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Flashcards in Diabetes Deck (34):
1

Features of regular insulin

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

2

Features of isophane insulin

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

3

Therapeutic use of regular insulin

for pre-meal use, short duration

4

Therapeutic use of isophane insulin

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

5

Rapid and short acting insulin analog

Insulin Lispro

6

What are the therapeutic considerations for insulin lispro

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

7

Slow and short acting insulin analog

Insulin glargine

8

Features that reduce solubility of insulin glargine

formulated with zinc and at acidic pH slows absorption

9

Dosing of insulin glargine

sub cutaneous once daily

10

Considerations for injecting rapid and slow insulin analogs

can be used together, but not mixed before injection

11

Inhaled insulin

Afrezza

12

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

glucagon

13

What is the only novel diabetes drug on the market

Pramlintidine

14

MOA of pramlintidine

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

15

What is the advantage with pramlintidine

decreases gastric emptying and reduces weight gain

16

Therapeutic use/dosing of pramlintidine

only given in combination with normal insulin injected sub

17

What is the prototype sulfonylureas (SUs)

Glimepiride

18

What is the MOA of glimepiride

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

19

Dosing for glimepiride

once daily

20

Metabolism of glimepiride

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

21

What is the MOA of meglitinides

similar to SUs, not very effective

22

What is the prototype for biguanides

metformin

23

What is the MOA of metformin

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

24

Pharmacokinetics of metformin

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