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Pharmacology > Chapter 14.1 > Flashcards

Chapter 14.1 Flashcards

1
Q
  1. State the location and specific cells responsible for the secretion of insulin and glucagon.
A

Location – pancreas
Alpha cells produce GLUCAGON
Beta cells produce INSULIN

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2
Q
  1. State the composition and classification of the insulin molecule
A

It is a large polypeptide of 51 amino acids

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3
Q
  1. List the characteristics of patients with type 1 diabetes regarding age of onset, insulin levels, and response to insulin. (will be on test)
A

Onset – juvenile
Insulin level – low level
Response to insulin – normal response
don’t make insulin - deficiency - You can’t use sugar for energy so the body uses fats causing ketoacidosis. Can also start to remove glycogen out of muscles

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4
Q

Type 2

A

Onset – adults
Insulin level – normal/high levels
Response to insulin – decreased response
do make insulin - make too much or too little

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5
Q
  1. State the percent of all diabetic patients who have type 1 and type 2 diabetes
A

Type 1 – 5-10%

Type 2 – 90-95%

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6
Q
  1. State the routes of administration for insulin and why these routes are used
A

Insulin NOT suitable for oral administration – usually administered through sub-Q injection – automatic glucose sensor – insulin pump
Alternative administration
Inhalation or nasal spray

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7
Q
  1. State how insulin is produced today
A

Produced using cell cultures & recombinant DNA techniques

Biosynthetic techniques to produce insulin analogs

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8
Q
  1. Define insulin analogs
A

It is like insulin but varies by a few amino acids - it alters the amino acids to change how the insulin works

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9
Q
  1. Classify the following insulins as rapid acting: lispro, NPH, and glargine. (will be on test)
A

Lispro

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10
Q

intermediate acting

A

NPH

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11
Q

long acting

A

Glargine

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12
Q
  1. State the rationale for insulin mixtures.
A

Patients will need different activity levels of insulin. For example if pt. is eating and needs it right away they can use rapid acting, while intermediate acting ones can be used to control insulin levels throughout the day.
to put two speeds in at the same tim

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13
Q
  1. State the peak effect and duration of the following insulins: rapid acting (lispro) and long acting (glargine).
    (will be on test)
A

rapid acting (lispro)
peak effect .5 – 1.5 hrs.
long-acting (glargine).
Peak effect 3 – 24 hrs.

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14
Q
  1. List the physiologic actions of insulin.
A

Increase glucose entry & storage in tissue (muscles & liver)

Increase protein synthesis & lipid storage

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15
Q
  1. List the physiologic actions of glucagon.
A

The primary effect of glucagon is to increase blood glucose to maintain normal blood glucose levels and to prevent hypoglycemia.

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16
Q
  1. State the acute problems associated with insulin insufficiency
A

Hyperglycemia followed by hypoglycemia

Shift to fat metabolism/ketones

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17
Q

Chronic problems

A

Repeated prolonged hyperglycemia – small vessel angiopathy - occlusion

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18
Q
  1. State how chronic hyperglycemia causes angiopathy.
A

In repeated high blood sugar (Hyperglycemia), glucose binds to proteins in the vessel wall and makes the walls thick and blood can’t get through & effects tissue

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19
Q
  1. List the microangiopathic clinical outcomes of poorly controlled diabetes mellitus. (will be on test)
A

Amputation – blindness – end stage renal failure & peripheral neuropathy

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20
Q

macroangiopathic

A

Hypertension – MI (heart attack & stroke) – CVA

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21
Q
  1. Define the concepts of intensive insulin therapy .
A

Monitoring blood glucose often & adjusting insulin dosage & food intake to keep insulin level in normal range.

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22
Q

a basal-bolus insulin regimen

A

Using both a basal & bolus dose to help control insulin levels. Basal doses give background level of long or intermediate acting for control over day/night while bolus dose to deal with glucose as a pt. is eating.

23
Q
  1. List the symptoms of hypoglycemia.
A

Headache – shaking – sweating – tired – weakness – hunger

24
Q
  1. State reasons that a patient on an insulin regimen might experience hypoglycemia.
A

Dose too high – delayed/missed meal – strenuous exercise

25
Q
  1. State the glucose level defining hypoglycemia. will be on test)
A

BG < 70 mg/dl

26
Q
  1. List common sources of 15 grams of carbohydrate used to treat hypoglycemia. (will be on test)
A 
Glucose tablet (usually like 3 tablets) – gel tub – 4 oz (1/2) of juice or regular soda – 1 TBSP of sugar, honey, corn syrup – 8 oz nonfat or 1% milk hard candies – jelly beans, or gum drops 
every 15 min until back to normal range
27
Q
  1. Outline a management plan for a patient having a hypoglycemic episode during a physical therapy session.
A

Consume 15-20 g of glucose – monitor symptoms & check glucose in 15 minutes. Repeat is needed – once they are back to normal levels eat a small snack.

28
Q
  1. State the location of incretins and what stimulates their release.
A

Location – released from GI tract after eating a meal

29
Q
  1. List the actions of the following two incretins: glucagon-like peptide-1 (GLP-1)
A

Regulate glucose metabolism by stimulating insulin release

30
Q

glucose-dependent insulinotropic polypeptide (GIP)

A

Inhibits glucagon activity – reduces appetite – increased beta cell mass & differentiation – promotes weight loss

31
Q
  1. State the mechanism of action and physiological effects of the following drugs used to manage type 2 diabetes: sulfonylureas
A

Increases insulin release (direct effect) – decreases hepatic glucose production (indirectly) – variable efficacy/effects tend to diminish with time.

32
Q

meglitinides

A

Act like sulfonylureas – increase insulin release from pancreatic beta cells

33
Q

GLP-1 agonists

A

Stimulate insulin release – inhibit glucagon production – enhance beta cell mass & differentiation

34
Q

DPP4 inhibitors

A

Inhibit dipeptidyl peptidase 4 (enzyme that breaks down incretins)
Prolong effects of GLP-1 & GIP

35
Q

biguanides

A

Acts directly on liver to decrease hepatic glucose production/increase peripheral sensitivity to insulin; metformin

36
Q

glitazones

A

Increase tissue sensitivity to insulin – Decrease hepatic glucose production; facilitate activity

37
Q

α-glucosidase inhibitor

A

inhibit glucose absorption from GI Tract

38
Q

sodium-glucose co-transporter-2 (SGLT-2) inhibitors (gliflozins).

A

Decrease glucose reabsorption in kidneys; glucose is lost in urine

39
Q
  1. State the most common adverse effect of the following medications or medication classifications used to manage diabetes: insulin
A

Dramatic fall in blood glucose levels because insulin lower blood glucose

40
Q

sulfonylureas

A

Hypoglycemia – GI disturbances - Headaches

41
Q

GLP-1 agonists

A

GI problems – pancreatitis – mild hypoglycemia

42
Q

metformin

A

GI problems – lactic acidosis

43
Q
  1. Match the following drugs with their therapeutic category: lispro (Humalog®)
A

Rapid acting insulin

44
Q

NPH (Humulin N®)

A

Intermediate acting insulin

45
Q

glargine (Lantus®)

A

Long-acting insulin

46
Q

glipizide (Glucotrol®) glyburide (DiaBeta®)

A

Sulfonylureas

47
Q

repaglinide (Prandin®)

A

Meglitinides

48
Q

exenatide (Byetta®) liraglutide (Victoza®)

A

GLP-1 agonists

49
Q

sitagliptin (Januvia®)

A

DPP4 inhibitors

50
Q

metformin (Glucophage®)

A

Biguanides

51
Q

pioglitazone (Actos®)

A

Glitazones

52
Q

acarbose (Precose®)

A

α-glucosidase inhibitors

53
Q

empagliflozin (Jardiance®)

A

sodium-glucose co-transporter-2 (SGLT-2) inhibitors (gliflozins)

54
Q
  1. State the considerations of a physical therapist working with patients who are being treated for diabetes mellitus.
A

Insulin absorption can be effect by physical agents – massage – recognize & deal w/ hypoglycemia – encourage & supervise non drug managements (diet & exercise

Pharmacology (22 decks)

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