Diabetes Flashcards

(34 cards)

1
Q

Features of regular insulin

A

physiologic levels of zinc, no protein
readily soluble and rapidly absorbed
onset 1/2 to 1 hour, peak in 2-4h duration of 5-8h
Can be given IV

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2
Q

Features of isophane insulin

A

insulin complexed with the protein protamine at neutral pH (NPH)
Onset 1-2h peak 6-12h duration 18-24h
Cannot be used IV

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3
Q

Therapeutic use of regular insulin

A

for pre-meal use, short duration

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4
Q

Therapeutic use of isophane insulin

A

between meal use, often combined with regular insulin at meal times

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5
Q

Rapid and short acting insulin analog

A

Insulin Lispro

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6
Q

What are the therapeutic considerations for insulin lispro

A

does not dimerize so acts more quickly and has shorter duration. This means that timing for meals is less important and there is less chance of hypoglycemia after meals/missed meals

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7
Q

Slow and short acting insulin analog

A

Insulin glargine

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8
Q

Features that reduce solubility of insulin glargine

A

formulated with zinc and at acidic pH slows absorption

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9
Q

Dosing of insulin glargine

A

sub cutaneous once daily

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10
Q

Considerations for injecting rapid and slow insulin analogs

A

can be used together, but not mixed before injection

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11
Q

Inhaled insulin

A

Afrezza

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12
Q

What is the treatment for severe hypoglycemia where the patient is unconscious

A

glucagon

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13
Q

What is the only novel diabetes drug on the market

A

Pramlintidine

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14
Q

MOA of pramlintidine

A

analog of amylin, peptide hormone release from beta cells along with insulin, which decreases liver glucose production

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15
Q

What is the advantage with pramlintidine

A

decreases gastric emptying and reduces weight gain

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16
Q

Therapeutic use/dosing of pramlintidine

A

only given in combination with normal insulin injected sub

17
Q

What is the prototype sulfonylureas (SUs)

18
Q

What is the MOA of glimepiride

A

block the ATP sensitive channel in islet cells, which leads to calcium dependent release of insulin. Increases insulin release

19
Q

Dosing for glimepiride

20
Q

Metabolism of glimepiride

A

metabolized by liver and excreted by kidney, contraindicated in liver and kidney disease

21
Q

What is the MOA of meglitinides

A

similar to SUs, not very effective

22
Q

What is the prototype for biguanides

23
Q

What is the MOA of metformin

A

activates AMP-K, increases glucose uptake in liver, does not alter insulin level, so no risk of hypoglycemia

24
Q

Pharmacokinetics of metformin

A

2-4 times per day orally, excreted unmetabolized by kidneys, contraindicated in patients with kidney disease

25
Advantages of metformin
does not cause hypoglycemia or weight gain
26
Adverse effects of metformin
Inhibits lactate metabolism, can cause lactic acidosis, especially in patients with impaired liver function Unpleasant GI effects
27
Prototype drugs of Reducers of GI glucose
Acarbose
28
MOA of acarbose
microbial sugars that inhibit sugar metabolism in the gut
29
dosing of acarbose
immediately before meals, always used with other agents
30
Side effects of acarbose
can caused hypoglycemia when in combination with other agents, not on its own Adverse GI effects (farts), especially in combination with metformin
31
Prototype thiazolidinediones
Pioglitazone
32
MOA of Pioglitazone
increases PPAR-gamma activity, increases transcription of insulin responsive genes - decreases gluconeogenesis - increase glucose uptake in muscle and adipocytes
33
Pharmokinetics of pioglitazone
orally effective, taken with food | metabolized by liver, excreted in feces
34
Adverse effects of piogliatazone
hepatotoxicity, cardiovascular