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Pharmacology > Antidiabetic Drugs > Flashcards

Antidiabetic Drugs Flashcards

1
Q

What cells in the pancreas secrete glucagon? Insulin?

A

Alpha cells

Beta cells

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2
Q

If GLP1 and GIP bind to beta cells, how is insulin released?

A

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

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3
Q

What 2 things cause insulin to be released?

A

BG

Incretins

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4
Q

What are incretins?

A

GLP-1

GIP

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5
Q

What are the 2 actions of incretins?

A
  • increase insulin release

- stop liver from producing glucose

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6
Q

What cells does GIP get secreted from in the GI system? GLP-1?

A

K cells

L cells

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7
Q

What breaks down incretins to raise BGL? Where is it released from?

A

DPP-4

Enterocytes

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8
Q

What is the BGL for a pt to be considered hypoglycemic?

A

<50mg/do

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9
Q

What are the CNS manifestations of a pt who is hypoglycemic?

A

Confusion
Irritable
Tremor
Diaphoresis

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10
Q

What are progressive/later Sx of a pt who is hypoglycemic?

A

Hypothermia
Seizures
Coma

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11
Q

What are the 3 Tx for a pt who is hypoglycemic?

A

Oral form concentrated glucose
IV dextrose
Glucagon

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12
Q

What is a contraindication for oral glucose for a pt who is hypoglycemic?

A

Unconscious pt who can’t swallow

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13
Q

What does glucagon to the BGL?

A

Increases BG

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14
Q

What are the 2 things that the liver does when glucagon is given?

A

Glycogenolysis

Gluconeogensis

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15
Q

What is glycogenolysis?

A

Liver breaks down glucagon to make glucose to be released into the blood

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16
Q

What is the 2 forms of gluconeogenesis?

A

AA break down into glucose

Glycerol from triglycerides breakdown into glucose

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17
Q

What are the 3 routes glucagon can be given?

A

IM
SC
IV

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18
Q

What Sx can glucose cause in a body? What is done to protect against this Sx?

A

N/V

Place pt on side prior to injecting

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19
Q

What percent of DM pt are type 1? Type 2?

A

Type 1=10%

Type 2=20%

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20
Q

What is the MOA of DM type 1? Type 2? What lack of transportation is causing this?

A

Type 1= Decreased insulin secretion

Type 2= insulin resistance

No GLUT 4 transportation

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21
Q

What is normal fasting BGL for a healthy pt?

A

80-100 mg/dl

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22
Q

What levels are needed to be collected in order to Dx someone w/ DM?

A

Multiple readings of Fasting BGL >126mg/dl
Or
>200mg/dl 2 hrs postprandial

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23
Q

What does postprandial mean?

A

After a meal

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24
Q

What cells does insulin bind to? What does the binding cause?

A

Insulin binds to adipocytes or skeletal cells

Opens GLUT4 transporters to let glucose into cell

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25
Q

Which GLUT cells don’t need insulin to keep them open? Where are they found?

A

GLUT 3

Found in the brain

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26
Q

Where are GLUT 1 found?

A

RBC

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27
Q

What are the Sx of pt not on medication w/ DM?

A 
Polyuria
Polydipsia 
Polyphagia 
Ketoacidosis
Tissue damage
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28
Q

What is polydipsia? What is polyphagia?

A

Increased thirst

Increased hunger

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29
Q

How come DM causes polyuria? What does glucose pull into DCT?

A

Glucose overwhelms reabsorption in PCT >300mg/dl

Pulls water into DCT and acts as osmotic

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30
Q

What tissue damage can be caused by DM if untreated?

A

Atherosclerosis
Diabetic retinopathy
Diabetic nephropathy
Neuropathy

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31
Q

What is nephropathy?

A

Damage to glomerulus leading to proteinuria

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32
Q

What is neuropathy?

A

Damage to neurons in end of extremities. Can’t feel toes

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33
Q

What is diabetic gastroparesis? How is it caused? What are the 4 Sx of it?

A

Decrease in gastric emptying

Damage to vagus nerve

Nausea
Fullness
Acid Reflux
Lack of appetite

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34
Q

What type of DM is Diabetic Ketoacidosis (DKA) often found in?

A

Type 1

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35
Q

What type of DM is hyperosmolar hyperglycemia syndrome (HHS) often found in?

A

Type 2

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36
Q

What is the age of a pt commonly in DKA? HHS?

A 
DKA= <40yo
HHS= >40yo
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37
Q

What is the serum glucose level of a pt w/ DKA? HHS?

A 
DKA= <600mg/dl
HHS= >600mg/dl
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38
Q

How many ketones are often in body of pt w/ DKA? HHS?

A 
DKA= >4
HHS= <2
39
Q

What is the pH of a pt w/ DKA? HHS?

A 
DKA= low pH
HHS= normal pH
40
Q

What is the Tx for pt w/ DKA? HHS?

A

DKA= insulin therapy

HHS=fluids and monitor K+ levels

41
Q

What is HbA1c measure?

A

Amount of glucose bound to hemoglobin in RBC

42
Q

How long does HbA1c measurements last for to determine glucose control?

A

Last 3 months

43
Q

What is HbA1c for non DM pt? What is the goal HbA1c for DM pt?

A

Non DM= 5%

DM= <6.5%

44
Q

How often should a type 1 DM pt use a glucometer? Type 2 DM?

A

Type 1= 5x/day

Type 2= at least 1/day

45
Q

What is a CGM what does it do?

A

Continuous Glucose monitor

46
Q

What are the 3 types of Tx for DM?

A

Watch diet
Exercise
Drugs

47
Q

How does exercise help w/ DM?

A

Causes GLUT 4 translocation w/o insulin

48
Q

What are the 2 categories of routes for DM drug therapy?

A

Parenteral

Oral

49
Q

What 3 types of drugs for DM are parenteral?

A

Insulin’s
Amylin analogs
Incretin mimetics

50
Q

What are the 6 drugs for DM that are oral?

A 
Secretagogues 
Alpha-glucosidase inhibitor
Biguanides 
Insulin sensitizer
DPP-4 inhibitors
SGLT2 inhibitors
51
Q

What are the two categories of secretagogues?

A

Sulfonylureas

Meglitinides

52
Q

What is another name for insulin sensitizing drugs?

A

Thiazolidinediones

53
Q

What 2 routes is insulin given?

A

SC

ORAL

54
Q

What is insulin indicated for(4)?

A

Reversing ketoacidosis
Gestational DM
Type 2 DM
Hyperkalemia

55
Q

What pump does insulin stimulate on cells?

A

Na/K pumps

56
Q

What type of chain is insulin? What makes up the A chain? B chain?

A

Polypeptide chain

A chain= 21 AA chain

B chain= 20 AA chain

57
Q

Why can’t insulin normally be given orally?

A

Because protein chain gets destroyed and gets absorbed into tripeptide chains (nothing longer)

58
Q

What bond hold A and B chains together in insulin?

A

Disulfide bonds

59
Q

What types of insulin are OTC?

A 
Regular(Humulin R)
Isophane NPH(Humulin N, Novokun N)
60
Q

How long does insulin last outside of the fridge?

A

1 month

61
Q

What are the number of units for insulin usually found as?

A

100 units/ml

62
Q

What can an insulin overdose cause?

A

Hypoglycemia

63
Q

How does stress effect BLG?

A

Stress releases cortisol which increases BGL

64
Q

What do IV infusion sets do to insulin? How does this effect the dose?

A

Infusion sets absorb insulin

May have to increase insulin dose

65
Q

What factor requires a pt to reduce insulin dose? Why?

A

Heavy exercise

It used up the glucose in the blood and body

66
Q

What factors can increase the need for insulin?

A

Stress
Illness
Surgeries

67
Q

Why do beta blockers cause a decrease in the need for insulin?

A

Because a decrease in sympathetic system will also decrease BGL

68
Q

Why do thiazides increase the need for insulin?

A

Thiazides increase the process of gluconeogenesis

69
Q

What are the ADR of insulin?

A

Lipodystrophy

Hypoglycemia

70
Q

How can a pt avoid lipodystrophy? What is lipodystrophy?

A

Rotate injection sites

Dimpling effect on skin and fat

71
Q

How does an insulin pump work?

A

Gives a small dose always…then gives large bolus of insulin at meal times

72
Q

What should always be given prior to giving insulin?

A

Take a BGL

73
Q

What insulin is given IV?

A

Regular insulin

74
Q

What drugs cause an increase in BGL which require and increase in need for insulin?

A

Corticosteroids
Thyroid drugs
Thiazides

75
Q

What are the MOA of Amylin(3)?

A

Slows gastric emptying
Suppress glucagon secretion from alpha cells
Decreases appetite

76
Q

What is Amylin secreted w/?

A

Insulin

77
Q

What conditions have decreased amounts of Amylin release?

A

Type 1 and type 2 DM

78
Q

What are the indications for Amylin?

A

Uncontrolled DM Type 1 and 2

79
Q

What route is Amylin given?

A

SC

80
Q

What are the 2 ADR of Amylin?

A

N/V

Weight loss

81
Q

What is the MOA of incretins?

A

GIP and GLP-1 act on beta cells to release insulin

82
Q

What is another name for incretin mimetics? Route? Indication?

A

Lizard spit

SC

Type 2 DM

83
Q

Why is the 4 MOA of GLP-1 agonists?

A

Increase insulin release from beta cells
Decrease glucagon secretion from alpha cells
Delay stomach emptying
Decrease appetite

84
Q

What is the MOA of Biguanides(3)?

A

Decrease liver glucose production
Decrease intestinal glucose absorption
Enhance glucose utilization by other tissues

85
Q

What effect do biguanides have on GI? What is it? What can it lead to?

A

Lactic acidosis

Increased glucose leads to lactate conversion from enterocytes

Can cause respiratory and cardiac distress

86
Q

What is the MOA of secretagogues? Indication?

A

Binds to SUR on beta cells to close ATP sensitive K+ channels which causes insulin release

87
Q

What is the MOA of thiazolidinediones? What is another name for them? ADR? Contraindications

A

Enhance peripheral response to insulin

Insulin sensitizers

Causes fluid retention
Increases liver enzymes

HF
liver failure

88
Q

What is the MOA of alpha-glucosidase inhibitor? When should it be given? ADR?

A

Inhibits disaccharidase which decreases the amount of glucose going into blood after a meal

given w/ each meal

Farts
Diarrhea

89
Q

What is the MOA of DDP-4?

A

Breaks down incretins

90
Q

What is DDP-4 inhibitors indicated for? What is it used in combo w/?

A

Type 2 DM

Combo w/ metformin or thiazolidinediones

91
Q

What is the MOA of an SGLT2 inhibitor?

A

blocks Sodium Glucose transporters in PCT to be reabsorbed…this causing glucose to act as osmotic to water

92
Q

What are ADR of SGLT inhibitors(4)?

A

Genital fungal infections
UTIs
Polyuria
Hypotension

93
Q

What type of insulin is inhaled Afrezza?

A

Regular insulin

Pharmacology (27 decks)

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