Diabetes Drugs (Konorev) Flashcards
Which of the following actions contributes to the anti hyperglycemic effect of insulin?
a. Activation of gluconeogenesis
b. Suppression of glycolysis
c. Activation of glycogenolysis
d. Suppression of glucose transport into cells
e. Activation of glycogen synthesis
e. Activation of glycogen synthesis; stimulating glucose uptake in cells (decreases blood glucose) and being stored as glycogen
A 24 yo woman wishes to try tight control of her diabetes to improve her long-term prognosis. Which of the following regimens is most appropriate?
a. Morning injections of mixed insulin lisper and insulin aspart
b. Injections of mixed regular insulin and upsilon glargine before going to bed
c. Morning and evening injections of regular insulin, supplemented by small amounts of NPH insulin at mealtimes
d. Morning injections of insulin glargine, supplemented by insulin lispro at mealtimes
d. Morning injections of insulin glargine, supplemented by insulin lispro at mealtimes
Hypokalemia is a side effect of insulin therapy that occurs due to:
a. increased elimination of K+ in urine
b. Increased secretion of K+ into bile
c. Increased transport of K+ from extracellular fluid into cells
d. Decreased absorption of K+ from GI tract
c. Increased transport of K+ from extracellular fluid into cells
Which of the following statements regarding Pramlintide, as an adjunct to insulin therapy, is correct?
a. Used to primarily treat T2DM patients
b. Administered orally
c. Taken before going to bed
d. Used to manage postprandial hyperglycemia
e. Known to cause hyperglycemia
d. Used to manage postprandial hyperglycemia
What are the 3 rapid acting insulins?
Aspart
Lispro
Glulisine
What is the only short acting insulin?
regular insulin
What are the 2 long acting insulins?
Detemir
Glargine
What is the one amylin analog and when is it used?
Pramlintide; used in combination with insulin in T1DM to enhance the effects of insulin in patients with absolute no insulin production; watch/monitor for hypoglycemia
What is the diagnostic criteria for diabetes mellitus?
increased plasma glucose levels; fasting levels over 125 mg/dl
How does insulin lower blood glucose levels
promotes intracellular glucose transport in cells via the GLUT4 transporter; activator of glycolysis and glycogen synthesis
When are rapid acting insulins recommended for clinical use?
in patients w T1DM to correct postprandial hyperglycemia; taken BEFORE the meal (sc injections only)
When are short acting insulins recommended for clinical use?
regular insulin; overnight coverage; 45 mins before meal for postprandial hyperglycemia and can be injected IV in urgent situations
Which insulin can be injected via IV in urgent situations of hyperglycemia?
regular insulin; a short acting insulin
What is the one intermediate- acting insulin
NPH; use is declining
When are long acting insulins recommended for clinical use?
basal insulin maintenance (1-2 sc injections only)
What is the importance of tight glycemic control in diabetic patients?
improves survival; reduced diabetic complications; has been shown to be effective in multiple trials
Why is insulin indicated to use in cases of severe HYPERkalemia?
insulin rapidly activates Na/K+ ATPase to shift K+ from extracellular fluid into cells
What is the most common and most severe adverse effect of insulin use?
hypoglycemia; due to delayed or missed meal, exercise, or OD of insulin
What is a dangerous complication in diabetic patients on a tight glycemic control?
hypoglycemic unawareness; they are not aware of their low blood sugar until it is dangerously low
Amylin
an endogenous polypeptide synthesized by B-cells along with insulin; enhances the action of insulin
Pramlintide
an amylin analog; enhances effects of insulin; used in combination with insulin in patients with absolute deficiency in insulin; watch/monitor for hypoglycemia
Which sequence correctly describes the cellular mechanism of glucose-induced insulin release from pancreatic B cells?
a. Glucose binds to the GLUT transporter; cell membrane depolarization; increase in cellular ATP; Ca2+ channel closes
b. Glucose binds to the GLUT transporter; increase in cellular ATP; K+ channel closes; cell membranes depolarization
c. Glucose binds to the GLUT transporter; increase in glucose uptake; K+ channel opens increase in intracellular Ca2+
d. Glucose binds to the GLUT transporter; K+ channel closes; cell membrane depolarization; decrease in intracellular Ca2+
e. Glucose binds to the GLUT transporter; K+ channel closes; cell membrane hyperpolarization; increase in intracellular Ca2+
b. Glucose binds to the GLUT transporter; increase in cellular ATP; K+ channel closes (K+ does NOT exit); cell membranes depolarization; releases Ca2+; exocytosis of insulin release
Which of the agents below will increase release of insulin by islet beta-cells?
a. Clonidien (alpha 2 agonist)
b. Verapamil (CCB)
c. Isoproterenol (non selective B agonist)
d. Somatostatin
e. Propranolol (non selective B blocker)
c. Isoproterenol (non selective B agonist); activates Gs coupled receptor; increased PKA and Ca2+ release; exocytosis of insulin
Which of the following combinations will most likely result in developing hypoglycemia in a treated patient?
a. Glyburide + diazoxide
b. Glyburide + aspirin
c. Glyburide + a beta-blocker
d. Glyburide + a calcium channel blocker
e. Glyburide + a CYP inducer
b. Glyburide + aspirin
