DRUGS NAMES AND KEY INFO 310

Metoprolol

first line angina B blocker

atenolol

second line angina beta blocker

verapamil

CCB for angina, can cause constipation and is a better choice for patients with underlying arrhythmias

diltiazem

CCB for angina, slightly better angina relief and lower risk of constipation, bradycardia or AV block

GTN

first line therapy for acute treatment of angina attacks

Angina treatment key counselling

BB and CCB prevent angina attacks and must be taken regularly. GTN should still always be carried. Always report new or worsening chest pain. high alcohol consumption can increase dizziness

Rapid-acting insulin examples

lispro, aspart, glulisine

Rapid-acting insulin release profile

onset at 15 mins, peak at 1 hour, duration 2-5 hrs

Rapid-acting insulin method of action

MoA: recombinant DNA technology prevents insulin monomers from self-associating into dimers and hexamers. This allows for faster absorption into the bloodstream.

Short-acting insulin examples

regular human neutral/soluble

Short-acting insulin release profile

onset 30-60 mins, peak at 2-4 hrs, duration 6-8 hrs

Short-acting insulin method of action

MoA: form hexamers in the SC tissue that slowly dissociates into dimers and then monomers, finally entering the blood vessels

Intermediate-acting insulin examples

NPH (regular insulin mixed with protamine)

Intermediate-acting insulin release profile

onset 1-2 hrs, peak 4-10 hrs, lasting 12-24 hrs

Intermediate-acting insulin method of action

MoA: Insulin is negatively charged at a neutral pH, so when mixed with protamine, it forms complexes with the protamine that dissociate slowly, delaying absorption

Long-acting insulin example

Glargine

Long-acting insulin release profile

Steady-state after 2-4 hrs, flat/peakless effect for ~24 hrs

Long-acting insulin method of action

MoA (glargine): amino acid substitutes shift the isoelectric point, making the molecule soluble at an acidic pH but less soluble at physiological pH. This makes the insulin form crystals that slowly dissolve and release insulin over time

Biphasic insulin (mixtures) example

combination rapid/short acting and intermediate acting insulins (eg Humulin 30/70 is 30% short acting and 70% NPH insulin)

Biphasic insulin (mixtures) method of action

MoA: mimics postprandial (post-meal) peaks and sustained basal secretion in a single injection