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Pharmacology - Winter > 15 - Diabetes > Flashcards

15 - Diabetes Flashcards

1
Q

What are some sx of diabetes?

A
  • Polyuria (frequent urination), polydipsia (excessive thirst), polyphagia (increased appetite)
  • Elevated fasting blood sugar
  • Ketosis
  • Weight loss
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2
Q

What are the levels to diagnose impaired fasting glucose?

A

Fasting plasma glucose = 6.1-6.9 mmol/L

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3
Q

What are the levels to diagnose impaired glucose tolerance?

A
  • Fasting plasma glucose over 7.0 mmol/L

- Plasma glucose 2h after 75-g glucose load = 7.8-11 mmol/L

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4
Q

What are the levels to diagnose diabetes mellitus?

A
  • Fasting plasma glucose 7 mmol/L or greater

- Plasma glucose 2h after 75-g glucose load = 11.1 mmol/L or greater

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5
Q

What is the normal fasting plasma glucose?

A

4.4-6.1 mmol/L

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6
Q

How is insulin secreted from a beta cell of the pancreas?

A
  • Glucose enters cell, driving metabolism and the production of ATP which binds to and closes the potassium channel
  • Cell becomes depolarized => opening of calcium channel, and when calcium enters it interacts w/ insulin to cause insulin release
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7
Q

When will a beta cell not interact w/ insulin?

A

When the cell is hyperpolarized b/c calcium channel won’t open

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8
Q

How does glucose enter a beta cell?

A

Through the GLUT2 channel (passive channel)

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9
Q

What is the main function of the GLUT1 and 2 channels?

A

Equilibrate intracellular and extracellular glucose

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10
Q

Where are GLUT4 channels found? What is its function?

A
  • Function = increase uptake of glucose
  • Skeletal, cardiac and smooth muscle
  • Mucosa
  • Adipose tissue
  • Leukocytes
  • Pituitary
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11
Q

What is the main effect of insulin?

A

Inhibits glycogenolysis

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12
Q

Describe the defects in glucose levels in diabetes

A
  • Increased extracellular glucose
  • Decreased intracellular glucose (in tissues w/ insulin-sensitive glucose transporters)
  • Increased intracellular glucose (in tissues w/ non-insulin sensitive transporters)
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13
Q

What does the liver do when there is decreased glucose production?

A
  • Decrease glycogenolysis
  • Gluconeogenesis isn’t affected or barely decreased
  • Decrease fat oxidation
  • Increase glucose oxidation
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14
Q

What does the liver do when there is increased glucose uptake?

A
  • Increase glycolysis

- Increase glycogen synthesis

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15
Q

What are the causes of hyperglycemia in type 2 diabetes?

A
  • Insulin resistance*
  • Increased glucose production
  • Impaired insulin secretion, and/or
  • Insufficient glucose disposal
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16
Q

What does decreased glucose uptake lead to?

A
  • Hyperglycemia
  • Glucosuria
  • Osmotic diuresis
  • Ultimately leads to electrolyte depletion => dehydration acidosis => coma (RARE)
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17
Q

What does increased protein catabolism lead to?

A
  • Increased nitrogen and amino acid loss in urine

- Ultimately leads to electrolyte depletion => dehydration acidosis => coma (RARE)

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18
Q

What does increased lipolysis lead to?

A
  • Increased FFA, cholesterol, and ketone bodies

- Ultimately leads to electrolyte depletion => dehydration acidosis => coma (RARE)

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19
Q

What are some complications of diabetes?

A
  • Macrovascular (blood vessels) –> heart disease, stroke, hypertension
  • Microvascular (eye damage)
  • Nephropathy -> renal failure
  • Neuropathy -> nerve damage
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20
Q

What is the difference between preproinsulin, proinsulin, and insulin?

A
  • Preproinsulin has signal sequence & chain C
  • Proinsulin only has chain C
  • Insulin has neither
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21
Q

Which formulations of insulin are rapid-acting?

A

Lispro and aspart

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22
Q

Insulin lispro closely resembles insulin response to ____

A

A meal

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23
Q

What is the function of regular novolin R?

A

Delays absorption into the bloodstream

24
Q

What is the benefit to long acting basal insulins?

A

Less nocturnal hypoglycemia

25
Q

Which drugs can decrease the hypoglycemic actions of insulin?

A
  • Glucocorticoids
  • Glucagon
  • Epinephrine
  • Growth hormone
  • Thyroid hormone
26
Q

Which drugs can increase the hypoglycemic actions of insulin?

A
  • ACE inhibitors
  • Alcohol
  • Salicylate
  • Beta blockers
  • MAO inhibitors
27
Q

What are some adverse effects of insulin?

A
  • Hypoglycemia
  • Lipoatrophy
  • Allergy
28
Q

What are sx of hypoglycemia?

A
  • Hunger, sweating, blurred vision

- Headache, fatigue

29
Q

What can cause hypoglycemia?

A
  • Insulin overdose
  • Exercise
  • Failure to eat
  • Labile disease
30
Q

How is hypoglycemia treated?

A
  • Oral or IV glucose

- Subcutaneous glucagon

31
Q

Which drugs are sulfonylureas?

A
  • Glimepiride
  • Glyburide
  • Glipizide
32
Q

What is the MOA of slfonylureas?

A
  • Release insulin from pancreatic beta cells
  • Reduce serum glucagon levels
  • Potentiate action of insulin on its target tissues
33
Q

What is the specific action of sulfonylureas?

A

Target SUR1 to block the K-ATP channel

34
Q

What are some adverse effects of sulfonylureas?

A
  • Hypoglycemia
  • Weight gain
  • Aggravation of myocardial ischemia
35
Q

What are contraindications to sulfonylureas?

A
  • Px w/ cardiovascular disease
  • Elderly
  • Px w/ hepatic impairment and/or renal insufficiency
36
Q

Which drugs are meglitinide analogs?

A

Repaglinide and nateglinide

37
Q

Can be meglitinide analogs be combined w/ metformin?

A

Yes

38
Q

Can repaglinide be used in the elderly and px w/ renal impairment?

A

Yes

39
Q

What is the MOA of metformin?

A

Activates cyclic AMP-activated protein kinase, which regulates hepatic glucose production and improves insulin resistance

40
Q

What does it mean when metformin is described as “euglycemic instead of hypoglycemic”?

A

Lowers blood glucose after food, but not fasting levels in steady state

41
Q

What effect does metformin have?

A
  • Increases glycolysis and insulin binding
  • Inhibits gluconeogenesis in liver and glucose absorption from the gut
  • Reduces plasma glucagon levels
42
Q

What are some adverse effects of metformin?

A
  • Lactic acidosis
  • Range of GI effects
  • B12 deficiency
43
Q

Which drugs are glitazones?

A

Rosiglitazone and pioglitazone

44
Q

What is the MOA of glitazones?

A
  • Decrease insulin resistance by binding to nuclear receptors which regulate genes responsible for lipid metabolism
  • Decreases gluconeogenesis, glucose output, and triglyceride synthesis in liver
  • Increases glucose uptake in skeletal muscle and adipose tissues
45
Q

When are glitazones used?

A

Type 2 diabetics who need more than 30 units of insulin daily

46
Q

What are contraindications to glitazones?

A

Px w/ heart failure and liver impairment

47
Q

What are adverse effects of glitazones?

A
  • Edema
  • Macular edema
  • Loss of bone density
  • Weight gain
  • So used less and less
48
Q

Which drugs are glucosidase inhibitors?

A

Acarbose and miglitol

49
Q

What is the MOA of glucosidase inhibitors?

A
  • Slows carbohydrate breakdown in the gut
  • Competitive inhibitors of alpha-glucosidase enzymes
  • Lowers post-prandial rise in blood glucose
  • Lowers A1C levels
50
Q

When are glucosidase inhibitors used?

A

Type 2 diabetes

51
Q

What are the effects of incretin-related molecules?

A

Increase insulin synthesis and release; also decrease glucagon

52
Q

Which drugs are DPP-4 inhibitors?

A

Sitagliptin-PO4 and saxagliptin

53
Q

Which drugs are GLP-1 analogues? What is their effect?

A
  • Exenatide and liraglutide
  • Enhance glucose-dependent insulin secretion from pancreatic beta cells; suppresses glucagon secretion from pancreatic alpha cells during hyperglycemia, which leads to decrease in glucose output from liver
54
Q

When is exenatide used? With which other drug(s)?

A
  • Type 2 diabetes

- Used w/ either metformin or sulfonylurea

55
Q

Is exenatide hypoglycemic or euglycemic?

A

Euglycemic

56
Q

What is dapagliflozin?

A

Sodium-glucose transport protein (prevents reabsorption of glucose)

57
Q

What are SE of dapagliflozin?

A
  • Excessive glycosuria => hypotension

- Urinary tract and bladder infection

Pharmacology - Winter (18 decks)

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