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Pharmacology I - CP > Insulins > Flashcards

Insulins Flashcards

1
Q

Islet of Langerhans secrete

A

insulin, glucagon, somatostatin, pancreatic polypeptide

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2
Q

Beta cells in islet of langerhans synthesize and secrete

A

insulin

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3
Q

alpha cells in islet of langerhans secrete

A

glucagon

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4
Q

glucagon

A

regulates carbs, fats, and protein metabolism

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5
Q

insulin

A

regulates carbs, fats, and protein metabolism

promotes storage of glucose, fatty acids, and amino acids

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6
Q

activation of Na/K ATPase in cell membranes by insulin moves ___

A

K+ into cells and decreases concentration of K+ in plasma

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7
Q

Which organ is primary source of endogenous glucose production following glycogenolysis and gluconeogenesis?

A

liver

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8
Q

What does glucagon stimulate and inhibit?

A

stimulates: glycogenolysis and gluconeogenesis
inhibits: glycolysis

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9
Q

Glycogenolysis

A

glycogen breakdown

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10
Q

blood glucose level range that can be regulated

A

50-300 (narrow)

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11
Q

insulin is released in response to ___

A

beta-adrenergic stimulation or acetylcholine

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12
Q

insulin release is inhibited in response to ___

A

alpha adrenergic stimulation or beta-blockade

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13
Q

insulin resistance

A

impaired intracellular signal decreases the recruitment of proteins that transport glucose to plasma membrane for glucose intake

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14
Q

what inhibits insulin secretion?

A

hypoglycemia, beta adrenergic antagonists, alpha adrenergic agonists, somatostatin, diazoxide, thiazide diuretics, volatile anesthetics, insulin

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15
Q

principle stimulation for glucagon secretion

A

hypoglycemia

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16
Q

glucagon

A

increases blood glucose by stimulating glycogenolysis in liver, activates adenylate cyclase for cAMP formation

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17
Q

type 1 diabetes mellitus

A

autoimmune mediated destruction of pancreatic beta cells, depend on exogenous insulin to regulate metabolism

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18
Q

type 2 diabetes mellitus

A

peripheral insulin resistance with failure to secrete insulin because of pancreatic beta cell dysfunction

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19
Q

elevated blood glucose levels and hypoinsulinemia leads to

A

diabetic myopathy, inhibition of lipase enzyme system, unopposed mobilization of fatty acids, formation of ketones, ketoacidosis, depletion of K

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20
Q

diabetics can have impaired vasodilation that leads to

A

chronic proinflammatory, prothrombotic, and proatherogenic state and vascular complications

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21
Q

diagnosis of diabetes

A

elevated fasting glucose > 126 or HbA1c of 6.5% or higher

for T1DM: glucose >200 and HbA1C>7%

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22
Q

long term complications of diabetes

A

retinopathy, kidney disease, HTN, CAD, peripheral/cerebral vascular disease, neuropathy

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23
Q

treatment for Type 1 DM

A

insulin
basal supplementation + short acting before food absorption
need at least 2 daily SQ injections of intermediate or long acting + rapid acting following meals

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24
Q

Intermediate acting basal insulins

A

NPH, lente, lispro protamine, aspart protamine

twice daily administration

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25
long acting basal insulins
ultra lente, glargine, detemir once daily
26
short acting insulin
regular meal time
27
rapid acting insulin
lispro, aspart, glulisine meal time
28
what is the most commonly used commercial preparation of inuslin?
Insulin U-100 (100u/mL)
29
typical daily exogenous dose of insulin for T1DM
0.5-1 u/kg/day (40-80units/day)
30
onset, peak, duration of rapid acting insulin
onset: 5-15 minutes peak: 45-75 minutes duration: 2-4 hours
31
onset, peak, duration of short acting insulin
onset: 30 minutes peak: 2-4 hours duration: 6-8 hours
32
onset, peak, duration of intermediate acting insulin
onset: 2 hours peak: 4-12 hours duration: 18-28 hours
33
onset, peak, duration of long acting insulin
onset: 1.5-2 hours peak: 3-9 hours, none duration: 6->24 hours
34
what preparations are used for continuous insulin pumps?
short acting (regular) and rapid acting (lispro, aspart, glulisine)
35
lispro onset, peak, duration
onset: 15 minutes peak: 45-75 minutes duration: 2-4hours
36
administration of regular insulin
IV or SQ
37
five main side effects of insulin
hypoglycemia, allergic reactions, lipodystrophy, insulin resistance, drug interactions
38
first symptoms of hypoglycemia are compensensatory effects of ___
increased epinephrine secretion
39
first symptoms of hypoglycemia include
diaphoresis, tachycardia, HTN, rebound hyperglycemia from SNS activation, mental confusion, seizures, coma
40
prolonged hypoglycemia can lead to
irreversible brain damage because the brain depends on glucose for oxidative metabolism
41
severe hypoglycemia treatment
50-100mL of 50% glucose IV | 0.5-1.0mg IV/SQ glucagon
42
chronic protamine exposure in NPH may stimulate production of antibodies against __
protamine (worry aboutin CABG)
43
hormones that counter hypoglycemic effects of insulin
adrenocorticotrophic hormone, estrogen and glucagon
44
epinephrine ____ insulin secretion and ____ glycogenolysis
inhibits; stimulates
45
which drugs increase duration of action of insulin?
tetracycline, salicylates, phenylbutazone
46
four major classes of oral antidiabetic drugs
secretagogues, biguanides, thiazolidinediones or glitazones, alpha-glucosidase inhibitors
47
how do sulfonylureas work?
stimulate insulin secretion
48
how do biguanides (metformin) work?
inhibit glucose production by the liver by activating adenosine monophosphate activated protein kinase
49
contraindications for metformin
lactic acidosis, AKI, GI intolerance, acute hepatic disease
50
metformin
does not undergo metabolism, not bound to plasma proteins
51
elimination half time of metformin
2-4 hours
52
dose of metformin
500-1000mg TID with meals
53
when should patients discontinue metformin before surgery?
48 hours before surgery
54
do not give metformin to patients with:
hepatic dysfunction, renal insufficiency, IV contrast dye, acute MI, CHF, arterial hypoxemia, sepsis
55
in order for sulfonylureas to be successful patients need to have
some beta cell function
56
do not administer sulfonylureas if the patient has
a sulfa allergy
57
MOA of sulfonylureas (glyburide, glipizide, glimepride)
act on sulfonylurea receptors on pancreatic and cardiac cells, inhibit adenosine triphosphate sensitive K+ channels on pancreatic beta cells = Ca2+ influx and stimulation of insulin release
58
glyburide
dose: 2.5- 20mg daily peak: 3 hours DOA: 18-24 hours elimination half time: 4.5-12 hours
59
glipizide
dose: 5-40mg daily peak: 1 hour after PO DOA: 12-24 hours elimination half time: 4-7 hours
60
glimepiride
dose: 2-4 mg daily DOA: 24+ hours elimination half time: 5-8 hours
61
meglitinides exert effects on
beta cells
62
meglitinides MOA
lowers blood glucose by stimulating release of insulin from beta cells
63
nateflinide (starlix) unique characteristic
accumulation of active metabolites may cause hypoglycemia
64
difference between repaglinide and nateflinide
repaglinide - nateglinide- | minimal kidney excretion excreted by kidney
65
alpha glucosidase inhibitors MOA
decrease carbs digestion and absorption of disaccharides by interfering with intestinal glucosidase activity
66
thiazolidinediones MOA
act at skeletal muscle, liver, and adipose tissue via peroxisome proliferator activator receptor-gamma to decrease insulin resistance and hepatic glucose production, and to increase use of glucose by liver
67
which patients are thiazolidinediones more effective?
obese patients
68
how long does it take to reach clinical effect for thiazolidinediones
4-12 weeks
69
when are thiazolidinediones contraindicated?
CHF, liver failure
70
glucagon like peptide 1 receptor agonists MOA
increase insulin secretion from beta cells, decrease glucagon production from alpha cells and reduce gastric emptying
71
dipeptidyl peptidase 4 inhibitors MOA
increase insulin secretion from alpha cells and reduce pancreatic alpha cell secretion of glucagon
72
pramlintide (amylin agonist) MOA
suppress gastric emptying, inhibit glucagon release and reduce HbA1C but does not alter insulin levels!
73
goal of combination therapy
target two or more causes of hyperglycemia simultaneously
74
primary and secondary aim of combination therapy
primary: decrease HbA1c, secondary: decrease in daily insulin dose
75
example of combo therapy
metformin (decrease insulin resistance in liver) + sulfonylurea (increased insulin secretion)
76
DM + HTN =
50% likelihood of diabetic autonomic neuropathy
77
incidence of periop CV instability is increased by concomitant use of ___
angiotensin-converting enzyme inhibitors or angiotensin receptor blockers
78
most T1DM have kidney disease by age
30
79
how can you assess diabetic patients for risk of difficult intubation?
praying hands, TMJ joint assessement, cervical spine mobility
80
percentage of T1DM that are difficult intubations
30%
81
keep glucose level in periop period
<180 mg/dL
82
hyperglycemia is associated with
hyperosmolarity, infection, poor wound healing, increased mortality
83
"time honored approach"
patient takes 2/3 nighttime insulin (NPH/regular) and 1/2 total morning insulin dose intermediate (NPH)
84
on day of surgery what should the patient do about their regular insulin?
hold AM dose of regular insulin
85
what should patients do with their continuous pump before surgery?
decrease overnight rate by 30% and keep at basal rate for day of surgery
86
if patient takes glargine and lispro/aspart daily
take 2/3 glargine dose and entire lispro/aspart night before, hold AM dose
87
insulin infusion
add regular insulin to NS ( 1 unit/mL) | start at 0.02 -0.1 unit/kg/hr
88
one unit of regular insulin should lower plasma glucose by __
25-30 mg/dL
89
when can patients restart their diabetic meds postop?
when resumes PO intake
90
how often should you measure plasma glucose levels when patient is on an infusion vs PO
infusion - q30mins-1hour | po - before surgery and after surgery
91
do you shut a continuous pump off for surgery?
no

Pharmacology I - CP (8 decks)

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