11a: Diabetes Flashcards
how does the pancreas function as an exocrine gland?
it excretes digestive enzymes into the duodenum of the pancreatic duct
how does the pancreas function as an endocrine gland?
it secretes 2 hormones into the bloodstream, insulin and glucagon
what is the function of insulin?
regulates blood glucose levels, and helps with metabolism of carbohydrates, proteins, and lipids
what is the function of glucagon?
it increases blood glucose in order to maintain normal blood glucose levels and to prevent hypoglycemia
is glucagon an agonist or antagonist of insulin?
hormonal antagonist of insulin
how does glucagon increase blood glucose?
it causes a rapid increase in glycogen breakdown in the liver, which releases glucose into the bloodstream from hepatic glycogen stores
what is normal fasting blood glucose (between meals)?
70-110mg of glucose
when does blood glucose rise?
after a meal
how does a rise in blood glucose after a meal affect insulin secretion?
insulin is secreted from the pancreas to promote the movement of glucose from the bloodstream to the tissues (to return blood glucose levels back to normal)
what does glucagon do when blood glucose levels fall?
glucagon is released, when then releases glucose from the liver
what is the issue with insulin in type 1 diabetes?
unable to synthesize insulin due to a destruction of pancreatic beta cells
what is the issue with insulin in type 2 diabetes?
combination of beta cell dysfunction and decreased sensitivity of peripheral tissues to circulating insulin (insulin resistance)
what are risk factors for type 2 diabetes?
genetic predisposition, poor diet, obesity, lack of exercise
what is the most common symptom of type 1 and type 2, and what does it mean?
hyperglycemia – lack of insulin causes glucose to be taken up by the peripheral tissues
how is type 1 diabetes treated?
exogenous insulin is given to replace normal pancreatic insulin
how is exogenous insulin used to treat type 2 diabetes?
may be given along with other drugs to supplement endogenous insulin release
what are the three concentrations of insulin?
short-acting, intermediate-acting, long-acting (these can be combined)
how does insulin have to be administered, and why?
subcutaneous injection, because it cannot be absorbed through the GI wall
what factors affect insulin dosage?
blood sugar levels, exercise, and dietary modifications
what is the purpose of insulin pumps?
continuous infusion that is delivered subcutaneously through a catheter
what is intensive insulin therapy?
method of insulin administration that is used when exogenous insulin is required for diabetics; patient monitors blood glucose throughout the day and administers insulin as needed (may be given long-acting once daily and short-acting as needed)
what is hypoglycemia?
when blood sugars drop too low which can cause decreased BP
when can hypoglycemia occur?
- when insulin dose is higher than needed
- if the patient misses or delays a meal
- strenous physical activity
what are symptoms of hypoglycemia?
headache, fatigue, hunger, tachycardia, sweating, anxiety, confusion
what is the goal of medications for type 2 diabetes?
stimulate insulin secretion and supply by working on the pancreatic beat cells, which then travel to the liver and inhibit hepatic glucose production
what is an example of an insulin sensitizer (for type 2)?
metformin (glucophage)
what is the function of metformin?
acts on the liver to inhibit glucose production, and increases the sensitivity of peripheral tissues to insulin
how is metformin administered (why is it unique)?
administered orally (diabetes medications are usually administered subcutaneously)
what is the main adverse effect of metformin?
lactic acidosis
what are symptoms of lactic acidosis?
confusion, lethargy, stupor, shallow rapid breathing, tachycardia (especially during exercise)
what are three generic types/purposes used for treating type 2 diabetes?
drugs that:
- stimulate insulin secretion
- act on liver to inhibit glucose production
- suppress glucagon secretion
what are the most important factors in controlling both type 1 and 2?
weight control, diet, exercise
rehab implications for diabetes
- peripheral neuropathies
- decreased peripheral blood flow leading to tissue ischemia, ulcers, poor wound healing, amputations
- hypoglycemia – have snacks available
- emphasize regular diet and avoid missing meals (esp before PT)
- emphasize appropriate diet and physical activity
- educate in proper skin care and footwear
what is the goal of drugs used to treat infectious diseases?
selective toxicity – kill the problem without causing excessive damage to other cells
what is the purpose of antimicrobial/antibiotics?
treat small, unicellular organisms (bacteria)
broad spectrum agents
drugs that are effective against a variety of bacteria
factors that determine which antibiotic is chosen (5)
- spectrum of the drug
- patient tolerance
- bacterial resistance
- type and location of infection
- physician preference
bactericidal drugs
drugs that kill or destroy bacteria
bacteriostatic drugs
drugs that limit bacteria growth
three mechanisms of antibacterial drugs
- inhibit bacterial cell wall synthesis and function
- inhibit bacterial protein synthesis
- inhibit bacterial DNA/RNA function
examples of antibacterial drugs
penicillin
erythromycin
clindamycin
adverse effects of antibiotics
hypersensitivity reactions – skin rashes, itching, respiratory difficulties (wheezing)
GI problems – nausea, vomiting, diarrhea
what is one of the most serious problems with antibacterial drugs?
the development of strains of bacteria that are resistant to one or more antibacterial agents
what are the most common drug resistance?
VRSA
MRSA
VRE
PRSP
rehab implications of antibacterials
- infections (bone, wounds, UTIs, pneumonia) – recognize and prevent
- potential for hypersensitivity reactions & GI problems
why are viruses unique?
they rely on the host (human) cell to function, so it is hard to treat without harming some human cells
what are examples of conditions that antiviral drugs can treat?
hep B, influenza, herpes simplex, CMV, warts, RSV
viral resistance
growing concern due to viruses being able to mutate and change structure so that drugs are no longer effective
interferons
group of proteins that are made in response to viral infection and help healthy cells resist infection; they are effective in controlling some forms of cancer
adverse effects of interferons (body’s response to infection)
fever, sweating, chills, muscle aches, general malaise, depression
two goals of pharmacological management of HIV
- control proliferation of HIV
- treat and prevent opportunistic infections that overwhelm the immune system
are there any drugs that kill HIV in humans?
no, but several antiviral drugs can reduce mortality and morbidity
protease inhibitors
drugs that inhibit HIV protease enzyme, which prevents the progression of HIV
verse effects of protease inhibitors
abdominal fat deposition, increased cholesterol, insulin resistance, increased risk of CV disease, diarrhea, headache, fatigue
mechanism of reverse transcriptase inhibitors
inhibit a key step in HIV replication, keep it from spreading
adverse effects of reverse transcriptase inhibitors
anemia, fever, chills, diarrhea, dizziness, headache, fatigue, myopathy, atrophy
highly active antiretroviral therapy (HAART)
when several anti-HIV drugs (usually 3 or more) are administered simultaneously to provide optimal inhibition of HIV replication and proliferation
opportunistic infections
major cause of illness and death in HIV patients due to decreased immune functions
examples of opportunistic infections
pneumonia, hepatitis, necrotizing lesions, vesicular eruption of the skin, tuberculosis, CNS infections
