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Flashcards in Martin pharm DM Deck (48):
1

What are the rapidly acting insulin preparations

insulin lispro
insulin aspart
insulin glulisine

2

what are the short acting insulin preparations

regular R- human
"humilin R and Novolin R"

3

what are the intermediate acting insulin preparations

NPH (N) isophane insulin suspension
"humilin N and novolin N"

4

what are the long acting insulin preparations

insulin glargine "lantus"
insulin detemir "levemir"

5

what are the mixed insulins

NPH/regular mixture
NPL/humalog mixture
NPA (Aspart protamine) / aspart

6

what are biguanides used for and name of drug

antihyperglycemic
metformin

7

what are sulfonylureas used for and drug names

stimulate insulin secretion
glimepiride
glipizide
glyburide

8

what are the non-sulfonylurea secretagogues used for and drug names

stimulate insulin secretion
repaglinide
nataglinide

9

what are the thiazolininediones used for and drug names

insulin sensitizers
piolitazone

10

what are the alpha glucosidase inhibitors used for and drug names

preven complex carbohydrate hydrolysis and delay carbohydrate absorrption
acarbose
miglitol

11

what are the glucagon like peptide 1 agonists used for and drug names

potentiate glucose dependent insulin secretion, suppress glucagon secretion, gastric emptying and promote satiety
exenatide

12

what drugs do we have that mimic amylin

pramlintide

13

what happens to proinsulin in golgi

packaged in secretory granules along with the enzymes that remove the connecting peptide to form insulin

14

what is important about the various crystallizations of insulin

determines how fast the crystals dissolved after subcutaneous injection

15

what form of insulin is absorbed

insulin free in solution

16

what determines rate of onset and duration of insulin preparations

the rate of dissolution of insulin crystals with local blood flow

17

principal stimulus of insulin secretion

glucose

18

what senses the plasma [ ] of glucose

langerhans B cells

19

what sympathetic Receptors control insulin secretion

alpha2 inhibit insulin secretion
beta 2 and vagal nerve stimulate insulin secretion

20

what allows for release of insulin into the blood

Ca

21

what occurs in a healthy patient with constant infusion of glucose

2 phases of insulin secretion

22

what occurs to the phases of insulin release in DM I? DM II?

both phases are missing in type I
the first phase is missing in DM II

23

where does degradation of insulin occur

liver and kidney

24

how long does insulin last in the blood

half life 5-8 minutes

25

target tissues for glucose homeostasis

liver, muscle, fat

26

insulin inhibits what processes

breakdown of glycogen, fat and protein

27

describe timing of each of the actions of insulin

phosphorylation-dephosphorylation of enzymes is sec- minutes
transcription translation effects- hours
changes in cellular proliferation and differentiation- days

28

what type of R is insulin

tyrosine kinase

29

how does glucose enter cells

GLUT R

30

how does insulin stimulate glucose transport

promotes energy dependent translocation of intracellular vesicles that contain GLUT4 to the plasma membrane

31

what transporter may contribute to DM II

GLUT2

32

how is pancreatic function in DM II

low or normal or high levels insulin.

33

Family Hx DM I? DM II

DM I not strong
DM II strong

34

Tx DM I

insulin
diet and exercise

35

how is subcut insulin different than physiologic

1- kinetics do not match response to ingestion of nutrients
2- diffuses into peripheral circulation, not portal

36

indications fo insulin therapy

all types I DM
DM II not controlled by diet and/or oral hypoglycemic agents
patients after pancreatectomy or gestational DM
management diabetic ketoacidosis
Tx hyperglycemic, nonketotic coma
perioperative management Type I and II patients

37

time of onset aciton, peak effect and duration of action of insulin depends on what

dose, anatomic site of injection, method Sq or IV, local blood flow, body temp, level of physical activity and degree of R

38

what insulin preparations can be used as IV infusions or subcutaneous infusion pumps

regular, aspart, glulisine, lispro

39

variability of insulin kinetics is mostly due to what

rates of SQ absorption and SQ blood flow

40

what is exubera

inhaled insulin

41

what is a single daily dose regimen

single daily dose of an intermediate acting insulin

42

what is split-mixed regimen

pre breakfast and pre supper injection of mixture of regular and intermidiate acting insulin

43

what is split mixed regimen with delayed evening dose

evening dose of NPH insulin is delayed until bedtime to increase amount of insulin available until the next morning

44

What is the intensive insulin therapy

1:1 basal:bolus ratio SQ
basal is glargine or detemir
bolus is rapid acting insulin or regular before each meal

45

What is split mix insulin therapy dosing

1- 2/3 total dose before breakfast (2/3 NPH 1/3 regular)
2- 1/3 total dose later in day: (1/3 regular before dinner
2/3 NPH at bedtime)

46

what makes evening dose of insulin so importnat

normal and diabetic patients have increased requirement o finsulin the the early morning

47

what insulin is used to meet postprandial demand

rapid acting insulin

48

What factors affect insulin absorption

site of injeciton, type of insulin, SQ blood flow
regional muscle activity at injections site, colume and concentration of injected insulin
depth of injection, mixing of regular insulin with NPH or NPL can slow absorbtion