism
• intermediate-acting and short-acting human insulin and analog combination

Question 8

what is the mechanism of action for NPH insulin?

Answer 8

• exogenous insulin that functions as a substitute for the endogenous hormone

lowers blood glucose by:
- stimulating glucose uptake in the skeletal muscle and fat
- inhibiting hepatic glucose production
- inhibition of lipolysis and proteolysis
- enhanced protein synthesis

Question 9

what is the therapeutic effect of NPH insulin?

Answer 9

control of hyperglycemia in diabetic patients

Question 10

what are the indications for NPH insulin(2)?

Answer 10

1) diabetes type 1
2) diabetes type 2

Question 11

what are the contraindications associated with NPH insulin?

Answer 11

hypoglycemia

Question 12

describe the absorption of NPH insulin

Answer 12

slower onset and longer duration of action than regular insulin, but not as long as the long-acting insulins

Question 13

what is the metabolism of NPH insulin?

Answer 13

metabolized by the liver, kidneys, spleen, and muscle

Question 14

describe the distribution of NPH insulin

Answer 14

identical to endogenous insulin

Question 15

what are some side effects of NPH insulin(8)?

Answer 15

1) hypoglycemia (can be life-threatening)
2) hypokalemia
3) cutaneous amyloidosis
4) erythema
6) lipodystrophy
7) pruritis
8) swelling

Question 16

what are some side effects of glipizide(8)?

Answer 16

1) photosensitivity
2) rash
3) hypoglycemia
4) hyponatremia
5) constipation
6) cramps
7) thrombocytopenia
8) dizziness

Question 17

what is the class of glucagon?

Answer 17

• pancreatic hormones

Question 18

what is the mechanism of action for glucagon?

Answer 18

1) activates hepatic glucagon receptors which promotes glycogen breakdown in the liver
* releases glucose and increases blood glucose within minutes

2) relaxes smooth muscles in the gastrointestinal tract (temporarily inhibits peristalsis)

Question 19

what are the therapeutic effects of glucagon?

Answer 19

1) increases blood glucose levels

2) relaxation of GI musculature, facilitating radiographic examination

Question 20

what are the indications for glucagon?

Answer 20

1) acute management of hypoglycemia
2) facilitation of radiographic examination
3) betablocker overdose
4) calcium channel blocker overdose

Question 21

describe the absorption of glucagon

Answer 21

well absorbed following IM, intranasal, and SUBQ administration.

• IV maximal glucose concentration: 5-20 minutes
• IM maximal glucose concentration: 30 minutes
• SUBQ maximal glucose concentration: 30-45 minutes
• intranasal maximal glucose concentration: 15 minutes

Question 22

describe the distribution of glucagon

Answer 22

extensively distributed to tissues

Question 23

describe the metabolism of glucagon

Answer 23

extensively degraded by the liver, kidneys, and plasma

Question 24

what is the half-life values (plasma, intranasal, and IM) for glucagon?

Answer 24

* plasma half-life: 8-18 minutes * intranasal half-life: 35 minutes * IM injection half-life: 45 minutes

Question 25

what are the side effects/adverse reactions of glucagon(8)?

Answer 25

1) epistaxis 2) red/itchy/watery eyes 3) itchy throat 4) nasal congestion 5) rhinorrhea 6) sneezing 7) headache 8) cough

Question 26

what is the class/action of insulin glargine (Lantus)

Answer 26

* alimentary tract and metabolism * antidiabetic agents * long-acting human insulin and analogs

Question 27

what is the mechanism of action of insulin glargine (Lantus)?

Answer 27

* binds to insulin receptors stimulating glucose uptake in muscles and adipose tissue and inhibits hepatic glucose production * regulates fat metabolism * regulates protein metabolism

Question 28

describe the absorption of insulin glargine (Lantus)

Answer 28

more stable in acidic conditions

Question 29

what is the onset and duration of action with insulin glargine (Lantus)?

Answer 29

onset: 1-2 hours duration of action: 24 hours

Question 30

describe the metabolism of insulin glargine (Lantus)

Answer 30

1) metabolized primarily in the liver 2) 2 metabolites are formed M1 and M2

Question 31

describe the excretion of insulin glargine (Lantus)

Answer 31

* primarily in kidneys * can be excreted in breast milk

Question 32

what is the half-life of insulin glargine (Lantus)?

Answer 32

unknown

Question 33

what are the indications for insulin glargine(Lantus)?

Answer 33

1) gestational diabetes 2) neonatal diabetes 3) type 1 diabetes 4) type 2 diabetes when lifestyle mods are insufficient

Question 34

what is the mechanism of action with regular insulin?

Answer 34

facilitates the uptake of glucose in muscle and adipose tisssue and inhibits hepatic glucose production

Question 35

what is the routes of regular insulin?

Answer 35

can be SUBQ or IV

Question 36

describe the IV onset and duration of action and peak of regular insulin

Answer 36

onset: 15 minutes peak: 15-30 minutes duration of action: 30-60 minutes

Question 37

describe the onset and peak of regular insulin administered SUBQ

Answer 37

onset: begins approx. 30 minutes after injection peak: 1.5-3.5 hours

Question 38

when is it best to administer regular insulin?

Answer 38

30 minutes before meal

Question 39

describe the metabolism of regular insulin

Answer 39

metabolized by liver, kidneys, and peripheral tissues

Question 40

how is regular insulin excreted?

Answer 40

mostly by the kidneys

Question 41

what are the indication for regular insulin?

Answer 41

1) diabetic ketoacidosis 2) type 1 diabetes 3) type 2 diabetes 4) gestational diabetes 5) neonatal diabetes

Question 42

what are the contraindications for regular insulin?

Answer 42

hypoglycemia

Question 43

what are acting lengths of regular, NPH, and lantus?

Answer 43

regular insulin - short acting NPH - intermediate Glargine (Lantus) - long acting

Question 44

describe the frequency of NPH, regular, and glargine

Answer 44

regular - with meals NPH - 2 times daily BID Lantus - daily QD

Question 45

which insulins can be administered IV?

Answer 45

regular insulin only. lantus and NPH need to be administered SUBQ

Question 46

which insulins are high alert medications?

Answer 46

regular, lantus, and NPH