Term
What is the function of insulin? |
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Definition
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Term
Duration of insulin when given IV? |
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Definition
- sustained pharm effect of 30-60 mins
- elimination half-time is 5-10 mins
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Term
Classifications of insulin preparations? |
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Definition
Rapid acting very rapid acting intermediate acting long acting
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Term
Onset, peak and duration of various insulins? |
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Definition
onset peak duration Rapid 0.5-1 2-3 6-8 Very rapid 0.25-0.5 0.5-1.5 4-6 Intermediate 1 4-8 10-14 Long acting 1 10-14 18-24 |
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Term
What insulin preparation is used most commonly in the perioperative setting? |
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Definition
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Term
What is insulin glargine? |
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Definition
otherwise known as Lantus recombinant insulin analog with extended duration of action constant flat release - no peak benefit- once daily dosing at bedtime
Do not mix with other solutions!!! |
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Term
Most serious adverse reaction of insulin therapy? Who is at risk? |
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Definition
Hypoglycemia pts that con't to recieve insulin ain the absence of CHO intake- ie: perioperative period |
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Term
Signs/symptoms of hypoglycemia? |
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Definition
diaphoresis tachycardia hypertension confusion
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Term
Recommended treatment for hypoglycemia? |
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Definition
severe treated with 50-100ml of D50 IV glucagon 0.5-1 mg IV or sc in absence of CNS depression- give carbs
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Term
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Definition
Rebound hyperglycemia in response to hypoglycemia- masks correct dx |
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Term
What type of allergic rxns can occur with insulin? |
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Definition
anti-body-mediated local or systemic insulin allergy local allergic reactions- most common chronic exp to protamine and NPH- may form antibodies to protamine lipodysthrophy- reflects atrophy of fat at injection sites
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Term
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Definition
| �� Patients requiring >100 units of exogenous insulin per day are considered to be insulin resistant. �� Insulin resistance may be acute or chronic. �� Acute insulin resistance is associated with trauma as produced by surgery and trauma. �� This is most likely the result of increases in cortisol concentrations. �� Chronic insulin resistance is most likely due to the development of antibodies against insulin. �� Sulfonylureas can decrease insulin requirements in some resistant patients. |
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Term
Common drug interactions of Insulin? |
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Definition
| Enhance the effects of Antagonize effects of insulin insulin Guanethidine ACTH Tetracycline and Epinephrine chloramphenicol Salicylates and phenylbutazone (increase duration of action of insulin) MAOIs potentiate hypoglycemic effects of Insulin. |
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Term
Mechanism of action of sulfonylureas oral hypoglycemic agents? |
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Definition
Principle site of action- pancreatic islet (beta) cells stimulate insulin release from the pancreas; reduce glucose output from liver, and increase insulin sensitivity at peripheral target sites
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Term
What pts are at highest risk of hypoglycemia with oral hypoglycemics? |
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Definition
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Term
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Definition
| a biguanide agent that is indicated as an adjunct to diet to lower blood glucose in pts with NIDDM |
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Term
Mechanism of action of metformin? |
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Definition
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Term
Precautions of metformin? |
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Definition
�� Metformin induced lactic acidosis is a rare potentially severe consequence of therapy with Metformin. �� It is recommended to withhold therapy in hypoxemia, dehydration, or sepsis. �� The risk of lactic acidosis is increased in patients with CHF requiring pharmacological management. �� Metformin is contraindicated in patients with renal insufficiency (Male with Serum Creatinine >=1.5, Females with Serum Creatinine >=1.4). �� Use of concomitant medications that may effect renal function may also effect Metformin disposition. �� Metformin therapy should be suspended for any surgical procedure and restarted only after normal intake is resumed and normal renal function is verified. �� It is recommended to hold Metformin for 48 hours in patients receiving radioactive dyes. |
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Term
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Definition
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Term
Advantage of Repaglinide over sulfonylureas? |
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Definition
| insulin release is glucose dependent |
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Term
Mechanism of action of Pioglitazone and Rosiglitazone? |
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Definition
| these agents lower blood sugar by improving target cell response to insulin, without increasing pancreatic insulin secretion. |
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Term
Major adverse effects of pioglitazone and rosiglitazone? |
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Definition
weight gain increased LDL and HDL edema, HA, diarrhea, upper respiratory infections elevated transaminases contraindicated in pts with liver dx
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Term
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Definition
| intestinal glycosidase inhibitor that decreases CHO digestion and absorption of disaccharides by interfereing with intestinal glucosidase activity |
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