Diabetes, Weight, Thyroid Pharm Flashcards
Which pancreatic cells account for 20% of islet mass and secrete glucagon?
Alpha Cells
*Hyperglycemic factor that mobilizes glycogen stores
Which pancreatic cells account for 75% of islet mass and secrete insulin?
Beta Cell
*storage and anabolic hormone
What are the 4 types of diabetes?
1-Type 1-insulin dependent
2-Type 2- non-insulin dependent
3- Type 3 (Others)
4- Type 4 Gestational
Insulin promotes glucose transport into muscle and fat cells via what transporter?
Glut-4
*Glut-2 in B-cells
What are the 5 steps of insulin release in B-cells?
1-Increase glucose through Glut-2 2-Increased ATP 3-Close K+ channel 4-Increase Ca influx through Ca channels 5-Release insulin
*sulfonylureas act here
What are the 3 main targets of insulin?
1-Liver
2-Muscle
3-Adipose tissue
What 4 effects does insulin have on the liver?
1-Inhibit glycogenolysis
2-Inhibit conversion of fatty and amino acid to keto acids
3-Inhibit conversion of AA to glucos
4-Anabolic action
What 3 effects does insulin have on muscle?
1-increase protein synthesis
2-Increase glycogen synthesis
3-Increase glucose transport
What effect does insulin have on adipose tissue?
Increased triglyceride storage
The length of time before insulin reaches the bloodstream and begins lowering blood glucose is?
Onset
The time during which insulin is at maximum strength in terms of lowering blood glucose is?
Peak time
how long insulin continues to lower blood glucose is?
Duration
Long-acting insulin mimics ____ and rapid acting is for_____
Basal
Meals
Which type of insulin group more closely mimic normal endogenous insulin when taken right before a meal?
Rapid-Acting insulin
*lasts approximately 4 hours
Which type of insulin group takes 30 minutes to take effect, peaks at 2-3 hours and persist 5-8 hours?
Short-acting insulin
*soluble crystalline zinc insulin. Take 30 min before meal
Which kind of insulin used to be the longest acting, is delayed when combined with protamine and is usually mixed with other insulins given throughout the day?
NPH (Neutral Protein Hagedorn)
Which long acting insulin has “peaks” with arginine and glycine attached to make it soluble in acid but precipitate at body pH and is a background insulin replacement?
Insulin Glargine
Which long acting insulin is a background replacement that has threonine dropped and myristic acid added to prolong availability through self-aggregation and albumin binding?
Insulin Determir
What are 3 possible insulin delivery systems?
1-S.C. injection
2-Portable pen injectors
3-Continuous S.C. infusion devices
Too much insulin causes what?
Hypoglycemia
Which type of diabetes may benefit from both insulin and other drug treatment?
Type II
*usually no ketoacidosis
What are the three principles mechanisms of action of oral anti-diabetic agents?
1-Binding to sulfonylurea and stimulate insulin secretion
2-Agents that lower glucose actions on liver, muscles, and adipose tissue
3-Slow intestinal absorption of glucose
Which drugs increase insulin release from B cells but bind to carrier proteins in the blood which can be dislodged by other drugs leading to rapid hypoglycemia?
Sulfonylureas
*hypoglycemia and weight gain side effects
Which three drugs are 1st generation sulfonylureas?
1-Tolbutamide (Orinase)
2-Tolazamide (Tolinase)
3-Chlorpropramine (Diabenase)
Which three drugs are 2nd gen sulfonylureas and do not bind carrier proteins and thus are less likely to cause hypoglycemia?
1-Glipizide (Glucotrol)
2-Glyburide (Glynase)
3-Glimepiride (Amaryl)
Which drugs are sometimes called metglitinides (repaglinide/prandin), also function at K+ channels and may cause hypoglycemia and weight gain?
Glitinides
Which diabetes drug in insulin-sparing and does not provoke hypoglycemia, decreases glucose production in the liver but has an illusive mechanism?
Biguanides (Metformin)
*GI upset, B12 deficiency, don’t use in alcoholics
Which diabetes drug reduces insulins resistance (especially in muscle and fat) by targeting PPAR-y, increases GLUT-4 expression but causes bone loss and weight gain?
Thiazolidinediones
*controversy regarding cardiac issue.
What two drugs are Thiazolidinediones?
1-Rosiglitazone (Avandia)
2-Pioglitazone (Actosel)
Which drug is a DPP-4 inhibitor and slows the inactivation of incretin hormones?
Sitagliptin (Januvia)
*Increases insulin, decreases hepatic glucose
Which type of drugs slow the digest/absorption of starch in the small intestines and must be taken with the first bite of meal?
a-Glucosidase inhibitors
*side effect of flatulence
Acarbose (prandase) is what kind of drug?
a-Glucosidase inhibitor
*reduces starch absorption
What two types of drugs are used as appetite suppressants?
1-Amphetamines (Ephedrine/PPA)
2-SSRI (Prozac)
Which weight loss drug works by inhibiting NE and DA uptake but may cause dry mouth and hypertension?
Phentermine
*May interact with MAOIs, SSRIs, CNS stimulants and antihypertensives
Which combination weight loss drug is contraindicated in pregnancy and may increase the risk of low blood sugar in patients with type II diabetes?
Phentermine + Topiramate (Qsymia)
Which weight loss drug is a 5-HT2c receptor agonist and activates receptors in the hypothalamus to suppress appetite?
Belviq (Lorcaserin)
*pro-opiomelanocortin is produced in the hypothalamus to suppress appetite
Which weight loss drug is a lipase inhibitor and thus diminishes fat absorption in the intestines but can cause diarrhea?
Orlistat (Alli)
Graves disease is a _______ condition
Hyperthyroidism
What are 4 drugs used to treat hyperthyroidism?
1-Thioamides (inhibit thyroid peroxidase rxns)
2-Iodides
3-beta blockers (inhibit T4-T3 conversion)
4-Radioactive iodine
Methimazole and propylthiouracil are two agents used to treat hyperthyroidism and are what kind of drugs?
Thioamides
What two drugs are used to treat hypothyroidism?
1-Levothyroxine (T4)
2-Liothyronine (T3)
What drug is a DPP-4 inhibitor to slow inactivation of uncertain hormones?
Sitagliptin (Januvia)
*results in insulin release and reduces glucagon activity
