Term
| Insulin has always been classified according to what 3 things? |
|
Definition
1. how long it works in the body, its DOA
2. How quickly it begins to work
3. How it can be administered |
|
|
Term
| List the rapid acting insulins. |
|
Definition
Insulin lispro (Humalog)
Insulin Glulisine (Apidra)
Insulin Aspart (Novolog) |
|
|
Term
| What is the disadvantage of rapid acting insulins? |
|
Definition
They are expensive compared to regular insulins
$$$ |
|
|
Term
| How long does it take rapid acting insulins to start working? |
|
Definition
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|
Term
| Rapid acting insulins peak at _________. |
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Definition
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|
Term
| Which rapid acting insulin has rapid absorption, even in obese patients? |
|
Definition
|
|
Term
| What is the DOA of rapid acting insulins? |
|
Definition
|
|
Term
| What is the disadvantage of regular (short acting) insulins? |
|
Definition
| It has a longer DOA which can lead to nocturnal hypoglycemia |
|
|
Term
| How long does it take regular insulin to start working? |
|
Definition
|
|
Term
| When does regular insulin levels peak and how long does it work? |
|
Definition
Peaks: 50-120 minutes
DOA: 3-8 hours |
|
|
Term
| What is the main advantage of regular insulin? |
|
Definition
|
|
Term
| _____________ is a disadvantage of NPH (an intermediate insulin). |
|
Definition
|
|
Term
| What is the onset of action, peak and duration of action of NPH? |
|
Definition
onset: 1-3 hours
peak: 8 hours
duration: 20 hours |
|
|
Term
| Most all insulin comes in ________ U/mL. |
|
Definition
|
|
Term
| Which insulins are considered long acting? |
|
Definition
Insulin Glargine (Lantus)
Insulin Detemir (Levemir) |
|
|
Term
| NPH is often combined with: |
|
Definition
| rapid or short acting insulins |
|
|
Term
| How much insulin would you give to someone with mild to moderate ketone levels? |
|
Definition
|
|
Term
| How much insulin would you give to someone with large amounts of ketones? |
|
Definition
|
|
Term
| How often would you administer Insulin detemir? |
|
Definition
| BID; because of its shorter DOA (12-24hrs) |
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|
Term
| Long acting insulins provide a continuous dose level which prevents __________. |
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Definition
|
|
Term
| Which form of insulin has no peak? |
|
Definition
|
|
Term
| Insulin Glargine can be administered ______ a day because of its DOA is _______. |
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Definition
|
|
Term
| Long Acting Insulin starts working in ______. |
|
Definition
|
|
Term
| What are some examples of mixed insulins? |
|
Definition
Humulin 70/30
Humulin 50/50
Humalog 75/25
Novolin 70/30
Novolog 70/30 |
|
|
Term
| With type 2 DM you have enough insulin to prevent _______ but not enough to prevent __________. |
|
Definition
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|
Term
| When ________ can no longer compensate for the increased demand for insulin, DM2 occurs. |
|
Definition
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|
Term
| ____________ makes cells less sensitive to circulating insulin. |
|
Definition
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|
Term
| GLP-1 has _______________ effects |
|
Definition
| Anti-hyperglycemic effects |
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|
Term
| What are the antihyperglycemic effects of GLP-1 (an incretin)? |
|
Definition
- Increases insulin secretion
- Increases uptake of glucose in tissues
- Decreases glucagon secretion
- Inhibits gastric emptying and acid secretion
- Increases satiety and decreases food intake |
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|
Term
| GLP-1 is metabolized by _______. |
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Definition
|
|
Term
| The deficiencies in ______ signaling contribute to the abnormal postprandial insulin secretion. |
|
Definition
|
|
Term
| List the insulin secretagogues. |
|
Definition
Sulfonylureas
Meglitinides |
|
|
Term
| List the insulin sensitizers. |
|
Definition
Biguanides
Thiazolidinediones (Glitazones) |
|
|
Term
| List the drug groups used to treat DM2. |
|
Definition
insulin secretagogues
insulin sensitizers
Alpha glucosidase Inhibitors
Dipeptidyl Peptidase IV Inhibitors (DPP-IV)
Incretin Mimetics |
|
|
Term
| The max A1c lowering of monotherapy is ________, so often you need 2 agents. |
|
Definition
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|
Term
| Eventually, as beta cells continue to decline, ______ of patients will require insulin. |
|
Definition
|
|
Term
| Sulfonylureas stimulate ________ release from pancreatic ________ (MOA) |
|
Definition
|
|
Term
| Besides stimulating insulin release, sulfonylureas also... |
|
Definition
1. suppress hepatic gluconeogenesis
2. decrease glucagon levels |
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|
Term
| Why are sulfonylureas prone to drug interactions? |
|
Definition
| because they are metabolized by P450 and are protein bound |
|
|
Term
|
Definition
1st gen: Tolazamide, Tolbutamide
2nd gen: Glyburide, Glipizide, Glimepiride |
|
|
Term
| Which sulfonylurea is good to use if a patient is prone to hypoglycemia? |
|
Definition
|
|
Term
| Patients on Glyburide are ________ as likely to experience ____________ than patients on Glipizide. |
|
Definition
|
|
Term
| Glyburide is 150xs more potent than ____________. |
|
Definition
|
|
Term
| How is Glipizide metabolized? |
|
Definition
|
|
Term
| Which sulfonylurea is indicated for use with insulin? |
|
Definition
|
|
Term
| What are the max doses of the 2nd generation sulfonylureas? |
|
Definition
Glyburide - 10 mg BID
Glipizide - 20 mg BID
Glimepiride - 8 mg |
|
|
Term
| List the AEs of sulfonylureas. |
|
Definition
hypoglycemia
weight gain
photosensitivity
decreased alcohol tolerance |
|
|
Term
|
Definition
|
|
Term
| What slight advantage does Nateglinide have over Repaglinide? |
|
Definition
|
|
Term
| If Repaglinide is combined with ___________, severe hypoglycemia may occur. |
|
Definition
|
|
Term
| Which drugs may inhibit the metabolism of Meglitinides? |
|
Definition
Azoles
Erythromycin/Clarithromycin |
|
|
Term
| Which drugs may increase the elimination of Meglitinides? |
|
Definition
Barbiturates
Rifampin
Carbamazepin |
|
|
Term
| ______________ are less likely than sulfonylureas to cause fasting hypoglycemia. |
|
Definition
|
|
Term
| Meglitinides are categorized as __________ glucose regulators. |
|
Definition
|
|
Term
| Meglitinides are insulin secretagogues which means their MOA is... |
|
Definition
| to stimulate insulin secretion in response to glucose. |
|
|
Term
| When should Meglitinides be given? |
|
Definition
30 minutes prior to meals
about 3xs a day |
|
|
Term
| Which DM2 drugs are considered "hypoglycemic" drugs? |
|
Definition
sulfonylureas
meglitinides |
|
|
Term
|
Definition
|
|
Term
| Metformin requires the presence of __________ to be effective. |
|
Definition
|
|
Term
| Which DM2 drugs are antihyperglycemic agents? |
|
Definition
| Biguanides and Thiazolidinediones |
|
|
Term
| Metformin enhances glucose ___________ and _____________ in target tissues by improving insulin receptor sensitivity; this decreases _________________ (MOA) |
|
Definition
uptake and utilization
insulin resistance |
|
|
Term
| Besides decreasing insulin resistance, Metformin also... |
|
Definition
1. decreases hepatic glucose production
2. may also dec. glucose absorption from the gut |
|
|
Term
| ___________ works best in patients with hyperglycemia who have insulin resistance. (Overweight diabetics) |
|
Definition
|
|
Term
| List the AEs of Metformin. |
|
Definition
GI symptoms
Lactic Acidosis |
|
|
Term
| Which drug should you temporarily discontinue if you have to get IV radiograph contrast imaging done? |
|
Definition
|
|
Term
| What is the max dose of Metformin? |
|
Definition
|
|
Term
|
Definition
| a combination of Metformin and Glyburide |
|
|
Term
|
Definition
| a combination of Metformin and Glipizide |
|
|
Term
| Thiazolidinedoines are also called... |
|
Definition
|
|
Term
| Glitazones potentiate ______________ (MOA) |
|
Definition
|
|
Term
| Besides potentiating insulin activity, Glitazones also... |
|
Definition
1. decrease peripheral resistance
2. decrease hepatic glucose production
3. decrease leptin levels |
|
|
Term
| Who is the ideal Glitazone patient? |
|
Definition
| DM2 patient with insulin resistance who does not respond well to other therapies |
|
|
Term
|
Definition
Rosiglitazone
Pioglitazone |
|
|
Term
| You can use Glitazones by themselves or with... |
|
Definition
| Metformin, insulin or sulfonylureas |
|
|
Term
| List the AEs of Glitazones. |
|
Definition
Edema
Weight gain
mild anemia
potential liver abnormalities |
|
|
Term
| When using Glitazones you should monitor what? |
|
Definition
|
|
Term
| Does Metformin cause weight gain? |
|
Definition
| No, it actually decreases appetite which may cause weight loss |
|
|
Term
Alpha-Glucosidase Inhibitors competitively inhibit alpha-glucosidase enzymes in the _________________. (MOA)
|
|
Definition
|
|
Term
| When should you take alpha-glucosidase inhibitors? |
|
Definition
| With the first bite of food at each meal |
|
|
Term
| Name the Alpha-glucosidase inhibitors. |
|
Definition
|
|
Term
| Only ____ of Acarbose is absorbed. |
|
Definition
|
|
Term
| Acarbose has a rare association with _____________. |
|
Definition
|
|
Term
| Alpha-Glucosidase inhibitors have their best effect in patients with... |
|
Definition
| mild to moderate diabetes whose diet is >50% carbs |
|
|
Term
| How is Miglitol absorbed? |
|
Definition
| systemically prior to its effect in the GI tract |
|
|
Term
| List the AEs of Alpha-glucosidase inhibitors. |
|
Definition
| GI disturbances - loose stools, flatulence and cramping |
|
|
Term
| List the positives of Alpha-glucosidase inhibitors. |
|
Definition
No weight gain
No hypoglycemia
|
|
|
Term
| What are alpha-glucosidase inhibitors usually combined with? |
|
Definition
metformin
insulin
sulfonylureas |
|
|
Term
| Which drug is an incretin mimetic? |
|
Definition
|
|
Term
| Exenatide is approved as an adjunctive therapy in patients who are taking which drugs? |
|
Definition
metformin
Sulfonylureas
TZDs
or a combination of these |
|
|
Term
| How is Exenatide administered? |
|
Definition
| By injection (a pre-filled pen device) BID |
|
|
Term
| Exenatide is _____________. It lowers blood sugar when levels are elevated but does not continue to lower it when levels reach normal. |
|
Definition
|
|
Term
| What are the 2 main ways Exenatide facilitates glucose control? |
|
Definition
1. Increases insulin secretion in response to food
2. suppresses glucagon release in response to food |
|
|
Term
| List the SEs of Exenatide. |
|
Definition
|
|
Term
| DPP-4 Inhibitors mimic may of the actions of _________. |
|
Definition
|
|
Term
| List the DPP-4 Inhibitors. |
|
Definition
Vildagliptin (under review)
Sitagliptin - Januvia |
|
|
Term
| How is Sitagliptin administered? |
|
Definition
|
|
Term
|
Definition
Increases insulin release in response to meals by prolonging GLP-1 activity
decreases glucagon levels |
|
|
Term
| Sitagliptin can be used as a monotherapy drug or in combination with... |
|
Definition
metformin
TZD
sulfonylurea |
|
|
Term
| List the SEs of Sitagliptin |
|
Definition
|
|
Term
| Which group of DM2 drugs is considered first line in patients who have classic diabetic dyslipidemia? |
|
Definition
|
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