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