Antidiabetic Drugs 1 Flashcards
hyperglycemia without ketoacidosis is seen in type ___ DM
type 2 DM because the insulin secretion is enough to restrain ketogenesis
insulin binding to the receptor causes ↑ expression of GLUT__ transporters
GLUT 4
which long acting insulin has the longest half life?
degludec
ATP blocks the _____ channels in the mechanism of insulin secretion
K channels
what is effect of insulin on potassium?
↑ K+ uptake into the cell
when do you see symptoms of Type 1 DM?
after 80-90% of β cells have been destroyed
which insulins are human insulins preparations
NPH (intermediate) and short acting
which has a higher risk of hypoglycemia: long acting insulin analogs or NPH insulin
long acting insulin analog
insulin lispro is a _______ acting insulin; describe how it does so
rapid acting;
↓ the propensity to form a hexamer by flipping the AA’s on portion 28 and 29: pro and lysine is switched to lysine and proline on the B chain
if the patient is exercising, how would they adjust their insulin dose?
- ↓ dose because exercise ↑ insulin sensitivity
what are the three long acting insulins
- insulin glargine
- insulin detemir
- insulin degludec
glucose given orally/IV results in higher insulin levels
orally; due to the incretins released by the GI which will cause ↑ secretion of insulin
what type of insulin is given to provide basal coverage in insulin regimens
one shot of a long acting insulin: -insulin glargine, detemir, degludec
rapid acting insulins are given to mimic the _____ release of insulin and are given _______
prandial; given 15 mins before meal
what are incretins? what do they do?
incretins are GI hormones that are released after the ingestion of food and ↑ insulin secretion
incretins: glucagon like peptide 1 and GIP (glucose deponent insulinotopic polypeptide)
soluble crystalline zinc insulin is a ____ acting insulin
short
keeping insulin in a ________ form, it allows for it to be absorbed very quickly
monomeric form;
formation of hexameters SLOWS the absorption of insulin
which has a higher risk of hypoglycemia:
rapid acting insulin analogs or regular insulin
regular insulin
the _____ subunit is the recognition site for insulin
α
describe the mechanism of insulin secretion:
- when there is ↑ insulin the blood there is ↑ glycolysis and CAC → ↑ ATP
- ATP will close the potassium channels which prevents K from leaving the cells → cell depolarizes
- depolarization of cell causes calcium channels to open → calcium enters cell → exocytosis of insulin
which insulins are analogs of
rapid and long acting
↑ propensity to form the hexamer form of insulin will ↑/ ↓ the time of activity of insulin
slows the time of action of insulin
how can diuretics cause hyperglycemia?
peeing out the K will then prevent the membrane depolarization → less insulin secretion
what are the tree rapid acting insulin drugs
- insulin lispro
- insulin aspart
- insulin glulisine
insulin receptor consists of two covalently linked _______
heterodimers;
α subunits on the outside and β subunits expands the entire membrane
________ (drugs) cause hyperglycemia by acting directly on peripheral tissues that antagonize the effect of insulin
epinephrine, glucocorticoids, atypical antipsychotics and HIV protease inhibitors
which drugs cause hyperglycemia by directly inhibiting insulin secretion
- phenytoin
- clonidine
- Calcium channel blockers
type 1 DM is characterized by marked elevations of blood glucose and _____
ketone bodies
NPH (neutral protamine hagedorn) is a ______ acting insulin
intermediate
what type of insulin is used in IV therapy?
human insulin
what type of insulin is used in the insulin pump
rapid acting glulisine, lispro or aspart
how would a patient adjust their insulin dose if they are suffering from an acute illness?
↑ dose because with illnesses there is ↑ insulin resistance
_________ acting insulins are given for basal control of insulin release
intermediate aka isophane insulin;
cyrstalline zinc insulin + protamine
what are drugs that can cause HYPOglycemia
- ethanol: inhibit gluconeogenesis
- β blockers: inhibit the effects of catecholamines on the mobilization of glucose
- salicylates: potentiate insulin secretion
regiments based on ____ and _____ acting insulin improve HBA1c levels dn reduce hypoglycemia most effectively
rapid and long acting (better than NPH insulin and regular insulin)
the β subunit is the recognition site for ______
tyrosine kinase
omeprazole is what type of drug?
PPI