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PHARMACOLOGY > [PF] INSULIN AND OHA > Flashcards

[PF] INSULIN AND OHA Flashcards

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1
Q

Fasting plasma glucose criteria for the diagnosis of diabetes:

A

> 7.0 mM (126 mg/dL)

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2
Q

Drugs that promote hypoglycemia:

A

“BTS meets BAPEL”

Beta adrenergic antagonists
Theophylline
Salicylates, NSAIDs
Bromocriptine
ACE inhibitors
Pentamidine
LiCl
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3
Q

Goal for A1C

A

<7.0%

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4
Q

Blood pressure

A

<140/90

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5
Q

Mainstay for treatment of virtually all type 1 and many type 2 diabetes patients.

A

Insulin therapy

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6
Q

Insulin may be administered:

A

IV, IM or SQ

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7
Q

For long term treatment

A

SQ Insulin

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8
Q

Short acting insulin:

A

“GLAR”

Glulisine
Lispro
Aspart
Regular

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9
Q

Long acting insulin:

A

Detemir
Glargine
Degludec
NPH

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10
Q

Short acting regular insulin should be injected _______ minutes BEFORE a meal.

A

30-45 minutes

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11
Q

IV or IM

A

Regular, unbuffered, 100 units/mL insulin

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12
Q

Only subcutaenous

A

Regular, unbuffered, 500 units/mL insulin

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13
Q

Absorbed more rapidly from subcutaneous sites than regular insulin

A

Short-acting insulin analogue

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14
Q

Short acting insulin analogue should be injected ______ or less before a meal.

A

15 minutes

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15
Q

Identical to human insulin except at positions B28 and B29.

A

Insulin Lispro

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16
Q

Rapid absorption and shorter duration of action.

A

Insulin Lispro

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17
Q

Insulin aspart is formed by the replacement of ______ at B28 with aspartic acid.

A

proline

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18
Q

Dissociates rapidly into monomers following injection.

A

Insulin aspart

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19
Q

Formed when glutamic acid replaces lysine at B29 and lysine replaces asparagine at B3

A

Insulin glulisine

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20
Q

Mixed with short-acting insulin

A

Insulin glargine

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21
Q

Lower risk of hypoglycemia

A

Insulin glargine

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22
Q

Administered at any time during the day

A

Insulin glargine

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23
Q

In patients with type 1 diabetes, insulin DETEMIR is administered ______ a day.

A

twice

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24
Q

Has a smoother time action profile and produces a reduced prevalence of hypoglycemia than NPH insulin.

A

Insulin Detemir

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25
Forms multihexamers after injection subcutaneously.
Insulin degludec
26
It has less severe hypoglycemia than glargine
Insulin degludec
27
Insulin dosing and regimens
1. Site of injection 2. The type of insulin 3. Subcutaneous blood flow 4. Smoking 5. Regional muscular activity at the site of the injection 6. The volume and concentration of the injected insulin 7. Depth of injection
28
In a mixed population of patients with type 1 diabetes, the average dose of insulin is usually _______ with a range of 0.4 - 1 units/kg/d.
0.6 - 0.7 units/kg body weight per day
29
Obese patients generally and pubertal adolescents may require more ________ because of resistance of peripheral tissues to insulin.
About 1-2 units/kg/d
30
Patients who require less insulin than others
0.5 units/kg/d
31
The major risk that must be weighed against benefits of efforts to normalize glucose control.
Hypoglycemia
32
(Enlargement of subcutaneous fat depots) has been ascribed to the lipogenic action of high local concentrations of insulin.
Lipohypertrophy
33
Sulfonylureas:
1. Glimepiride 2. Glipizide 3. Glipizide (extended release) 4. Glyburide 5. Glyburide (micronized)
34
Nonsulfonylureas (Meglitinides):
1. Nateglinide | 2. Repaglinide
35
GLP-1 Agonists:
1. Albiglutide 2. Dulaglutide 3. Exenatide 4. Liraglutide 5. Lixisenatide
36
Dipeptidyl peptidase-4 inhibitors:
1. Alogliptin 2. Linagliptin 3. Saxagliptin 4. Sitagliptin 5. Vildagliptin
37
Sulfonylureas are all effectively absorbed from the ________.
GI tract
38
_____ and ________ can reduce absoprtion of sufonylureas.
Food and hyperglycemia
39
_____ of Sulfonylureas are bound to protein.
90-99%
40
Hypoglycemic effects of Sulfonylureas are evident for _______.`
12-24
41
Sulfonylureas are metabolized in the ______ and metabolites are excreted in the urine.
Liver
42
Adverse effects of sulfonylureas:
Hypoglycemia which can lead to coma Weight gain
43
Less frequent side effects of sulfonylureas:
1. Nausea and vomiting 2. Cholestatic jaundice 3. Agranulocytosis 4. Aplastic and hemolytic anemias 5. Generalized hypersensitivity reactions 6. Dermatological reactions
44
Displace the sulfonylureas from binding proteins thereby transiently increasing the concentration of free drug.
Sulfonamides Clofibrate Salicylates
45
May enhance the action of SU and cause hypoglycemia.
Ethanol
46
Therapeutic uses of Sulfonylureas
Diabetes mellitus type 2
47
Non-sulfonylureas:
Repaglinide | Nateglinide
48
Repaglinide is absorbed rapidly from the _________.
GI tract
49
Repaglinide peak blood levels are obtained within ______
1 hour
50
The half life of repaglinide is about _______
1 hour
51
Metabolized primarily by the liver (CYP3A4) to inactive derivatives.
Repaglinide
52
The major side effect of repaglinide is _______.
Hypoglycemia
53
Is associated with a decline in efficacy (secondary failure) after initially improving glycemic control.
Repaglinide
54
Certain drugs may potentiate the action of repaglinide by displacing it from plasma protein-binding sites
1. Beta blockers 2. Chloramphenicol 3. Coumarin 4. Maois 5. NSAIDs 6. Probenecid 7. Salicylates 8. Sulfonamide
55
Certain drugs may potentiate the action of repaglinide by altering it metabolism:
1. Gemfibrozil 2. Itraconazole 3. Trimethoprim 4. Cyclosporine 5. Simvastatin 6. Clarithromycin
56
The drug's major therapeutic effect is reducing postprandial glycemic elevations in patients with type 2 diabetes.
Nateglinide
57
Nateglinide is most effective when administered at a dose of ______, 875 three times daily, 1-10 mins before a meal.
120 mg
58
It is metabolized primarily by hepatic CYPs (2C(, 70%; 3A4, 30%) and should be used cautiously in patients with hepatic insufficiency
Nateglinide
59
About 16% of an administered dose is excreted by the ______ as unchanged drug.
kidney
60
The only member of the biguanide class of oral hypoglycemic drugs available for use today.
Metformin
61
Metformin MOA activation of AMP-dependent protein kinase (AMPK) by metformin in the ________.
Mitochondria
62
Metformin is recommended twice-daily administration at doses of ______.
0.5-1.0 g
63
The maximum dose of metformin is ________ but therapeutic benefit starts to plateau at ______.
2550 mg | 2000 mg
64
A sustained-release preparation of Metformin is available for once-daily dosing starting at ______ DAILY with titration up to 2000 mg as necessary.
500 mg
65
Metformin is absorbed primarily from the ________.
small intestine
66
Stable, does not bind to plasma proteins
Metformin
67
Metformin is excreted unchanged in the ______.
urine
68
Half - life of metformin in the circulation of _______
2 hours
69
Therapeutic uses of metformin:
DM type 2
70
Thiazolidinediones:
1. Rosiglitazone | 2. Pioglitazone
71
Thiazolidinediones activates ____________.
Peroxisome proliferator-activated receptor-y (PPARy)
72
Regulates the transcription of several insulin responsive genes
Thiazolidinediones
73
Increased insulin sensitivity
Thiazolidinediones
74
Rosiglitazone and Pioglitazone are absorbed within _______.
2-3 hours
75
Bioavailability does not seem to be affected by food.
Rosiglitazone and Pioglitazone
76
Rosiglitazone and Pioglitazone is metabolized by the ______.
Liver
77
Maybe administered to patients with renal insufficiency.
Rosiglitazone and Pioglitazone
78
Not be used if there is active hepatic disease or significant elevations of serum liver transaminases.
Rosiglitazone and Pioglitazone
79
GLP-1 receptor agonists:
1. Exenatide 2. Liraglutide 3. Albiglutide 4. Dulaglutide 5. Lixisinatide
80
DPP4 - inhibitor
1. Sitagliptin (Januvia) 2. Saxagliptin (Onglyza) 3. Vildagliptin 4. Alogliptin
81
DPP4 - inhibitors are absorbed effectively from the ________.
Small intestine
82
DPP4 - inhibitors circulate in primarily in unbound form excreted mostly unchanged in the ______.
Urine
83
Agents used to treat hypoglycemia
Glucagon | Diazoxide

PHARMACOLOGY (6 decks)

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