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Endo/Repro Exam 2 > Diabetes Pharmacology Type I and Type II > Flashcards

Diabetes Pharmacology Type I and Type II Flashcards

1
Q

Earliest signs of diabetes?

A 
Increased:
Postprandial chylomicrons
VLDL cholesterol
Gluconeogenesis, ketogenesis
Plasma triglycerides
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2
Q

Three microvascular injuries that occur with diabetes?

A

Cataracts and retinopathy
Nephropathy
Neuropathy

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3
Q

How to prevent cataracts and retinopathy?

A

Keep A1c below 9%

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4
Q

How to prevent nephropathy?

A

Keep A1c below 8%

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5
Q

How to prevent neuropathy?

A

Keep A1c below 7%

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6
Q

What are the four goals of therapy?

A
  1. ) Prevent hyperosmolar coma/ketoacidosis
  2. ) Reduce microvascular injury
  3. ) Reduce hypertension
  4. ) Prevention of atherosclerotic disease
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7
Q

Two general types of drugs that increase plasma insulin?

A

Insulin

Secretagogues

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8
Q

Three general types of insulins?

A

Rapid acting and short acting
Moderate acting
Long acting

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9
Q

What are the rapid acting insulin?

A 
Lispro insulin (Humalog)
Insulin aspart (Novolog)
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10
Q

What are the short acting insulin?

A

Regular insulin

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11
Q

What are the moderate acting insulins?

A

Isophane/NPH

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12
Q

What are the long acting insulins?

A

Glargine
Detemir
Degludec

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13
Q

What are two types of secretagogues?

A

Sulfonylureas

Short-acting secretagogues

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14
Q

What are the sulfonylureas?

A

Glyburid
Glipizide
Glimepiride

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15
Q

What are the short acting secretagogues?

A

Repaglinide

Nateglinide

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16
Q

What are intermediate-mixed insulins preparations?

A

Isophane + regular insulin or Lispro

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17
Q

What may be used in a patient that has a high insulin dosage requirement?

A

Pramlintide

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18
Q

What are two general categories of direct acting agents for increased glucose uptake?

A

Biguanides

Thiazolidinediones

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19
Q

What are the Biguanides?

A

Metformin

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20
Q

What are the thiazolidinediones?

A

Pioglitazone

Rosiglitazone

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21
Q

What are the two general categories of GLP-1 mechanism for increased tissue glucose uptake?

A

GLP-1 Analogs

Dipeptidyl peptidase inhibitors

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22
Q

What are the GLP-1 analogs?

A

Liraglutide

Exenitide

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23
Q

What are the Dipeptidyl peptidase inhibitors?

A

Sitagliptin
Linagliptin
Saxigliptin

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24
Q

What does metformin cause?

A

Increased insulin sensitivity

Decreased gluconeogenesis

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25
Q

How does metformin mediate its affects?

A

Not well understood but increase AMP:ATP ratio activating AMP kinase

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26
Q

What are contraindications of metformin?

A

Hepatic and renal insufficiency
MI
Uncompensated CHF

27
Q

What can metformin cause?

A

Lactic acidosis

28
Q

How do thiazolidinediones work?

A

Ligands for cytosolic and nuclear PPAR receptors

29
Q

What are the two PPAR receptors?

A

Gamma

Alpha

30
Q

What affect to thiazolidinediones have?

A

Increased fatty acid uptake
Increased fatty acid oxidation
Increased insulin sensitivity and glucose uptake
Anti-inflammatory affects

31
Q

What are the two thiazolidinediones?

A

Pioglitazone

Rosiglitazone

32
Q

What receptors does pioglitazone work on?

A

PPAR-alpha

PPAR-gamma

33
Q

What receptors does rosiglitazone work on?

A

PPAR-gamma

34
Q

Which thiazolidinedione has better lipid metabolism effects?

A

Pioglitazone (PPAR-alpha)

35
Q

What do incretins/GLP-1 do?

A

Increase GLUT-2 expression in beta-cells of the pancreas

36
Q

When is GLP-1 released and where?

A

From small intestine and colon in response to carbohydrate, protein and fat intake

37
Q

What enzyme breaks down GLP-1 and GIP?

A

DPP4

38
Q

What do dipeptidylpeptidase inhibitors do?

A

Inhibit DPP4 increasing the life span of GLP-1 and GIP

39
Q

What releases GLP-1?

A

Distal small intestines and colon

40
Q

What releases GIP?

A

Duodenum

Jejunum

41
Q

What are the effects of GLP-1 (7-36) amide (active form)?

A 
Increased:
Insulin secretion
Satiety
Beta-cell survival
Decreased:
Glucagon secretion
Gastric emptying
Food intake
42
Q

What is are the effects of GLP-1 (9-36) amide (inactive form)?

A

Increased independent glucose clearance
Cardioprotective
Vasoactive

43
Q

What are the effects of GIP (1-42) active form?

A 
Increased:
Insulin secretion
Lipogenesis
Beta-cell survival
Decreased:
Lipolysis
44
Q

What are the effects of GIP (3-42) inactive form?

A

None

45
Q

What are the GLP-1 analogs?

A

Exenatide

Liraglutide

46
Q

Which GLP-1 analog has reduced DPP4 sensitivity?

A

Liraglutide

47
Q

What are examples of DPP4 inhibitors?

A

Sitagliptin

Linagliptin

48
Q

What are amylin analogs?

A

Pramlintide

49
Q

What are alpha-glucosidase inhibitors?

A

Acarbose

Miglitol

50
Q

What are inhibitors of sodium-glucose transport?

A

Dapagliflozin
Empagliflozin
Canagliflozin

51
Q

What is amylin?

A

Small peptide hormone that is released into the bloodstream by the beta cells of the pancreas along with insulin after a meal

52
Q

What is the only drug approved to lower blood sugar in Type I diabetics since insulin?

A

Pramlintide

53
Q

Mechanism of action of Pramlintide?

A

Inhibit release of glucagon

54
Q

What do alpha-glucosidase inhibitors do?

A

Inhibit intestinal alpha-glucosidase slowing post-prandial increase in plasma glucose

55
Q

What does alpha-glucosidase enzyme do?

A

Digests carbohydrates

56
Q

What is more commonly used among “skinny” Type II diabetics?

A

Alpha-glucosidase inhibitors

57
Q

Where do SGLT-2 transporters work and what do they do?

A

Co-transport sodium and glucose in the proximal convoluted tubule

58
Q

What are the SGLT-2 inhibitors?

A

Canagliflozin
Empagliflozin
Dapagliflozin

59
Q

What do the SLGT-2 inhibitors cause?

A

Decrease in reabsorption of glucose and sodium from the PCT allowing it to be released in the urine

60
Q

What are side effects of glucose in the urine?

A

Polyuria/dehydration
Urinary tract infections (fungal)
Urine loss of 200-500 Kcals/day
Ketoacidosis

61
Q

What drug is acid-soluble and precipitates at body pH?

A

Glargine insulin

62
Q

What drug heavily binds to albumin?

A

Detemir insulin

63
Q

What is the standard insulin therapy for Type I diabetics?

A 
Glargine insulin (once daily) + rapid acting insulin with meals
or insulin pump with rapid-acting insulin

Endo/Repro Exam 2 (18 decks)

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