Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
|
Insulins Lispro, Aspart, Glulisine
|
Injectable Zn-hexamers
Dissociate faster than reg. insulin Onset in 5-15 min Peak in 1-1.5 hour Duration 3-4 hours Used for Meals (Rapid Acting) Can be used in CSII pumps |
|
|
Human Regular Insulin
|
Crystalline Zinc Insulin
Onset in 30-60 min Peak action 2 hours Duration for 6-8 hours IV, IM, SC possible Used for emergencies (DKA) and changing insulin needs (surgery) |
|
|
Human NPH Insulin
|
Insulin complexed with protamine- slows release but precipitated state interferes w/ coag so never IV
Onset 2-4 hours Peak action 6-7 hours Duration 10-20 hours Intermediate release |
|
|
Insulin glargine
|
Long acting
pH 4 1x/day Not in preganancy and can't mix Onset 1.5 hour Flat action Duration 24 hours Long action so fewer injections |
|
|
Insulin Detemir
|
Attached FA to Zn-Hexamer
FA promotes albumin binding 1-2x/day SC injection Onset 1 hr Peak action is flat Duration 17 hrs. |
|
|
Goal Insulin Therapy
|
Fasting BG <126 mg/dL
2 hr post prandial BG <200 HbA1C <6.5% |
|
|
Contraindications of Insulin Therapy
|
Hepatic/Renal Disease
Elderly <7yrs. old |
|
|
Complications of Insulin Therapy
|
Hypoglycemia (BG<70mg/dl)
Usually a mismatch btwn amt and food intake Increase SC blood flow (hot tub) increases insulin absorption |
|
|
Treatment of Hypoglycemia
|
Glucose 15-20g
Severe- glucose IV or glucagon SC/Im until regained consciousness to ingest glucose |
|
|
Goal Insulin Therapy
|
Fasting BG <126 mg/dL
2 hr post prandial BG <200 HbA1C <6.5% |
|
|
Treatment of DKA
|
Regular insulin 0.1 units/kg/hr
10% fall/hr Electrolyte replacement as needed 30 min prior to terminating IV insulin give SC insulin |
|
|
Goal Insulin Therapy
|
Fasting BG <126 mg/dL
2 hr post prandial BG <200 HbA1C <6.5% |
|
|
Contraindications of Insulin Therapy
|
Hepatic/Renal Disease
Elderly <7yrs. old |
|
|
Biguanides
|
Metformin
Increases tissue sensitivity to insulin and lower liver gluconeogen. No hypoglycemia bc no insulin- release effect Decreases triglycerides 2-3x/day Absorbed from SI and excreted by kidney unchanged T1/2=2 hr. Combos possible |
|
|
Metformin Contraindications
|
Renal/Hepatic Failure
Lactic acidosis: Cardiac failure/MI, Chronic lung disease, Prolonged fast/low cal diet Severe GI symptoms Septicemia Alcoholism IV contrast media |
|
|
SEs of Metformin
|
Transient and dose-related
GI: Metallic taste and anorexia Chronically inhibit B12/Folate absorption (Ca supplement helps) Gradually increase dose w/ meal to minimize SE |
|
|
TZDs (-Glitazones)
|
Increases tissue sensitivity and decreases liver gluconeogenesis
Agonists of nuclear PPAR activate insulin-responsive genes Improves lipids more than Met. Hepatic Metab: Ok in renal-comp. patients Risk of heart failure: anemia, weight gain, edema Alters oral contraceptives CI in Heart Failure, Pregnancy, Liver Disease Combos possible |
|
|
1st Generation Sulfonylureas
|
Tolbutamide
Tolazamide Acetohexamide Chlorpropamide |
|
|
2nd Generation Sulfonylureas
|
Glyburide
Glipizide Gliclazide Glimepride *2nd Gen used the most because 100x more potent Given in combos with other drugs |
|
|
Sulfonylureas
|
Inhibit Beta Cell K channels to increase Beta cell sensitivity to glucose (ph2 secretion)
Bind to plasma proteins (Ist generation easily displaced) Hepatic metabolism and renal excretion SE: Hypoglycemia, Weight gain, lose efficacy in 1-2 yr. CI: caution in alcoholics, T1 DM, Pregnancy, Hepatic/renal disease, Elderly and CV disease |
|
|
Meglitinides
|
Repaglinide
Nateglinide Structurally different from SUs but same result No sulfur so good for allergies |
|
|
Alpha-glucosidase inhibitor
|
Acarbose, Miglitol
Inhibit brush border to decrease starch absorption Decreases post-meal glucose level Not a benefit to A1C or fasting gluc. No hypoglycemia Miglitol 6x more potent but acarbose poorly absorbed so stays in gut longer Used for T2 with severe hyperglycemia, elderly with post-meal hyperglycemia and Type 1 with delayed SC insulin absorption |
|
|
Alpha-glucosidase inhibitor: SEs and CI
|
SEs: Malabsorption, gas, bloating
Hypoglycemia with SUs not Met (Treat hypoglycemia with gluc not disaccharides) CI: Inflamed bowel, renal disease (miglitol) and hepatic disease (acarbose) |
|
|
Incretins
|
Exenatide
Glucagon-like peptide so glucagon decreases and effectively increases insulin Only works when glucose is present- low hypoglycemic risk Weight loss possible (Decreases apetite) Nausea and Vom |
|
|
Sitagliptins
|
DPP IV: Inhibits metabolism of Incretins
Potentiates glucose-induced insulin secretion Oral Potency and nausea< incretins Effectiveness as good as Met. SEs: URIs No weight loss or gain |
|
|
Pramlintide
|
Islet Amyloid Polypeptide Analog
Delays gastric emptying Inhibits glucagon Supresses appetite so weight loss Inject SC (T1 and insulin-treated 2) Must reduce short-acting insulin by 50% to prevent hypoglycemia |
|
|
Colesevelem
|
Bile acid sequestrant (Hyperchol. drug)
Reduces hyperglycemia SEs: Increased TGs, constipation, vitamin malabsorption |
|
|
Treatment for insulin overdose with glucagon
|
1 mg IM or IV
t1/2= 3-6min |
