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Endocrine Module > Diabetes Pharmacology > Flashcards

Diabetes Pharmacology Flashcards

1
Q

What chemical is in the mouth utilized for the digestion of carbs?

A

Alpha Amylase

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2
Q

What chemicals are in the small intestine that are utilized for the digestion of carbohydrates?

A

Alpha Amylase, Hydrolases, Glucosidases

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3
Q

What is the role of insulin in carbohydrate homeostasis?

A

Leads to storage of glucose, synthesized in pancreas, released in response to increasing blood glucose levels

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4
Q

What is the role of glucagon in carbohydrate homeostasis?

A

Stimulates release of glucose, synthesized in the pancreas, and prevents hypoglycemia

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5
Q

Glucogneogenesis

A

Formation of glucose not from glycogen

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6
Q

Glycogenolysis

A

Formation of glucose from glycogen

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7
Q

Glycolysis

A

Breakdown of glucose for energy

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8
Q

Glycogenesis

A

Formation of glycogen

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9
Q

Lipolysis

A

Breakdown of fat

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10
Q

Lipogenesis

A

Formation of fat

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11
Q

Beta Cells in the Pancreas do what?

A

Produce insulin and amylin
Insulin and C-Peptide are stored and CO-released together

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12
Q

Alpha Cells in the Pancreas do what?

A

Regulate glucagon secretion and hepatic glucose output

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13
Q

What is the Primary regulator of insulin release?

A

Glucose

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14
Q

What are the steps in insulin release?

A
  1. glucose into beta cells by FACILITATED diffusion (GLUT1)
  2. glucokinase phosphorylates glucose to Glucose 6 Phosphate
  3. glucose 6 phosphate INCREASES ATP levels via glycolytic pathway
  4. increased ATP:ADP ratio INHIBITS K+ Channels
  5. membrane depolarization of B cell, INFLUX of Ca2+
  6. calcium influx leads to EXOCYTOSIS of INSULIN granules
  7. insulin secretion via incretins
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15
Q

What does SUR (Sulfonylurea Receptor) do?

A

Block of SUR keeps K+ Channel Closed = Facilitation of Insulin Secretion with no regard to glucose levels

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16
Q

Does IV or Oral Glucose cause a higher Incretin Effect?

A

Oral (ingestion) of glucose causes more insulin release than an equivalent rise in blood glucose induced by IV, due to it going through the GI tract

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17
Q

What gut derived hormones are released proportionally to nutrient load?

A

GLP-1 and GIP

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18
Q

What type of diabetes has an impaired incretin effect?

A

Type 2, worse insulin response/release

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19
Q

How does the insulin receptor cause glucose transportation?

A
  1. insulin binds to the receptor
  2. receptor TYROSINE phosphorylates
  3. casacade activated
  4. PIP3 and Akt involved in translocation GLUT4 to cell membrane
  5. Glucose transported into the cell
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20
Q

Where are insulin receptors located?

A

Liver, muscle, and fat = ALL peripheral tissues

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21
Q

Where is GLUT4 located?

A

ON the cell MEMBRANE, important for storage of glucose

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22
Q

What does insulin activate for phosphorylation of glucose in the liver?

A

Hexokinase = trapping phosphorylated glucose in liver

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23
Q

What enzymes does insulin activate for glycogen synthesis?

A

Phosphofructokinase and Glycogen Synthase = promoting production of glycogen from excessive glucose

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24
Q

How are fatty acids exported from the liver?

A

Lipoproteins

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25
Q

How does insulin resistance affect the liver?

A

Gluconeogenesis causes glucose production despite hyperglycemia, glucagon is not inhibited

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26
Q

How does insulin resistance affect the muscle?

A

Decreased ability to take up glucose

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27
Q

How does insulin resistance affect the adipocytes?

A

Lipase enzyme is not inhibited leading to increased plasma FFA and decreased ability to take up glucose

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28
Q

What are the functions of Amylin?

A

Slows gastric emptying, decreases speed of glucose absorption, suppresses glucagon output, increases satiety, and is co-released with insulin

29
Q

What type of insulin is used for bolus/prandial dosing?

A

Rapid

30
Q

What type of insulin is used for basal dosing?

A

Long/Ultra Long

31
Q

Why must you always pair insulin with food?

A

HYPOglycemia

32
Q

What is the inhaled insulin on the market?

A

Afrezza

33
Q

What is the artificial pancreas on the market?

A

Medtronic MiniMed

34
Q

What are the adverse effects of insulin?

A

Hypoglycemia, Weight Gain, and Insulin Allergy

35
Q

What is the MOA of Sulfonylureas?

A

Increase insulin release from beta cells in pancreas by closing K-ATP channels SUR, decreases serum glucagon

36
Q

Are sulfonylureas independent or dependent on glucose?

A

Insulin Secretion is INDEPENDENT, risk of hypoglycemia

37
Q

What drugs are classified as Sulfonylureas?

A

Glyburide, Glipizide, and Glimepiride

38
Q

What is the MOA of Meglitinides/Glindies?

A

Block ATP sensitive potassium channels in beta cells to increase insulin release

39
Q

Are Meglitinides/Glindies independent or dependent of glucose?

A

Insulin release, somewhat DEPENDENT on glucose levels, less risk of hypoglycemia

40
Q

What drugs are classified as Meglitinides/Glinides?

A

Repaglinide and Nateglinide

41
Q

What are the pearls of Repaglinide?

A

Hypoglycemia possible, weight gain, Glucuronidation required for metabolism

42
Q

What are the pearls of Nateglinide?

A

Risk of hypoglycemia and weight gain

43
Q

What is the MOA of Biguanides?

A

Increases insulin sensitivity in muscle and liver involving activation of AMP Kinase (AMPK), decreases hepatic glucose formation, and stimulation of glucose uptake by increasing GLUT4

44
Q

Is Biguanide dependent on functioning beta-cells?

A

NO

45
Q

What drugs are classified as Biguanide?

A

Metformin

46
Q

What are the pearls of Metformin?

A

Rare hypoglycemia, EUGLYCEMIC Agent, do not use with impaired kidney function, GI upset/diarrhea

47
Q

What is the MOA of Thiazolidinediones?

A

Agonists at PPAR-y, nuclear receptor, encouraging redistribution of fat from central to periphery, increases secretion of adiponectin

48
Q

Are Thiazolidinediones independent or dependent on insulin?

A

DEPENDENT, REQUIRE insulin to be present for them to work

49
Q

What drugs are Thiazolidinediones?

A

Pioglitazone and Rosiglitazone

50
Q

What are the pearls of Pioglitazone and Rosiglitazone?

A

Raise HDL levels, weight gain, CHF (black box), increased bone fracture, decreased hematocrit

51
Q

What is the MOA of A-Glucosidase Inhibitors?

A

Inhibition of a-glucosidase in intestines, delay digestion and absorption of starch, inhibit glucose uptake from GI

52
Q

What drugs are A-Glucosidase Inhibitors?

A

Acarbose and Miglitol

53
Q

What are the pearls of Acarbose and Miglitol?

A

No weight gain, no effect on plasma lipids, no hypoglycemia, flatulence, diarrhea, abdominal pain, and bloating

54
Q

What is the MOA of GLP-1 Agonists?

A

GLP-1 receptor activation increases cAMP levels, increasing insulin synthesis and release in a glucose-dependent manner

55
Q

What drugs are classified as GLP-1 Agonists?

A

Exenatide, Liraglutide, Albiglutide, and Dulaglutide

56
Q

What are the pearls of Exenatide, Liraglutide, Albiglutide, and Dulaglutide?

A

N/V (dose dependent), weight loss, and pancreatitis

57
Q

What drug is a GLP-1 and GIP Agonist?

A

Tirzepatide/Mounjaro

58
Q

What are the pearls of Tirzepatide?

A

Decrease A1c and BW, nausea/diarrhea, vomiting, dyspepsia, acute pancreatitis, acute gallbladder dysfunction, black box for c-cell thyroid tumors

59
Q

What is the MOA for DPP-4 Inhibitors?

A

Block degradation of GLP-1 and GIP by dipeptidyl peptidase 4, increasing levels of GLP-1 and GIP

60
Q

What drugs are classified as DPP-4 Inhibitors?

A

Alogliptin, Sitagliptin, Saxagliptin, and Linagliptin

61
Q

What are the pearls of Alogliptin, Sitagliptin, Saxagliptin, and Linagliptin?

A

No satiety or gastric emptying effects

62
Q

What is the MOA of Amylin analogs?

A

Slows gastric emptying, decreases appetite, decreases glucagon release

63
Q

What drug is classified as an Amylin analog?

A

Pramlintide

64
Q

What are the pearls of Pramlintide?

A

Weight loss and N/V

65
Q

What is the MOA of SGLT2 Inhibitors?

A

Inhibits SGLT2, causing less glucose reabsorption, increase glucose in urine

66
Q

What drugs are classified as SLGT2 Inhibitors?

A

Canagliflozin, Dapagliflozin, and Empagliflozin

67
Q

Are SGLT2 Inhibitors dependent or independent of insulin?

A

Independent

68
Q

What are the pearls of Canagliflozin, Dapagliflozin, and Empagliflozin?

A

Low risk of hypoglycemia, some weight loss, and glucose in urine = increase UTIs

69
Q

What does SGLT2 stand for?

A

Sodium glucose transporter 2

Endocrine Module (16 decks)

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