Antidiabetic Drugs Flashcards
What cells in the pancreas secrete glucagon? Insulin?
Alpha cells
Beta cells
If GLP1 and GIP bind to beta cells, how is insulin released?
Glucose comes into GLUT2 channels in beta cells….increases ATP production….which closes ATP sensitive K+ channels…which depolarizers the cell and opens volatage gated Ca2+ cells….thus causing insulin and Amylin to be released
What 2 things cause insulin to be released?
BG
Incretins
What are incretins?
GLP-1
GIP
What are the 2 actions of incretins?
- increase insulin release
- stop liver from producing glucose
What cells does GIP get secreted from in the GI system? GLP-1?
K cells
L cells
What breaks down incretins to raise BGL? Where is it released from?
DPP-4
Enterocytes
What is the BGL for a pt to be considered hypoglycemic?
<50mg/do
What are the CNS manifestations of a pt who is hypoglycemic?
Confusion
Irritable
Tremor
Diaphoresis
What are progressive/later Sx of a pt who is hypoglycemic?
Hypothermia
Seizures
Coma
What are the 3 Tx for a pt who is hypoglycemic?
Oral form concentrated glucose
IV dextrose
Glucagon
What is a contraindication for oral glucose for a pt who is hypoglycemic?
Unconscious pt who can’t swallow
What does glucagon to the BGL?
Increases BG
What are the 2 things that the liver does when glucagon is given?
Glycogenolysis
Gluconeogensis
What is glycogenolysis?
Liver breaks down glucagon to make glucose to be released into the blood
What is the 2 forms of gluconeogenesis?
AA break down into glucose
Glycerol from triglycerides breakdown into glucose
What are the 3 routes glucagon can be given?
IM
SC
IV
What Sx can glucose cause in a body? What is done to protect against this Sx?
N/V
Place pt on side prior to injecting
What percent of DM pt are type 1? Type 2?
Type 1=10%
Type 2=20%
What is the MOA of DM type 1? Type 2? What lack of transportation is causing this?
Type 1= Decreased insulin secretion
Type 2= insulin resistance
No GLUT 4 transportation
What is normal fasting BGL for a healthy pt?
80-100 mg/dl
What levels are needed to be collected in order to Dx someone w/ DM?
Multiple readings of Fasting BGL >126mg/dl
Or
>200mg/dl 2 hrs postprandial
What does postprandial mean?
After a meal
What cells does insulin bind to? What does the binding cause?
Insulin binds to adipocytes or skeletal cells
Opens GLUT4 transporters to let glucose into cell
Which GLUT cells don’t need insulin to keep them open? Where are they found?
GLUT 3
Found in the brain
Where are GLUT 1 found?
RBC
What are the Sx of pt not on medication w/ DM?
Polyuria Polydipsia Polyphagia Ketoacidosis Tissue damage
What is polydipsia? What is polyphagia?
Increased thirst
Increased hunger
How come DM causes polyuria? What does glucose pull into DCT?
Glucose overwhelms reabsorption in PCT >300mg/dl
Pulls water into DCT and acts as osmotic
What tissue damage can be caused by DM if untreated?
Atherosclerosis
Diabetic retinopathy
Diabetic nephropathy
Neuropathy
What is nephropathy?
Damage to glomerulus leading to proteinuria
What is neuropathy?
Damage to neurons in end of extremities. Can’t feel toes
What is diabetic gastroparesis? How is it caused? What are the 4 Sx of it?
Decrease in gastric emptying
Damage to vagus nerve
Nausea
Fullness
Acid Reflux
Lack of appetite
What type of DM is Diabetic Ketoacidosis (DKA) often found in?
Type 1
What type of DM is hyperosmolar hyperglycemia syndrome (HHS) often found in?
Type 2
What is the age of a pt commonly in DKA? HHS?
DKA= <40yo HHS= >40yo
What is the serum glucose level of a pt w/ DKA? HHS?
DKA= <600mg/dl HHS= >600mg/dl
How many ketones are often in body of pt w/ DKA? HHS?
DKA= >4 HHS= <2
What is the pH of a pt w/ DKA? HHS?
DKA= low pH HHS= normal pH
What is the Tx for pt w/ DKA? HHS?
DKA= insulin therapy
HHS=fluids and monitor K+ levels
What is HbA1c measure?
Amount of glucose bound to hemoglobin in RBC
How long does HbA1c measurements last for to determine glucose control?
Last 3 months
What is HbA1c for non DM pt? What is the goal HbA1c for DM pt?
Non DM= 5%
DM= <6.5%
How often should a type 1 DM pt use a glucometer? Type 2 DM?
Type 1= 5x/day
Type 2= at least 1/day
What is a CGM what does it do?
Continuous Glucose monitor
What are the 3 types of Tx for DM?
Watch diet
Exercise
Drugs
How does exercise help w/ DM?
Causes GLUT 4 translocation w/o insulin
What are the 2 categories of routes for DM drug therapy?
Parenteral
Oral
What 3 types of drugs for DM are parenteral?
Insulin’s
Amylin analogs
Incretin mimetics
What are the 6 drugs for DM that are oral?
Secretagogues Alpha-glucosidase inhibitor Biguanides Insulin sensitizer DPP-4 inhibitors SGLT2 inhibitors
What are the two categories of secretagogues?
Sulfonylureas
Meglitinides
What is another name for insulin sensitizing drugs?
Thiazolidinediones
What 2 routes is insulin given?
SC
ORAL
What is insulin indicated for(4)?
Reversing ketoacidosis
Gestational DM
Type 2 DM
Hyperkalemia
What pump does insulin stimulate on cells?
Na/K pumps
What type of chain is insulin? What makes up the A chain? B chain?
Polypeptide chain
A chain= 21 AA chain
B chain= 20 AA chain
Why can’t insulin normally be given orally?
Because protein chain gets destroyed and gets absorbed into tripeptide chains (nothing longer)
What bond hold A and B chains together in insulin?
Disulfide bonds
What types of insulin are OTC?
Regular(Humulin R) Isophane NPH(Humulin N, Novokun N)
How long does insulin last outside of the fridge?
1 month
What are the number of units for insulin usually found as?
100 units/ml
What can an insulin overdose cause?
Hypoglycemia
How does stress effect BLG?
Stress releases cortisol which increases BGL
What do IV infusion sets do to insulin? How does this effect the dose?
Infusion sets absorb insulin
May have to increase insulin dose
What factor requires a pt to reduce insulin dose? Why?
Heavy exercise
It used up the glucose in the blood and body
What factors can increase the need for insulin?
Stress
Illness
Surgeries
Why do beta blockers cause a decrease in the need for insulin?
Because a decrease in sympathetic system will also decrease BGL
Why do thiazides increase the need for insulin?
Thiazides increase the process of gluconeogenesis
What are the ADR of insulin?
Lipodystrophy
Hypoglycemia
How can a pt avoid lipodystrophy? What is lipodystrophy?
Rotate injection sites
Dimpling effect on skin and fat
How does an insulin pump work?
Gives a small dose always…then gives large bolus of insulin at meal times
What should always be given prior to giving insulin?
Take a BGL
What insulin is given IV?
Regular insulin
What drugs cause an increase in BGL which require and increase in need for insulin?
Corticosteroids
Thyroid drugs
Thiazides
What are the MOA of Amylin(3)?
Slows gastric emptying
Suppress glucagon secretion from alpha cells
Decreases appetite
What is Amylin secreted w/?
Insulin
What conditions have decreased amounts of Amylin release?
Type 1 and type 2 DM
What are the indications for Amylin?
Uncontrolled DM Type 1 and 2
What route is Amylin given?
SC
What are the 2 ADR of Amylin?
N/V
Weight loss
What is the MOA of incretins?
GIP and GLP-1 act on beta cells to release insulin
What is another name for incretin mimetics? Route? Indication?
Lizard spit
SC
Type 2 DM
Why is the 4 MOA of GLP-1 agonists?
Increase insulin release from beta cells
Decrease glucagon secretion from alpha cells
Delay stomach emptying
Decrease appetite
What is the MOA of Biguanides(3)?
Decrease liver glucose production
Decrease intestinal glucose absorption
Enhance glucose utilization by other tissues
What effect do biguanides have on GI? What is it? What can it lead to?
Lactic acidosis
Increased glucose leads to lactate conversion from enterocytes
Can cause respiratory and cardiac distress
What is the MOA of secretagogues? Indication?
Binds to SUR on beta cells to close ATP sensitive K+ channels which causes insulin release
What is the MOA of thiazolidinediones? What is another name for them? ADR? Contraindications
Enhance peripheral response to insulin
Insulin sensitizers
Causes fluid retention
Increases liver enzymes
HF
liver failure
What is the MOA of alpha-glucosidase inhibitor? When should it be given? ADR?
Inhibits disaccharidase which decreases the amount of glucose going into blood after a meal
given w/ each meal
Farts
Diarrhea
What is the MOA of DDP-4?
Breaks down incretins
What is DDP-4 inhibitors indicated for? What is it used in combo w/?
Type 2 DM
Combo w/ metformin or thiazolidinediones
What is the MOA of an SGLT2 inhibitor?
blocks Sodium Glucose transporters in PCT to be reabsorbed…this causing glucose to act as osmotic to water
What are ADR of SGLT inhibitors(4)?
Genital fungal infections
UTIs
Polyuria
Hypotension
What type of insulin is inhaled Afrezza?
Regular insulin
