biopharm exam 2 - insulin

51 amino acid peptide

human insulin is a ______.

21

A chain has ___ aa

30

B chain has ____aa

2 disulfide bonds

_____ join the chains into a single molecule

5808

molecular weight of human insulin is

true

T/F: all insulin products in the US come from recombinant resources

basal secretion

in nondiabetics, insulin is constantly secreted at a low level. this is called

bolus secretion

bursts of insulin are secreted when glucose levels rise after meal this is called

true

T/F: insulin therapy is intended to replicate non-diabetic glucose control as closely as possible

-prevent hypo- and hyper-glycemia

-prevent slow progression of complications

-achieve optimal body weight

-promote normal growth and development

the primary treatment goals for insulin therapy are to

-insulin pump

-basal insulin once daily and 3-4 bolus injections before meals

typical therapy for a newly diagnosed type 1 DM patient.

false

T/F: type 2 DM patients begin typically begin insulin when diagnosed

-blood glucose level from continuous glucose monitor or fingerstick

-HbA1C level

doses are ideally based on

-SC

-IV infusion

-inhalation

insulin may be administered by

intensive care

IV infusion of insulin is used in ______ only

insulin analogs (one or more aa in the protein are different from human sequence)

regular (R) and isophane (N) contain the human insulin amino acid sequence. all others contain ______

-fiasp (faster insulin aspart)

-lyumjev (lispro aabc)

faster rapid acting

-insulin lispro

-insulin aspart

-insulin glulisine

rapid acting insulins

-regular

-Humulin (R)

-Novolin (R)

short acting

-insulin glargine

-insulin detemir

-insulin degludec

long acting (basal)

-NPH or isophane (humulin n novolin n)

intermediate acting

zinc insulin

rapid acting insulins contain a solution of ______

Zinc ions

______ are required to maintain insulin structure and functions for rapid acting insulin.

true

T/F: rapid acting insulins are used for bolus (postprandial) injection or continuous SC infusion via insulin pumps

30 min

rapid acting insulins, onset of action is _____ after SC injections

3-5 hours

rapid acting insulins duration of action is

fast onset

______ is desired to counter the spike in glucose after a meal for rapid acting insulins.

short duration

_______ is desired to prevent glucose level from going too low after a meal spike for rapid acting insulins

true

T/F: fast onset and short duration are also desired for insulin pumps to increasing and decreasing infusion rate can quickly adjust glucose to the desired level.

rapid acting insulin - glulisine

this is showing what kind of insulin?

excipients

faster rapid insulin or ultra rapid insulins (aspart or lispro) contain _____ to increase absorption rate

2 minutes

Faster rapid insulin onset is

3-5 hours

Faster rapid insulin duration is

niacinamide

for insulin aspart fiasp, _____ in the formulation increases insulin absorption rate

treprostinil; vasodilator

for insulin lispro aabc lyumjev, it contains ______ which is a _____ to increase insulin absorption rate

1/2 - 1 hours

short acting insulin onset is ________ after SC injection

4-12 hours

short acting insulin duration is

-N, NPH, isophane

-insulin human complex with protamine

intermediate acting insulin includes

lower

•Insulin human complex with protamine has a ____ solubility than insulin alone

lower; slower

•Insulin human complex with protamine has a ____ concentration in SC space that causes _____ absorption than regular.

longer duration

•Insulin human complex with protamine has slower dissolution as absorption proceeds causes _______ than regular

1-2 hours; 12-18 hours

onset of intermediate acting insulin is ____ duration is

true

T/F: intermediate acting insulins are mostly used to long-time diabetic patients who don't want to switch to newer products.

false

T/F: onset for intermediate acting insulins is fast enough for bolus use

true

T/f: long acting insulins are used to replace basal need.

false (no peak or very wide peak)

T/f: long acting insulins have a peak or a very narrow peak

24 hours

duration of long acting insulin is

consistent plateau

for long acting insulin repeated daily injection is intended to provide a _______ of insulin concentration

insulin glargine

______ is administered as a solution but precipitates that the injection site (long acting)

insulin detemir; insulin degludec

_______ and ______ self-associate or aggregate that the injection site (long acting)

serum albumin

Insulin detemir and insulin degludec also bind to

false

T/F: intermediate acting insulin is much better than insulin or pump

true

T/F: only free insulin molecules can distribute to tissues

suspension; SC

Isophane (NPH) human can is a ______ dosage form. it can be administered via the ______ route

-faster rapid acting

-rapid

-short

which types of insulin can be administered via IV route?

Isophane (N) (NPH)

______ insulin is the only suspension insulin product.

clear solutions

all other insulins besides isophane are

true

T/F: glucose lowering effect per mg of protein varies from batch to batch

unit

______ is a measure of expect pharmacological effect

false (its achieved by using Units over mg)

T/F: consistent clinical effect is achieved by using mg over Units

false (spell it our)

T/F: per ISMP guidelines, we should abbreviate U or u instead of spelling out Units

U-100

_____ is most common for vials

U-200 and U-300

_____ and _____ are used in pen products.

0.0345mg

1 USP insulin unit is equivalent to ______ of pure insulin derived from pork

false (should only use insulin pens)

T/F: patients who use vial and syringe should also use pens.

U-100

orange cap syringes are marked for ______ insulin only

100

illinois law allows sale of _____ syringes to patients 18 years and older by a pharmacy

false (intended for single use; injection a second time is more painful)

T/F: insulin syringes are intended for multiple use. the needle is very fine and gets less dull when piercing skin. a second injection with the same syringe is less painful

true

T/F: the needle on insulin syringes is permanently attached to the body

dead volume

insulin syringes have a very small _____ to reduce waste of product with each injection

200, 300

U-_____ and U-____ insulins are used with pen injector device

false (5x higher)

T/F: regular insulin U-500 is a specialty product. its the same insulin as Humulin R or Novolin R but 5x lower concentration than U-100

200 units

humulin R u-500 is a concentration human insulin indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus requiring more than ______ of insulin per day

false

T/F: U-100 and U-500 are interchangeable with correct volume concentration

false (slower onset and longer duration)

T/F: U-500 onset time is much faster and duration is shorter

true

T/F: U-500 is produced in pen and vial forms

pens

_____ are the best choice for patients who injection U-500 directly

green caps

U-500 vials should only be used with U-500 syringes. the syringes have ______ to match the color of the label on the vial.

glucagon; hypoglycemia

patients who use U-500 should also have a ______ in case they experience _______

preservatives

phenol and metacresol are ______ used in insulin products

refrigerated

for unopened insulin it should be _______

room temp; light

opened insulin should be stored at _____ protected from ________. it could also be refrigerated

false

T/F: pharmacists should counsel patients on if using insulin N, you should shake the vial vigorosuly to mix it.

90 degree

patients should insert the needle at a _____ angle into the vial.

priming

______ is required for new insulin cartridges when preparing a dose with a pen

90 to 45 degree

patients should pinch the skin and insert the needle at a ______ angle to skin

5-10 seconds

patients should hold the syringe or injector in place for _____ to allow the product to disperse in the SC space.

true

T/F: withdrawing the needle to quickly allows some product to squirt out

true

T/F: insulin may be administered by IV infusion in some emergency situations

DKA (diabetic ketoacidosis)

HHS (hyperosmolar hyperglycemic state)

_________ and ____ are situations where insulin can be IV infused

-faster rapid

-rapid

-regular

infusion solution must only be prepare with

1 unit/mL is NS

infusion is commonly prepared at a concentration of

false (it does adsorb to plastic so it may not reflect insulin delivered to patient)

T/F: insulin does not adsorb to plastic so 1 unit/mL added to the bag will be great to reflect insulin delivered to the patient.

blood glucose; plasma K+ value

with insulin and IV infusion _____ and _____ must be monitored frequently

intracellular; plasma

acidosis causes K+ shift from _____ to _____

intracellular

as acidosis is corrected, K+ shifts back to ______

SC

we should transition therapy to ______ insulin as soon as possible after administering insulin via IV infusion.

KCl

as acidosis is corrected, we may need to supplement extracellular _______

1-4 hours

the first SC dose is frequently given ______ before stopping infusion

regular

afrezza insulin inhalation is ______ powder is 4,8, or 12 unit cartidges