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59 Cards in this Set

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What are some uses for regular (human recombinant) insulin?
Fast Onset:
- Emergencies (ketoacidosis)
- Changing insulin needs (surgery)
- Prandial needs
What is Insulin lispro?
Rapid-acting insulin slightly modified from regular insulin
What is an advantage of using Insulin lispro?
You can give it 15 minutes before a meal or immediately (vs. 30-45 minutes), so it's more convinient
What is Insulin aspart/glulisine?
Rapid-acting insulins that can be used in CSII pumps
Why would you never give intermediate acting insulins IV?
Because they are in a precipitated state
What is Neutral Protamine Hagedorn (NPH)?
An intermediate acting insulin that is complexed with protamine (slows release)
What is Insulin Glargine?
A long acting insulin that precipitates at physiological pH
What is the indication of insulin glargine in pregnancy (first, think, "what is glargine?")
Not recommended
What is Insulin Detemir?
A long acting insulin
What is the advantage of Detemir over NPH or glargine?
Less variable serum concentrations.
How is insulin detemir formulated to carry out its stable serum concentration?
It is lipophilic, so it binds albumen
Why would one mix insulins?
Type I diabetics must use short and long acting insulins?
What is the Goal for fasting blood glucose in insulin therapy? 2 hr postprandial?
<126 mg/dL
<200 mg/dL
What is the goal for HbA1c in insulin therapy?
<7%
What is metformin?
A biguanide
What is metformin's MOA?
Suppression of hepatic glucose production via activation of AMPK (AMP-dependent Protein Kinase)
-Enhances peripheral glucose uptake and insulin sensitivity
-Oxidation of fatty acids (decreased triglycerides)
What is metformin's duration of action?
Short (half life=2 hr). Must be taken 2-3x daily.
What are some major contraindications of metformin?
- Renal or hepatic failure (threat of lactic acidosis)
-Lactic acidosis
- Cardiac Failure/MI
What are some SEs of metformin?
Lactic Acidosis (CI'd in Renal Failure)
Megaloblastic Anemia
What is Rosiglitazone?
A thiazolidinedione
What is Pioglitazone?
A thiazolidinedione
What is the black box warning with Rosiglitazone and Pioglitazone
CHF
What is the MOA of thiazolidinediones?
PPAR-y agonist. Activation of insulin responsive carbohydrates/lipid metabolic genes
What is one huge benefit of thiazolidinediones?
Does not compromise renal function
What are some of the side effects of thiazolidinediones?
Wt Gain
Edema
Hepatotoxicity
CV Toxicity
What is the indication of thiazolidinediones in pregnancy?
Contraindicated
What is tolbutamide?
A 1st generation sulfonylurea
What is Tolazamide?
A 1st generation sulfonylurea
What is Acetohexamide?
A 1st generation sulfonylurea
What is Chlorpropamide?
A 1st generation sulfonylurea
What is Glyburide?
A 2nd generation sulfonylurea
What is Glipizide?
A 2nd generation sulfonylurea
What is Gliclazide?
A 2nd generation sulfonylurea
What is Glimepiride?
A 2nd generation sulfonylurea
What is the difference between 1st and 2nd generation sulfonylureas?
- 2nd generations are 100-200x more potent
- 1st gens easily displaced from albumin
In what circumstances would you prescribe a sulfonylurea?
-When lifestyle changes/metfromin fails in TII DM
-Individual preference
You have a patient who is not responding to metformin the way he once did. What would you prescribe?
Sulfonylurea
What is the MOA of sulfonylureas?
Inhibition of B-cell ATP sensitive K+ channels
What is the most common SE of sulfonylurea?
Hypoglycemia
What are some important contraindications with sulfonylureas?
-TYPE I DM
-Pregnancy/lactation
-hepatic/renal disease
What is Repaglinide?
A Meglitinide
What is Nateglinide?
A Meglitinide
What is the MOA of meglitinides (Repaglinide, Nateglinide)?
Same as sulfonylurea?
What is the method of elimination of meglitinides?
Hepatic (90%), renal (10%)
What would you prescribe to a patient who has built tolerance to metformin and has a sulfonylurea allergy?
Meglitinide
What is Acarbose?
a-glucosidase inhibitor
What is Miglitol?
a-glucosidase inhibitor
What is the MOA of a-glucosidase inhibitors (miglitol, acarbose)?
Inhibits the enzyme on the intestinal brush border, decreasing the absorption of starches and complex sugars
You have an elderly patient with a postprandial hyperglycemia at risk for hypoglycemia and lactic acidosis. What would you prescribe?
a-Glucosidase inhibitor
What are some of the SEs of a-glucosidase inhibitors?
Malabsorption, fllatulence, bloating, diarrhea...improve with time
What is exenatide?
It is an incretin which is a glucagon-like peptide
What is the MOA of exenatide?
Amplifies insulin, decreases glucagon secretion
What is exenatide used for?
Type II DM...expensive SC injections
What are the side effects of exenatide?
Nausea and hypoglycemia (sulfonylurea combo)
What is sitagliptin?
DDP IV inhibitor
What are some SEs of sitaglipitin?
Nasopharyngitis, URIs
What is pramlintide?
Islet amyloid polypeptide (amylin) analog
What is the MOA of pramlinitide?
Delays gastric emptying, inhibits glucagon secretion, suppressing appetite
What is glucagon used for?
-counters insulin OD
-Endocrine Dx
-B-blocker poisoning
-Radiology of the bowel