Diabeetus Flashcards

1
Q

Type 1 diabetes

A

insulin-dependent, loss of beta cells. 5-10% of diabetics

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2
Q

Type 2 diabetes

A

insulin-independent, decreased response to insulin, 85-90% of diabetics

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3
Q

Type 3 diabetes

A

caused by gene mutations

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4
Q

Type 4 diabetes

A

gestational diabetes (4% of all pregnancies)

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5
Q

Central goal of DM therapy

A

correct hyperglycemia and maintain BGL near normal range. preventing, delaying, or reducing complications, minimizing side effects of therapy, and improving quality of life

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6
Q

non-pharmological approaches to treatment

A

diet and exercise: large reduction in type 2 incidence

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7
Q

what stimulates insulin release?

A

glucose, which stimulates depolarization of beta cells through closing K+ channels, causing the opening of Ca2+ channels

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8
Q

what does insulin do?

A

stimulates the production of triglycerides in adipose tissue, stimulates the production of glycogen in liver cells, and stimulates the production of protein in muscles

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9
Q

types of insulin

A

rapid acting, short acting, intermediate acting, and long acting

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10
Q

rapid-acting

A

peak in 30 min-2 hrs, can be injected or inhaled

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11
Q

inhaled insulin (Exubera)

A

used in combination with other insulin in Types 1 and 2 or alone in Type 2. contraindicated in smokers, not recommended for asthma or COPD patients. side effects are cough, shortness of breath, hypoglycemia

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12
Q

oral hypoglycemic agents

A

Sulfonylureas and meglitinides; act to increase the levels of insulin

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13
Q

sulfonylurea mechanism of action

A

block K+ channels, causing beta cell depolarization

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14
Q

prototypical sulfonylureas

A

tolbutamide (1st gen,~8hr duration) and glyburide (2nd gen, ~12-24 hr duration)

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15
Q

sulfonylurea contraindications

A

sulfa drug alerrgy, pregnancy, major stress (surgery, trauma, infection)

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16
Q

sulfonylurea side effects

A

hypoglycemia, weight gain, rash, elevated liver enzymes, allergic reaction

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17
Q

Meglitinides mechanism

A

inhibition of K+ channel at a different site from sulfonylureas

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18
Q

prototypical meglitinides

A

repaglinide, nateglinide

19
Q

meglitinide pharmacokinetics

A

rapid onset and short duration, intended to be taken after meal

20
Q

meglitinide side effects

A

diarrhea, allergic reactions, headache. less chance of hypoglycemia than sulfonylureas

21
Q

antihyperglycemic agents

A

biguanides, alpha-glucosidase inhibitors, thiazolidinediones. act without changing insulin levels

22
Q

biguanide mechanism of action

A

inhibit production of glucose in liver, increase sensitivity to insulin, decrease GI glucose absorption. comparable to sulfonylureas in efficacy

23
Q

prototypical biguanide

A

metformin

24
Q

metformin side effects

A

metallic taste, nausea/diarrhea, reduced absorption of B12 and folic acid

25
Q

metformin pharmacokinetics

A

little binding to plasma proteins, no active metabolites

26
Q

advantages of metformin

A

no hypoglycemia or increased weight

27
Q

a-glucosidase inhibitor prototype

A

acarbose

28
Q

acarbose mechanism

A

competitive inhibition of intestinal alpha-glucosidase, reduction in starch digestion and glucose absorption

29
Q

acarbose side effects

A

bloating and flatulence. can cause hypoglycemia in combo with insulin, treatable with glucose

30
Q

acarbose contraindications

A

intestinal diseases exacerbated by gas (ulceration, inflammatory bowel disease)

31
Q

thiazolidinediones prototypes

A

risigilitazone, pioglitazone

32
Q

thiazolidinedione mechanism of action

A

agonist for PPAR-gamma, increases insulin sensitivity in muscle, liver, and adipose tissue, and increases insulin’s action on glucose and lipid metabolism. reduces A1c by 1.0-1.5%

33
Q

pharmacokinetics of thiazolidinediones

A

take 3-6 weeks to reach maximum effect

34
Q

thiazolidinediones side effects

A

weight gain, fluid retention, some liver toxicity

35
Q

thiazolidinedione contraindications

A

heart failure; rosigilitazone can cause MI (43% increase in MIs in one study) and CHF

36
Q

new drugs

A

sitagliptin, exenatide, pramlintide

37
Q

sitagliptin mechanism

A

inhibition of DPP4, an enzyme that leads to increased insulin production and decreased glucagon production

38
Q

sitagliptin pharmacokinetics

A

rapid absorption (PO), little metabolism (79% excreted whole in urine), hl of 11.8-14.4 hr. used as sole therapy or in combo with metformin or thiazolidinediones

39
Q

sitagliptin side effects

A

none, no hypoglycemia or weight gain

40
Q

exenatide mechanism

A

enhances glucose dependent insulin release, suppresses elevated glucagon secretion, slows gastric emptying
decreases HbA1c by .4-.8% and 2 hr PPG bt 63-71 mg/dl

41
Q

exenatide pharmacokinetics

A

subQ, used in combo with sulfonylureas and/or metformin

42
Q

exenatide side effects

A

indigestion, diarrhea, weight loss (1-3 kg)

43
Q

pramlintide mechanism

A

synthetic analog of amylin, a hormone co-secreted with insulin that slows gastric emptying, suppresses glucagon secretion after meals, and modulates appetite
decrease H1c by .5%, 1.5 kg weight loss

44
Q

pramlintide pharmacowhatever

A

SubQ before meal