Insulin Pharmacology Quiz

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Questions and Answers

What is a serious risk associated with the use of targeted synthetic DMARDs and Janus kinase inhibitors?

Increased blood pressure

Enhanced kidney function

Reduced liver enzymes

Increased risk for infections (correct)

Which of the following indicates the contraindications for the use of oral glucocorticoids?

Pregnancy and hepatotoxicity

Bronchitis and obesity

Thyroid disorders and migraines

Breastfeeding and renal impairment (correct)

Which medication interaction should be monitored when administering targeted synthetic DMARDs?

Calcium supplements

CYP inducers/inhibitors (correct)

Antihistamines

Antidepressants

What is a potential adverse effect of long-term therapy with oral glucocorticoids?

Cushing’s disease Signup and view all the answers

For which condition are targeted synthetic DMARDs indicated?

Moderate to severe RA not responding to methotrexate Signup and view all the answers

What is the primary mechanism of action for Sulfonylureas?

Promote insulin secretion by the pancreas Signup and view all the answers

Which oral diabetic agent is contraindicated in patients with type 1 diabetes mellitus?

Sulfonylureas Signup and view all the answers

Which of the following medications is known to cause severe metabolic acidosis?

Metformin Signup and view all the answers

What is a common side effect associated with Meglitinides?

Hypoglycemia Signup and view all the answers

Which medication significantly increases the risk of hypoglycemia when combined with Sulfonylureas?

Fluoroquinolone Signup and view all the answers

What is a notable long-term effect of Metformin after 12-15 years of use?

Vitamin B12 deficiency Signup and view all the answers

Which of the following pairs of drugs have a documented interaction with Meglitinides?

Ketoconazole and rifampin Signup and view all the answers

Which of the following medications is contraindicated during pregnancy and lactation?

Glipizide Signup and view all the answers

What is a common side effect associated with 5-alpha-reductase inhibitors like Finasteride and Dutasteride?

Decreased ejaculate volume Signup and view all the answers

Which drug class may lead to serious drug-drug interactions with nitrates?

PDE-5 inhibitors Signup and view all the answers

What is a key safety consideration when prescribing bisphosphonates for osteoporosis?

Contraindicated in esophageal abnormalities Signup and view all the answers

Which is a possible adverse effect of alpha-1 adrenergic antagonists?

Floppy iris syndrome Signup and view all the answers

What type of obstruction is primarily treated with 5-alpha-reductase inhibitors?

Mechanical obstruction Signup and view all the answers

Using which of the following can potentially increase levels of silodosin?

CYP inhibitors Signup and view all the answers

Which situation should prompt caution when prescribing bisphosphonates?

Patients with preexisting mineral absorption issues Signup and view all the answers

What is NOT a characteristic feature of PDE-5 inhibitors like Levitra?

Effective for BPH treatment Signup and view all the answers

Study Notes

Insulin: Rapid Acting

Drugs: Lispro (Humalog), aspart (NovoLog), Glulisine (Apidra), Afrezza (inhaled)
Indications: Given with meals to control postprandial rise in blood glucose.
MOA: Mimic actions of endogenously produced insulin.
Side Effects/Adverse Effects: Significant risk for hypoglycemia, hypersensitivity, antibody formation, site irritation, cough/URI symptoms, weight gain, hypokalemia, lipodystrophy, lipohypertrophy, peripheral edema, vision changes.
Contraindications: Hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis.
Drug Interactions (D2D): Hypoglycemic agents, hyperglycemic agents, beta-adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens.
Special Considerations: Must be used in conjunction with an intermediate or long-acting agent in DM type 1.
Pregnancy/Lactation: Safe.

Insulin: Short Acting

Drugs: Regular Insulin (Humulin R, Novolin R)
Indications: Control postprandial hyperglycemia. Infused via insulin pump for basal glycemic control.
MOA: Mimic actions of endogenously produced insulin.
Side Effects/Adverse Effects: Significant risk for hypoglycemia, hypersensitivity, antibody formation, site irritation, cough/URI symptoms, weight gain, hypokalemia, lipodystrophy, lipohypertrophy, peripheral edema, vision changes.
Contraindications: Hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis.
Drug Interactions (D2D): Hypoglycemic agents, hyperglycemic agents, beta-adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens.
Special Considerations: Onset
Pregnancy/Lactation: Considered safe.

Insulin: Intermediate Duration

Drugs: Natural protamine Hagedorn Insulin (Humulin N, Novolin N, NPH)
Indications: Glycemic control between meals and during the night.
MOA: Combines insulin with protamine and decreases solubility, delaying absorption.
Side Effects/Adverse Effects: Risk of allergic reactions.
Contraindications: Hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis.
Drug Interactions (D2D): Hypoglycemic agents, hyperglycemic agents, beta-adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens.
Special Considerations: Only insulin that can be mixed with short-acting insulins.
Pregnancy/Lactation: Safe.

Insulin: Long Duration

Drugs: Glargine U-100 (Lantus), Detemir (Levemir)
Indications: Once daily dosing to treat type 1 and 2 DM
MOA: Modified human insulin with prolonged duration of action. No peak.
Side Effects/Adverse Effects: Significant risk for hypoglycemia, hypersensitivity, antibody formation, site irritation, cough/URI symptoms, weight gain, hypokalemia, lipodystrophy, lipohypertrophy, peripheral edema, vision changes.
Contraindications: Hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis.
Drug Interactions (D2D): Hypoglycemic agents, hyperglycemic agents, beta-adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens.
Special Considerations: Can be given at any time of day, but should be given at the same time each day. Can do a split dose, cannot mix.
Pregnancy/Lactation: Safe.

Insulin: Ultra-Long Duration

Drugs: glargine U-300 (Toujeo), Degludec (Tresiba)
Indications: Once daily for type 1 and 2 DM. Used to provide basal glycemic control.
MOA: Modified human insulin that is concentrated to prolong duration of action in excess of 24 hours. Only human analog with effects persisting up to 42 hours.
Side Effects/Adverse Effects: Significant risk for hypoglycemia, hypersensitivity, antibody formation, site irritation, cough/URI symptoms, weight gain, hypokalemia, lipodystrophy, lipohypertrophy, peripheral edema, vision changes.
Contraindications: Hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis.
Drug Interactions (D2D): Hypoglycemic agents, hyperglycemic agents, beta-adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens.
Special Considerations: Must be used in conjunction with an intermediate or long-acting agent in DM type 1.
Pregnancy/Lactation: Safe.

Biguanides

Drugs: Metformin (Glucophage, Fortamet)
Indications: Initial therapy in patients with type 2 DM, prevention of T2DM, GDM, PCOS
MOA: Decrease glucose production by the liver, increases tissue response to insulin, decreases absorption of glucose in the gut. Cannot cause hypoglycemia.
Side Effects/Adverse Effects: GI (N/V, decreased appetite, diarrhea), weight loss.
Safety: Use caution with pre-existing renal impairment. Contraindicated in heart failure
Drug Interactions (D2D): Tagamet (increases serum concentration), carbonic anhydrase inhibitors, alcohol, insulin, other glycemic controlling drugs.
Special Considerations: Monitor elderly for renal impairment. Causes decreased absorption of vitamin B12 and folic acid after 12-15 years of use.
Pregnancy/Lactation: Safe.

Sulfonylureas

Drugs: Glipizide, glyburide, glimepiride
Indications: Type 2 DM
MOA: Promote insulin secretion by the pancreas, may also increase tissue response to insulin. Must have endogenous insulin production to work.
Side Effects/Adverse Effects: Hypoglycemia, weight gain, increased risk for cardiovascular mortality.
Safety: Contraindicated in T1DM and diabetic ketoacidosis. Use with caution in renal and hepatic disease, hemolytic anemia, and the elderly.
Drug Interactions (D2D): Increased risk for hypoglycemia when used with medications that lower glucose (fluoroquinolone, macrolides, sulfonamides)
Special Considerations: Secondary failure can occur, and the effect of the medication wears out over time as the disease progresses.
Pregnancy/Lactation: Do not use.

Meglitinides (Glinides)

Drugs: Nateglinide (Starlix), repaglinide (Prandin)
Indications: Type 2 DM
MOA: Promote insulin secretion by the pancreas, shorter-acting than sulfonylureas. Taken with each meal.
Side Effects/Adverse Effects: Hypoglycemia, weight gain
Contraindications: Contraindicated in diabetic ketoacidosis, T1DM, and combination with NPH and gemfibrozil.
Drug Interactions (D2D): CYP inhibitors/inducers: rifampin, barbiturates, carbamazepine, ketoconazole, itraconazole, erythromycin, trimethoprim, montelukast.
Pregnancy/Lactation: Do not use.

Thiazolidinediones (Glitazones)

Drugs: Pioglitazone (Actos), rosiglitazone (Avandia)
Indications: Type 2 DM
MOA: Turn on insulin-responsive genes and increase sensitivity to help regulate carbohydrate and lipid metabolism (decrease insulin resistance). Usually added to metformin.
Side Effects/Adverse Effects: None listed
Pregnancy/Lactation: Do not use.
This is a summary and not meant to be an exhaustive list. Always consult a medical professional for diagnosis and treatment.*

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Description

Test your knowledge on rapid and short-acting insulin medications, including their indications, mechanisms of action, side effects, and contraindications. Learn more about their use in diabetes management and important drug interactions.