Unit 6 Drugs Random Order Flashcards
(105 cards)
1
Q
Saw Palmetto
A
Use: BPH
May be eff. but not as eff. as existing drugs (azosins”
Mech: Inh test synth (enz inh)+Inh test binding to receptor
SE:
- Minimal SE
- Drug interactions due to hormone effects
2
Q
Aluminum hydroxide
Al(OH)3
A
Antacid
Speed-slow
Duration-long
Neutralizing-low
SE:
- Constipation
- Adsorbs drugs
- Loss of phosphate
- Al toxicity
2
Q
Polyethylene glycol
A
GI Drug
Cathartic–Osmotic agent
DOC for colonoscopy
3
Q
Castor oil
A
GI Drug
Cathartic–Gastric Irritants
Mech: Stimulate gastric nn
Increase motility
Decrease electrolyte secretion into gut
SE:
- Nephritis
- Liver damage
3
Q
Linaclotide
A
GI Drug
Cathartic–Secretion enhancer
Mech: Activate guanylate cyclase
Increase Cl secretion in stomach
3
Q
Garlic
A
Uses: Decrease blood lipids
May slightly lower blood lipids
1 fresh clove/day
SE:
- Induce P450
- Bad breath
- Decrease clotting
- Decrease conc. of some reverse transcriptase inh.
4
Q
Mg(OH)2
A
GI Drug
Cathartic–Osmotic agent
AKA Milk of Magnesia
4
Q
Codeine
A
Tx: Diarrhea
Narcotic agent
Mech: act a specific receptor
Not generally used for obvious reasons
4
Q
Digoxin
A
Emetic–central stimulant
Mech: Stimulates DA sites in CTZ
5
Q
Sucralfate
A
GI drug-Enhance mucosal defense
Aluminum salt
Tx: Ulcers
Mech: Complex that becomes viscous and binds to damaged mucosa when exposed to acid
SE:
- Constipation
- Excess Al absorption
Contraindication: H+ depleters (PPI or antacids)
SucrALfate=ALuminum salt→Excess Al
Sucralfate=sucrose=sticky…so this sticks to damaged mucosa
6
Q
Immunosuppressants for IBS
A
Methotrexate
Cyclosporine
7
Q
Miglitol
A
Tx: Diabetes
Glucose abs. delayers
Mech: Inh. alpha glucosidase
Prevents breakdown of complex carbs in gut
SE:
- Unabsorbed carbs ferment in gut
- Cramps
- Diarrhea
- Flatulence
Mig--litol
_Midg_ets (Mack) are little b/c they don’t absorb any carbs
8
Q
Dronabinol
A
Anti-emetic–THC derivative
Mech: Bind cannabinoid receptor
SE: Increased appetite
8
Q
Calcitonin
A
Tx: Ca disorders
Mech: Binds to and inh. osteoclasts
Effects opposite of PTH
Secreted by thyroid gland
1st line of defense for Paget’s disease
SE:
- Increase risk of cancer
9
Q
What are the short acting designer insulins?
A
Regular human insulin
Lispro
Aspart
Glulisine
2-5 hrs
10
Q
Pramlintide
A
Tx: Diabetes
Amylin analogs
Mech: Activate amylin receptor→
Decrease gastric emptying
Decrease appetite
Route: SubQ before meals
SE:
- Severe hypoglycemia
- prAMLINtide=AMyLIN analog*
11
Q
Scopolamine
A
Anti-emetic–anti-cholinergic
Mech: Block muscarinic receptor
Route: Patch
SE:
- Dry
- Drowsy
- Etc.
12
Q
What are the gastric irritants used as cathartics?
A
Cascara
Senna
Castor oil
Bisacodyl
13
Q
Psyllium
A
GI Drug
Cathartic–Bulk adding agent
Mech: Like eating fiber
14
Q
Yohimbe
A
Use: ED
Mech: Alpha 2 blocker in CNS
SE:
- Hypertension
- MAOI
- CNS excitation
- Tachycardia
- Tremor
14
Q
Ergocalciferol (D2)
A
Tx: Ca disorders
Mech: Vit D analog
Less potent than calcitriol
SE: Hypothyroidism
15
Q
Tolbutamide
A
Tx: Diabetes
Oral hypoglycemic agents
First gen sulphonylureas
Mech: K channel blockers
Block K channels on B cells →Increase Ca→Insulin secretion
Duration: 6-12 hrs
Contra/Indications:
- Do not use if you have renal or hepatic damage
- Not overweight
- Have some islet fxn
SE:
- Hypoglycemia and hypoglycemia coma
- More common in drugs w/ longer duration
- Can be teratogenic
- Can increase death due to cardiovascular problems
16
Q
What are the stool softeners?
A
Dioctal sodium sulfosuccinate
Mineral oil
16
Q
Alpha galactosidase
A
Tx: Diarrhea
Mech: Increase metab. of oligosacc.→digestible sugars
Oligosacc. produce gas
- Alpha GAlactoSidase inh. GAS production*
- *Be careful there are alpha-glucosidase inh in the diabetes section**
18
Misoprostole
GI drug-Enhance mucosal defense
**Tx**: Ulcers
Drop in PGs→Ulcer
Asprin (NSAIDs) and GCs can decrease PGs
**Mech**: Prostaglandin analog
SE:
* Uterine contractility (abortifacient)
* You eat **miso** soup when you have a stomach ache because it is **prostagrandin anarog** (say that w/ a strong asian accent)*
19
Which antihistamines are used as anti-emetics?
Diphenhydramine
Dimenhydramine
Meclizine
Cyclizine
20
-prazole
GI drug
Decrease acid formation
Mech: ATPase inhibitor
Known as proton pump inhibitor (PPI) but actually irreversibly inhibit ATPase required to drive H+ pump
**Best available class of GI drugs**
_Prodrug_-activated by acid
They are weak bases though→ stay in parietal cell
SE:
* Hypochlorhydria-lack of H+ production
* Decrease Ca absorption→osteoporosis
* Decrease Vit B12 absorption
20
Isophane
Tx: Diabetes
Designer insulin
Protamine insulin
Intermediate acting
21
Glargine
Tx: Diabetes
Designer insulin
Short acting (24+ hrs)
*Determined to get large (that a long time)*
*_Detemir_ +_glargine_=long acting insulins*
22
-setron
**Ondansetron**
**Granisetron**
**Dolasetron**
**Palonosetron**
Anti-emetic (for IBS+chemo)
Mech: 5HT receptor blocker
Affect CTZ +rec. in gut
SE: Constipation
***_SE_**lective **_T_**e**_R_**minators **_O_**f **_N_**ausea*
***_-SETRON_***
*-setron blocks serotonin*
23
Echinacea
Use:
* Upper resp. inf.
* Wound healing
* Antifungal
Can decrease sympt. of flu if used early
SE:
* Allergies
* Related to ragweed
24
Cinecalcet
Tx: Ca disorders + hyperparathyroidism
Mech: Calcium mimetic
Sensitizes parathyroid Ca receptors to Ca→Decrese PTH secretion
*Like there is a lot of Ca around*
SE
* Hypocalcemia
* Nausea
* Diarrhea
24
Fluoride
Tx: Ca disorders
Effects: Increase osteoblasts
Makes bone harder but more brittle
Not for osteoporosis
25
Cyclizine
Anti-emetic--Antihistamine
Mech: Block H1 receptor
SE: Anticholinergic effects
26
Diphenoxylate
Tx: Diarrhea
*Narcotic agent*
Mech: act a specific receptor
Acts primarily in gut
Opiate like effects in CNS though too
Given in comb w/ atropine to avoid abuse
27
Nabilone
Anti-emetic--THC derivative
Mech: Bind cannabinoid receptor
SE: Increased appetite
29
What are the osmotic cathartics?
MgSO4
Mg(OH)2
Polyethylene glycol
30
Compazine
Anti-emetic
Mech: DA blocker
*Related to anti-psychotic drugs *(phenothiazine)
SE: Extrapyramidal effects
32
Magnesium hydroxide
## Footnote
*Milk of magnesia*
Antacid
Speed-slow
Duration-medium
Neutralizing-high
SE:
* Laxative
* Some Mg toxicity
32
Cascara
GI Drug
Cathartic--Gastric Irritants
**Mech**: Stimulate gastric nn
Increase motility
Decrease electrolyte secretion into gut
SE:
* Nephritis
* Liver damage
33
Ginseng
Uses: Increase energy
No clear effect
35
Scopolamine
Tx: Diarrhea
*Anti-cholinergic agent*
Mech: Blocks muscarinic receptor
SE: Many systemic
35
Aminobisphosphonates
**other -dronates**
Aminobisphosphonates are more potent
Tx: Ca disorder
**Mech**: Enzyme inhibitor (farnesyl pyrophosphate synthetase)
Inh. enzyme in mavalonic acid synthesis pathway→abnormal cytoskeletal structure in osteoclasts
Pyrophosphates have an affinity for Ca and are incorporated into bone
When ingested by osteoclasts→decrease activity and apoptosis
T1/2: Many years
Use: 1st line tx for osteoporosis and pagets
Used in tx of MM too
SE:
* GI upset, peptic ulcers
* Inflammation of eye
* IV infusions cause 1st dose effect (flu-like symptoms)
* Osteonecrosis of jaw
* Decrease blood flow to area
* Esp in pts w/ lost of dental disease/surgery
* Bone w/ bisphosphonates may be more susceptible to infections
***B**elly ache and peptic ulcers*
***I**nfections/**I**nfarcts*
***S**wollen eye*
***F**irst dose eff (IV)→**F**lu-like symptoms*
***O**steonecrosis of jaw*
36
Bisphosphonates
**Tiludronate**
**Etidronate**
Bisphosphonates are less potent
Tx: Ca disorder
**Mech**: Enzyme inhibitor
Cause formation of abnormal ATP→inh ATP requiring enzymes
Pyrophosphates have an affinity for Ca and are incorporated into bone
When ingested by osteoclasts→decrease activity and apoptosis
T1/2: Many years
Use: 1st line tx for osteoporosis and pagets
Used in tx of MM too
SE:
* GI upset, peptic ulcers
* Inflammation of eye
* IV infusions cause 1st dose effect (flu-like symptoms)
* Osteonecrosis of jaw
* Decrease blood flow to area
* Esp in pts w/ lost of dental disease/surgery
* Bone w/ bisphosphonates may be more susceptible to infections
***B**elly ache and peptic ulcers*
***I**nfections/**I**nfarcts*
***S**wollen eye*
***F**irst dose eff (IV)→**F**lu-like symptoms*
***O**steonecrosis of jaw*
37
Infliximab
Tx: IBS
Mech: Binds TNF alpha
40
Calcium carbonate
CaCO3
Antacid
Speed-rapid
Duration-medium
Neutralizing-high
SE:
* Constipating
* Hypercalcemia
41
Cranberry
Uses: UTI
May inh. recurrent UTI
Not helpful for current inf.
**Mech**: Proanthrocyanadin prevents bact from binding to UT cells
May also acidify urine
SE:
* Inh P450
43
Sodium Bicarbonate
NaHCO3
Antacid
Speed-rapid
Duration-short
Neutralizing-high
SE:
* CO2 production
* Belching
* Na may compromise low sodium diets
* **Systemic absorption**
* Contains Na
* Important in those w/ kidney dysfunction
43
Bran
GI Drug
Cathartic--Bulk adding agent
**Mech**: Like eating fiber
45
Loperamide
Tx: Diarrhea
*Narcotic agent*
**Narcotic DOC for diarrhea**
Mech: act a specific receptor
Acts ONLY in gut--no CNS effects
46
Crofelemer
Tx: Diarrhea
Mech: Blocks Cl channel in gut
Also decreases secretion of Na and H2O
***C**rofe**L**emer blocks **CL** channels*
* or *
* CROws block the CLouds*
* CROfelemer blocks CL channels*
46
Acarbose
**Rosiglitazone**
**Pioglitazone**
Tx: Diabetes
*Glucose abs. delayers*
**Mech**: Inh. alpha glucosidase
Prevents breakdown of complex carbs in gut
SE:
* Unabsorbed carbs ferment in gut
* Cramps
* Diarrhea
* Flatulence
* A-carb-ose*
* No-carb-abs.*
47
-gliptin
or
-glyptin
**Sitagliptin**
**Saxagliptin**
**Linaglyptin**
**Alogliptin**
Tx: Diabetes
*Incretin enhancer*
**Mech**: Inh DPP-4 Enzyme →prevent incretin metab
Orally
Often used in combo w/ other drugs
* Put a _lip_ of _dip_ in (_oral_). Dip comes in a _tin_*
* G-_LIP_-_TIN_ are _DPP_ inh. Taken _orally_.*
48
Valerian
Uses: Sedative
Mild sedative effect
Mech: Increase GABA
SE:
* Hepatotoxicity
* Dont use w/ anti-dep
49
Raloxifene
Tx: Ca disorders +estrogen dependent breast cancer
Mech: **Activates estrogen receptors** **in bone**
Blocks estrogen receptors in breasts
Estrogen analog
SERM-selective estrogen receptor modulator
**Inh. osteoclast activity**
SE
* Pulmonary embolisms
* Stroke
* Preg. cat X
* Raloxifene like Tamoxifene affect estrogen receptor*
* SE=SEX*
***S**troke*
***E**mbolism (pulmonary)*
***X** (preg cat.)*
50
Metformin
Tx: Diabetes
*Insulin enhancers*
**Mech**: Act. protein kinase→
Increased glc abs. by muscle
Decreased glc production by liver
SE:
* Lactic acidosis (potentially fatal)
* Weight loss due to anorexia
* George **Foreman** was an **A**merican **P**rofessional (**K**ick)boxer *
* Met**formin** **A**ctivates **P**rotein **K**inase*
* He worked out so hard he had lactic acidosis and had to be anorexic to make his weight class*
51
Kola nut
Caffeine
Increased HR
Insomnia
53
Bismuth subsalicylate
GI drug-Enhance mucosal defense
Anti-diarrheal agent--absorbing agent
Mech: Increase mucous production in stomach
Inh. growth of H. pylori
Unpleasant taste+odor
SE:
* Long term use→Darkening of feces, tongue, and teeth
54
What are the bulk adding agents?
Bran
Methylcellulose
Polycarbophil
Psyllium
56
Meclizine
Anti-emetic--Antihistamine
Mech: Block H1 receptor
SE: Anticholinergic effects
57
Gli--ide
or
Gly--ide
**Glipizide**
**Glyburide**
**Glimepiride **(most potent)
Tx: Diabetes
Oral hypoglycemic agents
Second gen sulphonylureas
More rapid onset and longer duration
**Mech**: K channel blockers
Block K channels on B cells →Increase Ca→Insulin secretion
Contra/Indications:
* Do not use if you have renal or hepatic damage
* Not overweight
* Have some islet fxn
SE: Less than 1st gen
* Hypoglycemia and hypoglycemia coma
* More common in drugs w/ longer duration
* Can be teratogenic
* Can increase death due to cardiovascular problems
57
-gliflozin
Canagliflozin
Dapagliflozin
Empagliflozin
Tx: Diabetes
*Inh. of glc resorption by kidney*
**Mech: **Inh. SGLT2 (Na-glc cotransporter)
in PCT--allows kidney to eliminate blood glc
SE:
* Hypotension
* Hypokalemia
* Due to increased urine output
* Gential fungal inf
* Urine loaded w/ glc
59
Senna
GI Drug
Cathartic--Gastric Irritants
**Mech**: Stimulate gastric nn
Increase motility
Decrease electrolyte secretion into gut
SE:
* Nephritis
* Liver damage
60
Soy
Uses:
* Hyperlipidemia
* Osteoporosis
* Menopause
Decreases LDL
Decreases Menopausal symptoms
**Mech**: Metab. to estrogen like compound
SE: Allergic rxns
62
Diphenhydramine
or
Dimenhydramine
Anti-emetic--Antihistamine
Mech: Block H1 receptor
SE: Anticholinergic effects
63
(Apo)morphine
Emetic--central stimulant
Mech: Stimulates DA sites in CTZ
64
Dioctal sodium sulfosuccinate
GI Drug
Cathartic--Stool softener
Detergent
**Mech**: Emulsifies contents of colon
65
Mineral oil
GI Drug
Cathartic--Stool softener
**Mech**: Acts like a lubricant
Why mineral oil should NOT be used:
* Prevents fat soluble vitamin absorption
* Aspiration pnemonia →may damage lungs
* May contain carcinogens
67
Regular human insulin
Tx: Diabetes
Designer insulin
Short acting (2-5 hrs)
*Afrezza is the inhaled form*
68
Tolazamide
Tx: Diabetes
Oral hypoglycemic agents
First gen sulphonylureas
**Mech**: K channel blockers
Block K channels on B cells →Increase Ca→Insulin secretion
Duration: 12-60 hrs
Contra/Indications:
* Do not use if you have renal or hepatic damage
* Not overweight
* Have some islet fxn
SE:
* Hypoglycemia and hypoglycemia coma
* More common in drugs w/ longer duration
* Can be teratogenic
* Can increase death due to cardiovascular problems
69
Lispro
Tx: Diabetes
Designer insulin
Short acting (2-5 hrs)
70
St Johns Wort
Uses:
* Mild depression
* anxiety
As eff as standard anti-dep.
**Mech**: Inh. reuptake of NE, 5HT, DA
SE:
* Phototoxicity
* Other allergic rxns
* In breast milk→lethargic baby
* Induces P450
* Wafarin
* BC
* Anti-depressant interactions
71
Bisacodyl
GI Drug
Cathartic--Gastric Irritants
**Mech**: Stimulate gastric nn
Increase motility
Decrease electrolyte secretion into gut
SE:
* Nephritis
* Liver damage
71
Glulisine
Tx: Diabetes
Designer insulin
Short acting (2-5 hrs)
72
Denosumab
Tx: Ca disorders
Mech: Blocks a receptor (RANKL)
RANKL required for osteoclast production, activity, and survival
Given every 6 mnths
SE:
* Hypocalcemia
* Osteonecrosis of jaw
* Skin inf.
*Deno- SHO*
***S**kin inf.*
***H**ypocalcemia*
***O**steonecrosis*
73
Atropine
Tx: Diarrhea
*Anti-cholinergic agent*
Mech: Blocks muscarinic receptor
SE: Many systemic
74
-glutide
**Liraglutide **(Inj 1x/day)
**Albiglutide** (Inj. 1x/week)
Tx: Diabetes
*Incretin enhancer*
**Mech**: Bind to and *activate* receptors on B cell
Incretin analog
SE:
* Thyroid tumor
* I want my _glutes_ to be as hard as c**_oncrete_***
* -_glutide_ to be as hard as **_incret_**in*
76
-glitazone
**Rosiglitazone**
**Pioglitazone**
Tx: Diabetes
*Insulin enhancers*
**Mech**: Act. PPAR→
Increased insulin receptor response
Increased # insulin receptors
Increased glc uptake by cells
SE:
* Wt gain
* Edema
* Fractures of arms and legs
* Macular edema
* Cardio problems
* MI
77
Exenatide
Tx: Diabetes
*Incretin enhancer*
**Mech**: Bind to and *activate* receptors on B cell
Analog of GLP-1 (incretin)
Not broken down by DPP-4
Injection 2x/day
SE:
* Pancreatitis
78
Chlorpropamide
Tx: Diabetes
Oral hypoglycemic agents
First gen sulphonylureas
**Mech**: K channel blockers
Block K channels on B cells →Increase Ca→Insulin secretion
Duration: 60+ hrs
Contra/Indications:
* Do not use if you have renal or hepatic damage
* Not overweight
* Have some islet fxn
SE:
* Hypoglycemia and hypoglycemia coma
* More common in drugs w/ longer duration
* Can be teratogenic
* Can increase death due to cardiovascular problems
80
-glinide
**Repaglinide**
**Nateglinide**
Tx: Diabetes
Oral hypoglycemic agents
Sulphonylurea-like agents
Rapid onset, short duration
**Mech**: K channel blockers
Bind diff site on K channel
Block K channels on B cells →Increase Ca→Insulin secretion
Contra/Indications:
* Do not use if you have renal or hepatic damage
* Not overweight
* Have some islet fxn
SE:
* Hypoglycemia and hypoglycemia coma
* More common in drugs w/ longer duration
* Can be teratogenic
* Can increase death due to cardiovascular problems
81
Erythromycin
Tx: Gastroparesis
prokinetic agents--*agents that increase stomach emptying rate*
**Mech**: Acts directly on motilin receptor
Route: Oral but IV possible if oral is not
SE:
* ototoxicity
* pseudomemb. colitis
* cardiac arrythmia
* Especially if metabolism is inh by P450
* Remember erythro is a macrolide*
* Motiliy*
* Arrythmias*
* Cholesteric toxicity (liver tox)/Colitis*
* Restricts P450*
* Ototoxicity*
82
Glucocorticoids
Effects: Inh. osteoblasts
So bone loss
83
Antibiotic combo for H pylori infection
GI drug-Enhance mucosal defense
Metronidazole
+/-
Amoxicillin
+/-
Clarithromycin
+/-
Tetracycline
84
Alvimopan
Tx: Gastroparesis
prokinetic agents--*agents that increase stomach emptying rate*
Mech: Blocks opiate receptor in gut but not anywhere else
Blocks constipation due to post op opioid use
85
Simethicone
Tx: Diarrhea
Mech: Changes gas surface tension of gas pocket in gut
86
MgSO4
GI Drug
Cathartic--Osmotic agent
87
Difenoxin
Tx: Diarrhea
*Narcotic agent*
**Active metabolite of diphenoxylate**
Mech: act a specific receptor
Acts primarily in gut
Opiate like effects in CNS though too
Given in comb w/ atropine to avoid abuse
88
Ginko
Uses:
* Dementia
* Intermittent claudication--pain in leg
About as eff. as tacrine for tx of alzheimer's
But tacrine isn't really effective at all
SE:
* Inh platelet activating factor
* Decrease clotting
* Interacts w/ warfarin
89
Methylcellulose
GI Drug
Cathartic--Bulk adding agent
**Mech**: Like eating fiber
90
Flax oil seeds
Uses:
* Constipation
* Diarrhea
* IBS
* Diabetes
* Arthritis
* Atherosclerosis
* Menopause
May slightly lower total cholesterol
May decrease hot flashes
**Mech**: Soluble fiber and phyto estrogens
SE:
* Increase GI act.
* Allergic rxns
91
Polycarbophil
GI Drug
Cathartic--Bulk adding agent
**Mech**: Like eating fiber
92
Ipecac
Emetic--reflex stimulant
Mech: Act. receptors in GI mucosa
Instant severe vomiting
SE: Cardiotoxic
93
Teriparitide
Tx: Ca disorders
Mech: PTH analog
Increase osteoblast activity
Daily subQ injections for short periods
*High doses→osteoclast stimulation so only given in short bursts*
SE-increase incidence of osteosarcoma
95
Which GCs used for IBS
**Prednisone**
**Budesonide**
96
Lubiprostone
GI Drug
Cathartic--Secretion enhancer
**Mech:** Acts on PGE receptor
PGE1 derivative
Also acts on Cl channel in intestine
97
Detemir
Tx: Diabetes
Designer insulin
Long acting (24+ hrs)
*Determined to get large (that a long time)*
*_Detemir_ +_glargine_=long acting insulins*
98
Heparin
Effects: Act. osteoclasts
So bone loss
99
-tidine
GI drug
Decrease acid secretion
Mech: H2 receptor blockers
SE:
* Confusion in elderly
* Bradycardia
Cimetidine:
* Inh. P450
* Prevent synth of test.
* Anti-androgenic
* Cause gynecomastia
100
Ma huang (ephedra)
Use:
* Weight loss
* Nasal congestion
* Asthma
* Increase athletic performance
Strong CNS stimulant
SE:
* Stroke
* Hypertension
* MI
101
Metoclopramide
## Footnote
Tx: Gastroparesis
*prokinetic agent--agents that increase stomach emptying rate*
Also used for hiccups
**Mech**: DA and possible 5HT antagonist
Route: Oral or IV
Increase motility w/o secretion (of H or gastrin)
SE:
* Sedation
* Depression
* Parkinson like symptoms
***Meto**clopramide increases **moti**lity*
* All that motility→shakes (parkinson like symptoms)*
* All those shakes →sedation *
* All that sedation→depression *
102
Paracalcitrol
Tx: Ca disorders
Mech: Vit D analog
Less potent than calcitriol
SE: Hypothyroidism
103
-sala-
**Sulfa**_sala_**zine**
**Me**_sala_**mine**
**Ol**_sala_**zine**
**Bal**_sala_**zide**
Tx: IBS--Salicylates
Mech: Decrease PG synth
*Online it says mech is unclear--may not be the same as aspirin*
Not systemically absorbed-like a topical drug for the stomach
SE:
* Diarrhea
* Take 3-5 weeks to work
104
Aspart
Tx: Diabetes
Designer insulin
Short acting (2-5 hrs)
105
What are the long acting designer insulins?
Detemir
Glargine
