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Pharmacology Test 4 Material > Insulin and Oral Antidiabetic Agents > Flashcards

Insulin and Oral Antidiabetic Agents Flashcards

1
Q

What are the two things that happen with insulin deficiency?

A
  1. Anabolic/catabolic balance is disturbed and catabolic reactions prevail
  2. Metabolic changes similar to those that occur during fasting/starvation
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2
Q

Type 1 DM

  1. Common cause
  2. Insulin Level
  3. Treatment
A
  1. Autoimmune destruction of B cells in the pancreas
  2. Very low or undetectable, insulin secretion cannot be stimulated
  3. Has to be treated with insulin (alone or in combination with pramlintide)
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3
Q

Type 2 DM

  1. Cause
  2. Insulin Level
  3. Treatment
A
  1. Decreased responsiveness of peripheral tissues to insulin
  2. Subnormal levels, blunted insulin response upon stimulation
  3. Does not have to be treated with insulin

**90% of cases, often overweight

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4
Q

Gestational DM

  1. Cause
  2. Treatment
  3. Long term outcomes
A
  1. Steroid (progestin and estrogen) induced insulin resistance
  2. Insulin is the only FD approved treatment
  3. Reversible after delivery, but potentially higher likelihood for DM2 later on in life
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5
Q

Drug induced DM-like state

  1. Drugs that cause this
  2. Treatment
A
  1. Glucocorticoids and growth hormone

2. Termination of treatment

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6
Q

Why use BS levels for DM goal treatment?

A

Used as a convenient indicator of all the metabolic abnormalities that occur in DM

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7
Q

Regular Insulin

  1. Human or analog?
  2. Modifier present
  3. Duration
A
  1. Human
  2. None
  3. 4-6hr
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8
Q

NPH Insulin

  1. Human or analog?
  2. Modifier present
  3. Duration
A
  1. Human
  2. Protamine (makes more of it a dimer so slower absorption)
  3. 12-16hr
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9
Q

Rapid acting insulins

  1. Names
  2. Modifiers
  3. Duration
A
  1. Lispro, aspart, glulisine
  2. None
  3. 3-4hrs
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10
Q

Name the three intermediate/long acting insulin analogs and their durations

A
  1. Glargine –> 18-20hrs
  2. Detemir –> 16-18hrs
  3. Degludec –> 20-24hrs
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11
Q

Inhalable Insulin

  1. Name
  2. Type of insulin
  3. Duration
A
  1. Afrezza
  2. Regular Human Insulin
  3. Same as lispro/aspart/glulisine, faster than SQ regular human insulin
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12
Q

Intensive Insulin Therapy

  1. Which patients receive this?
  2. What does it entail?
A
  1. All type 1 and some type 2
  2. Rapid/short acting before meals AND intermediate or long acting once or twice a day
    OR
    Continuous SQ insulin infusion pump –> rapid or regular insulin
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13
Q

Conventional Insulin Therapy

  1. Which patients receive this?
  2. What does it entail?
A
  1. Type 2 diabetics
  2. Constant doses
    - intermediate or long acting once a day
    - several injections at constant doses
    - disposable patch pumps
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14
Q
  1. What are the side effects of insulin therapy?

2. How does exercise affect insulin need?

A
  1. Hypoglycemia and lipodystrophy

2. Increasing exercise decreases insulin need

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15
Q

Name the three sulfonylureas and their duration of action

A
  1. Glipizide –> 12-24 hrs
  2. Glyburide –> 12-24 hrs
  3. Glimepiride –> 12-24 hrs
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16
Q

Name the two meglitinides and their duration of action

A
  1. Repaglinide –> 5-8 hrs

2. Nateglinide –> 2-4 hrs

17
Q

Sulfonylureas and meglitinides

  1. Mechanism of action
  2. Side effects
A
  1. Bind to the K+ channels and act similarly to ATP causing depolarization–> Ca++ comes in and induces insulin release
  2. Hypoglycemia and MANY drug interactions
18
Q

Metformin

  1. Mechanism of action
  2. Side effects
A
  1. Biguanide: Reduces gluconeogenesis –> decreases hepatic glucose output, enhances insulin action, impaired glucagon action
  2. GI discomfort, **Lactic acidosis, Vit B12 deficiency

**COMMON FIRST LINE DRUG FOR DM2

19
Q

Pioglitzaone

  1. Mechanism of action
  2. Side effects
A
  1. Thiazolidinedione: Agonist of PPARy –> intracellular steroid-like receptor that increases insulin sensitivity in target tissue (by regulating gene transcription
  2. **Increased risk of CV disease, **Weight gain
20
Q

Rosiglitazone

  1. Mechanism of action
  2. Side effects
A
  1. Thiazolidinedione: Agonist of PPARy –> intracellular steroid-like receptor that increases insulin sensitivity in target tissue (by regulating gene transcription
  2. **Increased risk of CV disease, **Weight gain, fluid retention and edema
21
Q

Exenatide

  1. Mechanism of action
  2. Side effects
A
  1. Incretin Agonist: Agonists at incretin (GLP-1) receptors on pancreatic B cells and increase glucose-induced insulin release
  2. Nausea, HA, Diarrhea

**SubQ

22
Q

Liraglutide

  1. Mechanism of action
  2. Side effects
A
  1. Incretin Agonist: Agonists at incretin (GLP-1) receptors on pancreatic B cells and increase glucose-induced insulin release
  2. Nausea, HA, Diarrhea

**SubQ

23
Q

Sitagliptin

  1. Mechanism of action
  2. Side effects
A
  1. Incretin Degradation Inhibitor: Inhibit DPP-1 enzyme that degrades endogenous incretins, increasing endogenous incretins and glucose-induced insulin release
  2. Cold symptoms, photophobia, joint pain, ??pancreatitis

**Oral

24
Q

Saxagliptin

  1. Mechanism of action
  2. Side effects
A
  1. Incretin Degradation Inhibitor: Inhibit DPP-1 enzyme that degrades endogenous incretins, increasing endogenous incretins and glucose-induced insulin release
  2. Cold symptoms, photophobia, joint pain, ??pancreatitis

**Oral

25
Q

Pramlintide

  1. Mechanism of action
  2. Side effects
A
  1. Synthetic amylin analog: hormone that acts on a cells to inhibit glucagon secretion and has appetite suppressant effect
  2. Hypoglycemia, N/V

**SubQ

26
Q

Canagliflozin

  1. Mechanism of action
  2. Side effects
A
  1. Na+/glucose co-transporter (SGLT2) inhibitor: inhibit glucose reabsorption in the kidney thus promoting glucose excretion in the urine
  2. UTI**, increased amputation

**Oral

27
Q

Empagliflozin

  1. Mechanism of action
  2. Side effects
A
  1. Na+/glucose co-transporter (SGLT2) inhibitor: inhibit glucose reabsorption in the kidney thus promoting glucose excretion in the urine
  2. UTI**, increased amputation

**Oral

28
Q

What drugs promote hypoglycemia?

A

Ethanol, B-adrenergic antagonists

Salicylates and sulfonylureas

29
Q

What drugs promote hyperglycemia?

A

Glucocorticoids and epinephrine

Clonidine, Ca++ channel blockers, and thiazide diuretics

Pharmacology Test 4 Material (12 decks)

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