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Flashcards in Insulin Deck (26)
1

Aspart

Insulin
Rapid

2

detemir

Insulin
Long acting

Modded C-terminal thr B chain deleted and myristic acid added to increase self aggregation and binding to albumin

3

glargine

Insulin
Long acting

Modded A21 from Asn to Gly and two Arg residues at B31 and B32

Makes insulin soluble at acidic pH but precipitates in neutral pH slowing the absorption

4

glulisine

Insulin
Rapid

5

lispro

Insulin
Rapid

6

NPH

Insulin
Intermediate acting

7

regular crystalline insulin

Insulin

Short Acting, wild type insulin

8

exenatide

incretin-like drugs

Incretin agonist

SQ

SE:
- Nausea
- Anorexia
- Headaches
- Diarrhea
- Pancreatitis

9

sitagliptin

incretin-like drugs

Inhibit incretin degradation

Oral (sit and eat)

Incretin stimulates insulin release from B cells and reduces glucagon from A cells

SE:
- Headache
- Increased rate of infections
- Pancreatitis

Lowers postprandial glucose

10

pramlintide

amylin analogs

Amylin hormone made by B cells that inhibit glucagon secretion by A cells

CNS anorectic Effect

SQ

W/insulin useful in type I diabetics

SE:
- hypoglycemia
- nausea
- vomiting
- anorexia

11

chlorpropamide

sulfonylureas:
First Gen
60 h

They

12

glipizide

sulfonylureas
Second Gen
More potent and available
10-24 h

They

13

glyburide

sulfonylureas
2nd Gen
10-24h

They

14

glimepiride

sulfonylureas
2nd gen
10-24h

They

15

tolbutamide

sulfonylureas
1st Gen
6-12h

They

16

repaglinide

meglitinides:

Similiar to sulfonylureas prevent K efflux from B cells increasing insulin production

Chemically unrelated

Binding affinity to K channels higher than sulfonylureas

More potent than sulfonylureas but shorter acting 4-5h

Side effects:
Hypoglycemia

Cautiously use in patients with renal or hepatic insufficiency

17

nateglinide

phenylalanine analogs

Stimulates insulin production by preventing the efflux of K in B cells

Faster response but less sustained

Side Effects:
Hypoglycemia but less pronounced

Safer in reduced renal function patients

18

metformin

biguanides

Oldest insulin drug

Inactivate mito gylcerophosphate dehydrogenase

Antagonize the action of glucagon and/or activate AMP-activated protein kinase

Occur in Liver

Reduce gluconeogenesis and hepatic glucose output

First line therapy in type 2 diabetes

SE:
- GI discomfort
- Lactic acidosis
- Does not induce weight gain or hypoglycemia

19

rosiglitazone

thiazolidinediones

Agonist of PPARy
Increase insulin sensitivity in target tissues

SE:
- weight gain
- fluid retention
- liver toxicity

20

pioglitazone

thiazolidinediones

Agonist of PPARy
Increase insulin sensitivity in target tissues

SE:
- weight gain
- fluid retention
- liver toxicity

21

acarbose

a-glucosidase inhibitors

Reduce intestinal absorption of carbs by inhibiting alpha glucosidases

SE:
- Flatulence
- Diarrhea
- Abd pain

22

miglitol

a-glucosidase inhibitors

Reduce intestinal absorption of carbs by inhibiting alpha glucosidases

SE:
- Flatulence
- Diarrhea
- Abd pain

23

bromocriptine

dopaminergic agents

Stimulates insulin secretion through adrenergic stimulation

24

canagliflozin

inhibitors of glucose reabsorption

Inhibits SGLT2 in Kidney

Inhibit reabsorption promoting glucose excretion of kidney

ORAL

SE:
- UTIs
- Increased Urination

25

Adverse Reaction to Insulin

Hypoglycemia
- Cause overdose or failure to eat
- Treatment: oral glucose, IV glucose, SQ or IM glucagon

Lipodystrophy at site of injection

Insulin allergy and resistance

26

Adverse Reactions to Sulfonylrueas

Hypoglycemia

Resistance

Tachyphylaxis