Insulin and Oral Hypoglycemics Flashcards Preview

Anesthesia Pharmacology > Insulin and Oral Hypoglycemics > Flashcards

Flashcards in Insulin and Oral Hypoglycemics Deck (49)
1

Where is insulin made?
In what form is it made and what are the steps to become insulin?

made in the beta cells of Islets of Langerhans
Preproinsulin->proinsulin->insulin+C-peptide

2

Insulin leads to increased synthesis of _________, _________., and ___________

glycogen, protein and fatty acid

3

Insulin decreases glucose phosphorylation in cells. t/f

F, it enhances phosphorylation

4

Name 5 metabolic processes insulin decreases

Glycogenolysis
gluconeogenesis
ketogenesis
lipolysis
protein catabolism

5

what is the main function of insulin?

carry glucose across cell membrane?

6

Aside from monitoring glucose during an insulin infusion, what other lab is important to consider?

potassium
insulin drive K intracellular

7

Insulin is made of 2_________, joined by 3 ___________.

amino acid chains
disulfide bonds

8

Endogenous insulin is metabolized by kidney and liver, and ____% first pass

50

9

What is the duration of action of endogenous insulin

30-60 minutes

10

What is the basal rate of insulin production

1 u/hour
up to 40 u/day

11

What is onset, peak, and duration of Fast acting insulin?
What's an example?

Lispro
Onset 5-15 min
peak 1 hour
Duration: 4-5 hours

12

What is onset, peak, and duration of regular insulin?

Onset: 30 min
Peak 2-3 hours
Duration 6-10 hours

13

What is onset and duration of NPHt's an example?

Isophane
Onset 2-5 hours
Duration 10-20 hours
Variable peak

14

What is onset and duration of Long acting insulin?
What's an example?

Ultralente
Onset: slow
duration prolonged: 16-20 hours

15

What are guidelines for insulin preoperatively?

cut A.M. insulin in half or cut all of it
DM pts should be first case of the day
or start an IV and check glucose as soon as they come in

16

What is the real long acting insulin that doesn't have much of a peak

glargine/lantus

17

give 3 examples of bolus insulins and 4 basal insulins

Bolus: regular, humalog/lispro, Novolog/aspart (Apidra/glulisine)
Basal; NPH, Lente, Ultralenta, lantus/glargin (Levemir/detemir)

18

________ (Bolus/Basal) insulin more accurately reflects endogenous insulin

Bolus

19

What are uses of regular insulin?

Abrupt onset of hyperglycemia
Ketoacidosis
Hyperkalemia

20

What does NPH stand for?

Neutral protamine hagedorn
Hagedorn was a danish guy who created NPH insulin

21

How does protamine affect subQ insulin?

slows subQ absorption

22

How much protamine in is nph insulin?

0.005 mg/u

23

What is the calculation for basal dose or infusion of insulin?

(glucose-100)/40

24

What is the calculation for a bolus dose of insulin?

glucose/150

25

1 U of insulin lows blood glucose ___________mg/dL

25-30

26

What are the side effects of insulin?

Hypoglycemia!!!!!
Allergic rxn
Lipodystrophy
resistance
drug interactions

27

What are initial symptoms of hypoglycemia?

Diaphoresis
tachycardia
hypertension

28

What is the allergic reaction to insulin etiology?

Immune reactions are rare, it is usually a local allergy
protamine

29

What is lipodystrophy?

Loss of fat from one area
Lump or small dent in the skin that forms when a person performs injections repeatedly in the same spot.
Can cause rejection or slowed absorption of injected medication
Rotate injection sites

30

What drugs do insulin interact with?

Epinephrine-inhibits insulin release
MAO Inhibitors-inhibits pancreatic islets
Antibiotics
-tetracycline-inhibits insulin release
Salicylates-increase insulin release

31

HOw do sulfonylureas work?

Stimulate insulin secretion
hypoglycemia is a risk

32

How do meglitinides work?

stimulate insulin secretion
hypoglycemia is a risk

33

How do biguanides work?

Inhibit glucose production by liver
metformin

34

What are the alph-glucosidase inhibitors?

Slows digestion and absorption of carbohydrates
acarbose

35

Which group of pts would you want you want to avoid sulfonylurea?

sulfa allergy
They will be ineffective in type 1 dm

36

Waht is mechanism and site of action of sulfonylurea?

Binds to ATP dependent channel on b cells in islets of longerhans
causes an increase in intracellular Ca which results in increased fusion of insulin granulae with the cell membrane

37

What is primary and secondary failure of sulfonylurea?

primary-pt never achieve satisfactory response
secondary- pts become resistant

38

______% of sulfonylurea are protein bound

90-95% bound to albumen

39

where is sulfonylurea metabolized?

liver metabolism
renal excretion

40

Tolbutamide (orinase), Acetohexamide and chlorpropamide are examples of?

first gen sulfonylureas

41

Glyburide and glipizide are examples of ?

second gen sulfonylureas

42

What drug class does metformin belong to? HOw does it work?

biguanide
inhibits gluconeogenesis

43

What is the side effect of metformin?

Lactic acidosis

44

Metformin should be held at least _____ hours before surgery

12

45

Too much acarbose can induce hypoglycemia. T/F

F

46

IN a pt with type II diabetes, what is a strong independent predictor of cardiomyopathy?

Hgb A1C levels

47

What is prediabetes range of A1C?

5.7-6.4%, whcih corresponds to fasting plasma glucose test 100-125

48

The goal for A1C is less than _____% which is estimated average glucose of ____

7%
154

49

A1C measures glucose over the last ____ months

3