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Spring Pharm Exam 3 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

pathogenesis of hyperglycemia (2 points)

A

1 - Beta cell dysfunction

2 - insulin resistence in tissues

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2
Q

Insulin secreted when

A

elevation of blood glucose
vagal stimulation
B2-adrenergic agonists

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3
Q

Insulin MOA liver

A

promotes glucose storage

inhibits gluconeogenesis and ketogenesis

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4
Q

Insulin MOA muscle

A

Increased AA transport, protein synthesis and glycogen synthesis

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5
Q

Insulin MOA Fat cells

A

Inhibits intracellular lipolysis

increased TG storage and FA synthesis

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6
Q

Mechanism of hyperglycemia in diabetes

A

reduced glucose transport into muscle
reduced conversion of glucose storage as glycogen
increased conversion of protein to glucose

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7
Q

Mechanism of ketoacidosis in diabetes

A

increased mobilization of peripheral fat –> increased lipolysis –> increased FFA –> increased acetyl CoA –> increased ketone bodies

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8
Q

Prandial insulin are given before meals –> covers between meals and are rapid-acting and short-acting

A

:)

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9
Q

Humalog
Novolog
Apidra
are examples of

A

Rapid- acting insulins

onset 5-15 minutes and duration ~4hours

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10
Q

Intermediate acting basal insulin are given…

A

before breakfast –> covers between lunch and dinner.
before dinner or at bedtime –> covers overnight
Example: NPH

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11
Q

Long acting basal insulin is given…

A

once (Lantus) or twice (Levemir) daily –> provides “background” insulin levels

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12
Q

SSx of hypoglycemia with long acting insulin

A

CNS impairment: night sweats, HA, visual disturbance, confusion etc. come on more gradually

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13
Q

SSx of hypoglycemia with short acting insulin

A

Mimic autonomic hyperactivity: tachycardia, palpitations, tremor, nausea, hunger. Come on more rapidly

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14
Q

SSx of ketoacidosis (not enough insulin)

A

Gradual onset (hours or days)
Acetone breath, dry/flushed skin, thirst
TX: saline, insulin, possible replacement of K+ and PO4

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15
Q

Biguanides (Metformin, Glucophage) MOA

A

Increase the suppression of insulin on hepatic glucose production
Initial Pharm tx after lifestyle modifications

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16
Q

Biguanides (metformin, glucophage) SE

A

does NOT cause hypoglycemia or weight gain

N/V/D, bloating, possible lactic acidosis if bad kidneys

17
Q

Insulin Secretagigues (Sulfonylureas, Glipizide, Glimiperide) Meglitinides (rapid acting) MOA

A

Insulin release is enhanced in response to glucose (NOT the synthesis)

18
Q

Insulin Secretagigues (Sulfonylureas, Glipizide, Glimiperide) meglitinides (rapid acting) SE

A

Hypoglycemia possible, significant weight gain

Meglitinides can cause bloating, flatulence, ABD cramping, diarrhea but no weight gain

19
Q

Sulfonylurea considered second line TX to be added to metformin. (1st line in pts who cant take metformin)

A

Can be a part of the 3-drug regimen

20
Q

Thiazolidinediones MOA

A

increases target cell sensitivity to insulin to increase glucose uptake.. involves change in gene regulation

21
Q

Thiazolidinediones SE

A

low risk of hypoglycemia

fluid retention edema, hemodilution, exacerbation of heart failure

22
Q

Thiazolidinediones role in T2DM

A

second line tx to be added to metformin. can be part of 3-drug combination with metformin and a sulfonylurea/incretin enhancer/ or insulin

23
Q

Incretins - GI hormones released after meals to stimulate insulin secretion (ex: glucagon-like-peptide-1)

A

:)

24
Q

Incretin mimetic (Victoza, Byetta) MOA

A

Agonists are GLP-1 receptor: increased insulin production, inhibition of glucagon release, slows rate of gastric emptying

25
Q

Incretin mimetic SE

A

Subcutaneous BID

Increased risk of hyperglycemia if used with sulfonylureas

26
Q

Incretin mimetic role in T2DM

A

second line therapy to be added to metformin

can be part of 3-drug regimen with metformin and a thiazolidinedione/sulfonylurea/or insulin

27
Q

Dipeptidyl peptidase IV (DPP-4) inhibitors MOA

A

enhance the action of endogenous incretins by blocking degradation

28
Q

Dipeptidyl peptidase IV (DPP-4) role in T2DM

A

second line therapy to be added to metformin

can be part of 3-drug regimen with metformin and a thiazolidinedione/sulfonylurea/or insulin

Spring Pharm Exam 3 (8 decks)

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