Insulin and Drug-Eluting Stents: Types, Properties, and Applications

What is the purpose of the diluting fluid for insulin?

It is used to prepare any strength of insulin below 100U/ml for small children and veterinary use.

What are the physical properties of insulin injection?

Insulin injection is a colorless to straw-colored solution, substantially free from turbidity, with 1.4-1.8% glycerin added for stability and 0.1 to 0.25% phenol or cresol for preservation.

What is the recommended storage condition for insulin in use?

The vial being used may be stored at room temperature (15-30°C or 59-86°F) for up to one month.

What effect does freezing have on insulin?

Freezing reduces the potency of insulin.

What are the two formulations of human insulin initially marketed?

Neutral regular human insulin (Humulin R) and NPH human insulin (Humulin N).

What is the onset and duration of action for Neutral regular human insulin?

It has a rapid onset of action and a relatively short duration of action of 6 to 8 hours.

When should Insulin Aspart be administered for optimal effect?

Insulin Aspart should be administered 5 to 10 minutes before mealtime.

What are the pharmacokinetics of Insulin Aspart compared to insulin lispro?

Insulin Aspart has similar pharmacokinetics to insulin lispro, with an onset of action of 0.25 hours, peak effect at 0.5-1 hour, and a duration of action of 3 hours.

Why are higher doses of NPH insulin needed when using Insulin Aspart?

Higher doses of NPH insulin are needed because Insulin Aspart has a very short duration of action.

What percentage of a meal-related regimen can be provided by Insulin Aspart?

50 to 70% of a meal-related regimen may be provided by Insulin Aspart.

How was NPH insulin created?

NPH insulin was created in 1936 by adding neutral protamine to regular insulin.

What components make up the solid phase of NPH insulin suspension?

The solid phase consists of crystals of insulin, zinc, and protamine.

What is the difference between Humulin 70/30 and 50/50 in terms of insulin concentration?

Humulin 50/50 achieves a higher insulin concentration (Cmax) with more rapid elimination than Humulin 70/30.

What are the characteristics of Humulin premixed insulin preparations?

Humulin 70/30 and 50/50 are cloudy suspensions with a zinc content of 0.01 to 0.04 mg/100U.

What should patients avoid doing with Humulin 70/30 and 50/50 formulations?

Patients should not attempt to change the ratio of these products by adding NPH or regular insulin.

What are the advantages of premixed formulations of insulin?

Premixed formulations provide a rapid onset of action and intermediate duration without the risks of contamination from mixing.

What is the role of glycerin and phenol in NPH insulin?

Glycerin and phenol are required for stability and preservation of NPH insulin.

What is Humalog Mix composed of?

Humalog Mix consists of Insulin lispro and neutral protamine lispro (NPL) in a fixed ratio.

What are the components of Humalog Mix 50/50?

Humalog Mix 50/50 consists of 50% insulin NPL suspension and 50% insulin lispro injection.

What happens to insulin glargine once injected?

Once injected into subcutaneous tissue, insulin glargine is neutralized, causing the formation of microspheres.

How quickly does insulin glargine begin to work?

Insulin glargine begins working in 2 hours.

What is the primary purpose of Drug-eluting stents (DESs)?

To make a significant impact in interventional cardiology by delivering medication to prevent restenosis.

What is the polymer used for coating the SYNERGY™ XD stent?

Polylactic-acid-co-glycolic acid copolymer (PLGA).

What condition is the XIENCE V stent used to treat?

Coronary artery disease.

What is the composition of insulin injection?

Insulin injection is a sterile aqueous solution of human insulin prepared through biosynthetic means, containing either 100 or 500 USP insulin units per milliliter.

What must be stated on the labeling of insulin injection?

The labeling must state the potency in USP insulin units per milliliter and the expiration date, which must not be later than 24 months after the date of manufacture.

How should insulin be stored to maintain stability?

Insulin should be stored in a cold place, preferably the refrigerator.

What should be done with insulin remaining in the vial after one month?

Any remaining insulin should be discarded.

What is recombinant DNA (rDNA)?

Recombinant DNA is a form of artificial DNA created by combining two or more sequences that would not normally occur together.

What is a recombinant protein?

A recombinant protein is a protein derived from recombinant DNA.

How should Neutral regular human insulin be stored?

It should be stored in a cold place, preferably in a refrigerator, and freezing should be avoided.

What is Lispro insulin solution and how is it created?

Lispro insulin solution consists of zinc insulin lispro crystals in a clear aqueous fluid, created by reversing amino acids at positions 28 and 29 on the insulin B-chain.

What is Apidra and how does it differ from human insulin?

Apidra is insulin glulisine, a rapid-acting insulin analogue that replaces asparagine at position B3 with lysine and lysine at position B29 with glutamic acid.

What is the primary use of Apidra?

It is used to treat type 1 (insulin-dependent) diabetes in adults and children who are at least 4 years old, usually given with another long-acting insulin.

What is Insulin Aspart and how is it produced?

Insulin Aspart is a recombinant ultra-short-acting insulin produced using Saccharomyces cerevisiae (Baker's yeast).

How does Insulin Aspart differ from regular human insulin?

Insulin Aspart is homologous with regular human insulin except for a single substitution of proline by aspartic acid at position B28.

What is NPH insulin and what does it stand for?

NPH insulin stands for Neutral Protamine Hagedorn, and it is an intermediate-acting insulin.

What is the usual dose range for NPH insulin given subcutaneously?

The usual dose range for NPH insulin is 10 to 80 U.

What is the pH range of Isophane insulin suspension (NPH Insulin)?

Isophane insulin suspension is buffered to a pH of 7.1 to 7.4.

What is the source of protamine used in NPH insulin?

Protamine is prepared from the sperm or mature testes of fish belonging to the genus Oncorhynchus.

How long is the duration of action for NPH insulin?

NPH insulin has a longer duration of action, slightly less than 24 hours, compared to regular human insulin.

What is the significance of pH in the solubility of insulin?

Insulin is least soluble at pH 7.2, and suspensions with alkaline pH have a longer duration of action than solutions.

What preservatives are used in Humulin 70/30 and 50/50 formulations?

m-Cresol and phenol are the preservatives used in both Humulin 70/30 and 50/50 formulations.

What is the composition of the Humulin 70/30 combination?

Humulin 70/30 consists of 70% Isophane insulin suspension and 30% insulin injection.

How do the cumulative amounts of insulin absorbed compare between Humulin 70/30 and 50/50?

The cumulative amounts of insulin absorbed (AUC) are identical for both Humulin 70/30 and 50/50.

What is the composition of Humalog Mix 75/25?

Humalog Mix 75/25 contains 75% insulin NPL suspension and 25% insulin lispro injection.

What percentage of diabetes patients use Humalog Mix for twice daily injections?

More than 40% of diabetes patients who inject insulin twice daily use Humalog Mix.

What is insulin glargine (Lantus) used for?

Insulin glargine is a long-acting basal insulin preparation intended for once daily subcutaneous administration at bedtime for type I diabetes in adults and children, and for adults with type II diabetes who require long-acting insulin.

How is insulin glargine modified from human insulin?

Insulin glargine is created by replacing the amino acid asparagine at position 21 of human insulin with glycine and adding two molecules of arginine to the C terminus of the B chain.

What is the pH of insulin glargine and its solubility?

Insulin glargine is formulated at a pH of 4.0 and is completely soluble at that pH.

What is the classification of extended insulin zinc suspension?

Extended insulin zinc suspension is classified as long-acting due to the slow absorption of zinc insulin crystals.

What is the pH range of extended insulin zinc suspension?

The pH of extended insulin zinc suspension is buffered to 7.2 to 7.5.

What is LEVEMIR and its duration of action?

LEVEMIR (insulin detemir) is a long-acting recombinant human insulin analog with a duration of action of up to 24 hours.

How is insulin detemir produced?

Insulin detemir is produced by expression of recombinant DNA in Saccharomyces cerevisiae followed by chemical modification.

What modification differentiates insulin detemir from human insulin?

Insulin detemir differs from human insulin by omitting the amino acid threonine at position B30 and attaching a C14 fatty acid chain (myristic acid) to lysine at B29.

What is AFREZZA and its purpose?

AFREZZA is an ultra rapid-acting mealtime insulin therapy approved for controlling hyperglycemia in patients with Type 1 or Type 2 diabetes.

What type of product is AFREZZA?

AFREZZA is a drug-device combination product consisting of inhalation powder pre-metered into single-use dose cartridges and an inhaler.

What technology is AFREZZA based on?

AFREZZA is based on Technosphere, a dry powder inhaler technology.

Which three drugs are currently approved by the FDA for use in DESs?

Sirolimus, everolimus, and paclitaxel.

What types of agents do the drugs used in DES coatings fall under?

Immunosuppressive agents, cellular proliferation inhibitors, and anti-inflammatory agents.

What is the function of sirolimus in DESs?

It inhibits smooth muscle cell proliferation and migration.

Which company developed a DES that uses paclitaxel?

Boston Scientific.

What is the Onyx Frontier™ stent made by Medtronic coated with?

BioLinx™ polymer, which delivers zotarolimus.

What is the role of zotarolimus in the Onyx Frontier™ stent?

It inhibits neointimal growth.

What is the composition of the BioLinx™ polymer used in the Onyx Frontier™ stent?

A blend of C10 polymer, C19 polymer, and polyvinylpyrrolidone (PVP).

What polymer is used in the TAXUS stent for paclitaxel delivery?

Translute polymer, which is a poly(styrene-b-isobutylene) triblock copolymer.

How does the TAXUS stent release paclitaxel?

Through a diffusion-controlled system directly from the polymer matrix.

What is the indication for the Orsiro Mission DES stent?

To improve coronary luminal diameter in patients with ischemia due to atherosclerotic lesions and myocardial infarction.

What materials are used in the construction of the Orsiro Mission DES stent?

Cobalt chromium, L-605, coated with proBIO® and BIOlute®.

What is the composition of the SYNERGY™ XD stent?

A platinum chromium alloy stent coated with everolimus and a bioabsorbable polymer.

What is unique about the ACHIEVE Stent from Cook, Inc.?

It can be directly impregnated with a drug without a polymer layer.

What is the purpose of directly attaching paclitaxel to the ACHIEVE Stent's surface?

To eliminate complications associated with certain polymers, such as inflammation and thrombosis.

What type of stent is BiodivYsio™ AS PC?

A phosphorylcholine coated Stent Delivery System.

How is the BiodivYsio™ AS stent inserted into the body?

Through the femoral artery in the groin area, threaded up to the heart.

What procedure is performed before placing the BiodivYsio™ AS stent?

Angioplasty, which involves expanding a balloon within the artery.

What is the significance of the XIENCE™ V Everolimus Eluting Coronary Stent?

It has demonstrated superiority over the TAXUS® Paclitaxel-Eluting Coronary Stent System in clinical trials.

What is the polymer layer used in the XIENCE V stent made of?

A unique durable fluoropolymer.

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