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Pharm Test 4 > diabetes > Flashcards

diabetes Flashcards

1
Q

Beta cells produce

A

insulin, proinsulin, C peptide and amylin

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2
Q

what is amylin?

A

something that suppresses production of glucagon which is the opposite of insulin

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3
Q

what do alpha cells release?

A

glucagon

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4
Q

what do delta cells release?

A

somatostatin

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5
Q

what is an insulin secretagog?

A

glucose, something that makes the body secrete insulin

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6
Q

what are the 2 major types of secretory tissues that are in the pancreas?

A

exocrine gland-digestive enzymes
endocrine gland- alpha, beta, delta cells

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7
Q

where are the alpha beta and delta cells?

A

in the islets of langerhans

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8
Q

insulin receptors are what kind of receptor?

A

tyrosine kinase

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9
Q

what does insulin binding to insulin receptors do?

A

translocates glucose transporters to the cell wall

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10
Q

we always have a ____ level of insulin

A

constitutive

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11
Q

describe homeostasis processes when bg rises.

A

bg rises
insulin is released from beta cells
liver stores some as glycogen
bc insulin came out and was bound to insulin receptors now glucose transporters are moved to the cell wall
this pulls glucose into the cell

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12
Q

glucagon causes breakdown of _______ in the liver to _______ bg

A

glycogen
raise

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13
Q

type 1 diabetics are

A

insulin dependent- autoimmune thing where the body doesn’t produce insulin

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14
Q

type 2 diabetics are ________ on insulin

A

non-dependent

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15
Q

type 4 diabetes happens during

A

pregnancy. Pregnancy hormones block insulin receptors.

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16
Q

type 3 diabetes is from

A

pancreatitis, drug therapy, illness, etc.

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17
Q

cardinal symptoms of diabetes

A

polydipsia
polyphagia
polyuria

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18
Q

Describe the sorbitol pathway, and why it leads to peripheral neuropathy and blindness.

A

Sorbitol and fructose increase intracellular osmotic pressure (attracts water leading to cell injury)
More glucose means more sorbitol, Sorbitol can not leave the cell, excess sorbitol in cell, more water rushes in, cells burst

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19
Q

2 types of diabetes tests:

A

fasting BG
glucose tolerance test

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20
Q

Describe the structure of insulin

A

long string of amino acids
Broken down into beta and alpha chain held together by disulfide linkages
They are in the active form when they are together
The proform has a C peptide. Only the body makes c peptide.

21
Q

what is leptin?

A

something that makes you feel full

22
Q

what are the types of glucose transporters?

A

glut 1,2,4

23
Q

4 main types of insulin preparations :

A

rapid acting
short acting
intermediate acting
long acting

24
Q

what are the rapid acting insulins?

A

Lispro, aspart, glulisine

25
Q

what are the short acting insulins?

A

Novolin, humulin

26
Q

what are the intermediate acting insulins?

A

Neutral protamine Hagedorn (NPH)

27
Q

what are the long acting insulins?

A

Glargine, detemir

28
Q

what does the tight control of bg look like?

A

Basal + bolus (calculated)
Long acting once per day, rapid acting before meals

29
Q

what does the conventional control of bg look like?

A

70/30 premixes

30
Q

illness makes your ____ go up so you need more insulin

A

bg

31
Q

1 unit of Rapid acting insulin disposes ____ of carbohydrates

A

12-15g

32
Q

If lunch intake has 60 carbs how many units of rapid acting insulin should you give?

A

4 units.

60/15=4

33
Q

1 unit of rapid acting drops the bg by

A

50mg/dl

34
Q

if bg is 200 you should give how many units of rapid acting insulin?

A

2 units

200/50=100

35
Q

symptoms of hypoglycemia

A

Anxiety, blurred vision, palpitations, shakiness, slurred speech, sweating

36
Q

treatment for hypoglycemia

A

Glucose / simple sugars: 3-4 glucose tablets, ½ can of soda
Glucagon injection
1 mg IM, IV, SQ - may repeat in 20 minutes if needed
Inhibits insulin release, raises BG levels

37
Q

how does glucagon work?

A

inhibits insulin release from beta cells in the liver

38
Q

8 classes of oral antidiabetic drugs

A

biguanines
insulin secretagogues
thiazolidinediones
alpha-glucosidase inhibitors
bile acid sequestrant
amylin analogs
gliflozin
incretin based therapies

BIT A BAGI

39
Q

what is first line therapy oral antidiabetic?

A

biguanide

40
Q

how does biguanide work?
drug example?

A

Slows down gluconeogenesis (glucose production in liver)
metformin

41
Q

MOA of insulin secretagogue?

A

makes us produce more insulin via binding to K+ channels

42
Q

MOA of Thiazolidinediones (TZDs

A

Increase insulin signal transduction
Increased effect of Glut 4 going to cell surface

43
Q

MOA of Alpha-glucosidase inhibitors

A

Blocks digestion of complex carbohydrates

  • smelly farts
44
Q

MOA of Bile acid sequestrant

A

Big gloop that goes through intestine and blocks glucose from being absorbed so take with food

45
Q

MOA of amylin analogs

A

suppresses glucagon release

46
Q

MOA of gliflozin

A

targets SGLT2 transporters. blocks glucose uptake in the PCT

more glucose going out in urine, also works as an osmotic diuretic (good for BP reduction)

47
Q

side effects of gliflozins

A

Dehydration
Necrosis of genital region
High glucose in urine → bacteria in genital region fed a steady diet of glucose bc they are peeing out glucose, especially bad with bedridden patients

48
Q

pts with dm have a LDL goal of

A

<100

49
Q

Diagram a treatment algorithm for patients with Type II diabetes.

A

Combination therapy
Biguanide
Biguanide + Insulin OR Biguanide + Secretagogue
Biguanide + 2-3 other classes
Intensive Insulin Therapy

Pharm Test 4 (9 decks)

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