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?

<p>Cushing’s disease (D)</p> Signup and view all the answers

For which condition are targeted synthetic DMARDs indicated?

<p>Moderate to severe RA not responding to methotrexate (B)</p> Signup and view all the answers

What is the primary mechanism of action for Sulfonylureas?

<p>Promote insulin secretion by the pancreas (D)</p> Signup and view all the answers

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

<p>Sulfonylureas (A)</p> Signup and view all the answers

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

<p>Metformin (B)</p> Signup and view all the answers

What is a common side effect associated with Meglitinides?

<p>Hypoglycemia (C)</p> Signup and view all the answers

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

<p>Fluoroquinolone (C)</p> Signup and view all the answers

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

<p>Vitamin B12 deficiency (A)</p> Signup and view all the answers

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

<p>Ketoconazole and rifampin (C)</p> Signup and view all the answers

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

<p>Glipizide (C), Nateflinide (D)</p> Signup and view all the answers

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

<p>Decreased ejaculate volume (B)</p> Signup and view all the answers

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

<p>PDE-5 inhibitors (A)</p> Signup and view all the answers

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

<p>Contraindicated in esophageal abnormalities (C)</p> Signup and view all the answers

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

<p>Floppy iris syndrome (C)</p> Signup and view all the answers

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

<p>Mechanical obstruction (D)</p> Signup and view all the answers

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

<p>CYP inhibitors (A)</p> Signup and view all the answers

Which situation should prompt caution when prescribing bisphosphonates?

<p>Patients with preexisting mineral absorption issues (B)</p> Signup and view all the answers

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

<p>Effective for BPH treatment (C)</p> Signup and view all the answers

Flashcards

Metformin MOA

Decreases glucose production by the liver, increases tissue response to insulin, and decreases glucose absorption in the gut.

Metformin SE

Gastrointestinal issues (nausea, vomiting, decreased appetite, diarrhea), weight loss.

Metformin Usage Caution

Use with caution in patients with pre-existing renal impairment, and contraindicated in heart failure.

Sulfonylureas MOA

Promote insulin secretion by the pancreas and may increase tissue response to insulin.

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Sulfonylureas Contraindication

Contraindicated in type 1 diabetes and diabetic ketoacidosis.

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Meglitinides MOA

Promote insulin secretion by the pancreas, taken with each meal.

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Meglitinides Contraindication

Contraindicated in diabetic ketoacidosis, type 1 diabetes, and with certain other medications.

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Thiazolidinediones Indication

Treatment for type 2 diabetes mellitus

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Targeted Synthetic DMARDs/JAK Inhibitors

Drugs that reduce inflammatory responses for moderate to severe RA not responding to methotrexate, Psoriatic arthritis, and Ulcerative Colitis. Examples include tofacitinib (Xeljanz) and Baricitinib (Olumiant)

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Adverse Effects of Targeted Synthetic DMARDs/JAK Inhibitors

Potential side effects include infection, bone marrow suppression, gastrointestinal perforations, liver injury, hyperlipidemia, and an increased risk of malignancies.

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Glucocorticoids (oral)

Anti-inflammatory and immunosuppressive drugs used for rheumatoid arthritis, lupus, and other inflammatory conditions. Examples include prednisone, prednisolone, methylprednisolone, etc.

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Glucocorticoid Long-Term Side Effects

Long-term use can cause toxicity, gastrointestinal bleeding, infections, hyperglycemia, growth delays, cataracts/glaucoma, and peptic ulcers. Cushing's syndrome, adrenal suppression also occur.

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Drug Interactions with Glucocorticoids

Glucocorticoids can interact with NSAIDs, insulin, digoxin, potassium-sparing diuretics, and oral hypoglycemics. Caution is needed.

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Levitra: Nitrate Interaction

Levitra should not be taken with nitrates due to a risk of dangerously low blood pressure.

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Levitra: CYP Inhibitors

Taking Levitra with CYP inhibitors (like ketoconazole) can increase Levitra levels in the body, potentially leading to side effects.

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5-Alpha Reductase Inhibitors: MOA

These drugs (like Finasteride and Dutasteride) shrink the prostate gland over time by reducing the production of dihydrotestosterone (DHT).

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5-Alpha Reductase Inhibitors: Safety Concern

These drugs can be absorbed through the skin, so women who are pregnant or may become pregnant should avoid contact with them.

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Alpha-1 Adrenergic Antagonists: MOA

These drugs (like Tamsulosin and Silodosin) relax smooth muscles in the bladder neck and prostate, improving urinary flow.

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Alpha-1 Adrenergic Antagonists: Side Effects

Common side effects can include abnormal ejaculation and problems with the iris during cataract surgery.

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Bisphosphonates: MOA

These drugs (like Alendronate and Ibandronate) reduce bone loss by inhibiting the activity of osteoclasts, which break down bone tissue.

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Bisphosphonates: Safety Considerations

Caution is needed in patients with pre-existing mineral absorption issues and long-term use. These drugs can cause esophageal irritation and should not be taken by patients who cannot stand or sit upright for at least 30 minutes.

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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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