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Pharmacology 2 > Drugs Acting on Glucose Metabolism > Flashcards

Drugs Acting on Glucose Metabolism Flashcards

0
Q

Alpha cells produce what?

A

Glucagon

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1
Q

Beta cells produce what?

A

Insulin

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2
Q

Delta cells produce what?

A

Somatostatin

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3
Q

F cells produce what?

A

Pancreatic polypeptide

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4
Q

Is insulin amino acid sequence preserved across species?

A

Yes

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5
Q

Insulation secretion has what effect on blood glucose?

A

Rise in blood glucose concentration.

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6
Q

What 5 GI hormones can stimulate insulin secretion?

A
  • Gastrin
  • CCK
  • Secretin
  • Gastric Inhibitory Polypeptide
  • Glucagon
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7
Q

Amino acids and fatty acids in the GIT can stimulation the secretion of what?

A

Insulin

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8
Q

Vagal stimulation affects what receptors?

A

M receptors

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9
Q

Catecholamines act on what receptors?

A

Beta 2 receptors

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10
Q

What are 3 things that inhibit insulin secretion?

A
  • Decrease in blood glucose concentration
  • Somatostatin
  • Catecholamines (a2 or I3 receptors)
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11
Q

What are 3 effects insulin has on storage and building?

A
  • Stimulates glycogenesis
  • Stimulates lipogenesis
  • Stimulates protein synthesis
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12
Q

What are 3 things insulin can inhibit?

A
  • Glycogenolysis
  • Gluconeogenesis
  • Lipolysis
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13
Q

Insulin can stimulate the uptake of what into cells?

A

Potassium

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14
Q

What type of effect does insulin have in a fetus?

A

Anabolic

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15
Q

What 3 parts of the body are involved in the metabolism of insulin?

A
  • Liver
  • Kidneys
  • Muscle
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16
Q

Too much insulin leads to what?

A

Hypoglycemia

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17
Q

Too little insulin can lead to what?

A

Hyperglycemia

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18
Q

What are 5 differential for hypoglycemia?

A
  • Artifact
  • Unable to make glucose
  • Excessive consumption
  • Exogenous hypoglycemic agents
  • Endogenous hypoglycemic agents
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19
Q

What are 5 reasons the body may be unable to make glucose?

A
  • Liver failure/cirrhosis
  • Portosystemic shunt
  • Severe malnutrition (neonates/toy breeds)
  • Hypoadrenocorticism (pituitary/GH deficiency)
  • Glycogen storage diseases
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20
Q

What are 2 examples of causes for excessive consumption of glucose that can cause hypoglycemia?

A
  • Sepsis

- Extreme exertion

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21
Q

What are 2 examples of exogenous hypoglycemic agents?

A
  • Insulin overdose

- Overdose of other hypoglycemic agents

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22
Q

What are 4 examples of endogenous hypoglycemic agents?

A
  • Xylitol toxicity (dogs)
  • Insulin-secreting islet cell neoplasia (insulinoma)
  • Extrapancreatic neoplasias
  • Islet cell hyperplasia
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23
Q

What are 2 therapeutic considerations if not involving insulin?

A
  • Give dextrose (if severe)

- Treat the underlying disease

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24
Q

What are 2 examples of therapeutic considerations if involving insulin?

A
  • Iatrogenic

- Endogenous

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25
Q

What are 3 types of pharmacologic treatment of hypoglycemia?

A
  • Replacement
  • Diet
  • Anti-hypoglycemic agents
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26
Q

What are 2 examples of replacement pharmacologic treatment of hypoglycemia?

A
  • Dextrose

- Glucagon

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27
Q

What are 4 examples of anti-hypoglycemic agents?

A
  • Glucocorticoids
  • Diazoxide
  • Somatostatin
  • Streptozotocin
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28
Q

Is glucagon commonly used?

A

No

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29
Q

If administering glucagon, what is the initial dose and what dose follows?
How is the dose adjusted?

A
  • Initial dose of 50ng/kg followed by 10-15ng/kg/min

- Adjust based on blood glucose measurement.

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30
Q

What is the dose if using dextrose to treat acute hypoglycemia?
Maintenance of hypoglycemia?

A
  • 1mL/kg of 50% dextrose diluted (1:4)

- 2.5-5% dextrose IV adjusted based on blood glucose levels.

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31
Q

What are 2 consideration with the use of dextrose for the treatment of hypoglycemia?

A
  • Hyperosmolality/irritation

- Rising glucose stimulate insulin secretion.

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32
Q

What can be given to treat acute hypoglycemia?

A

Karo syrup/corn syrup

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33
Q

What are 4 consideration when using dietary management of chronic hypoglycemia?

A
  • Frequent, small meals.
  • Complex carbs (simple carbs may stimulate insulin secretion).
  • Easily digestible.
  • Moderate fate and protein.
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34
Q

What is the goal of therapy with hypoglycemia?

A

To eliminate/minimize clinical signs associated with hypoglycemia.

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35
Q

Is the goal of hypoglycemia treatment to maintain a “normal” blood glucose?

A

Not necessarily.

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36
Q

What are 2 examples of glucocorticoids?

A
  • Prednisone

- Prednisolone

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37
Q

What do glucocorticoids increase?
Decrease?
Stimulate?

A
  • Increase gluconeogenesis
  • Decrease glucose uptake into tissue
  • Stimulate glucagon secretion
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38
Q

Do glucocorticoids have good bioavailability?

A

Yes

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39
Q

Where is prednisone metabolized to prednisolone?

Is this required?

A
  • Liver

- Yes

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40
Q

Glucocorticoids are usually started at what dose?

A

About 0.5mg/kg/day, increase as needed.

41
Q

What are 2 examples of side effects that can be seen with low doses of prednisone, prednisolone?

A
  • Pu/pd

- Panting

42
Q

What happen to the side effects seen with prednisone/prednisolone as the dose is increased?

A

Get progressively more severe.

43
Q

How is diazoxide administered?

A

Orally

44
Q

T/F: With diazoxide, you should start at the higher end of the dose and decrease from there.

A

False - Start at lower end of dose and increase.

45
Q

What can be used in place of glucocorticoids and diet if they are no longer working in the treatment of hypoglycemia?

A

Diazoxide

46
Q

What are 4 side effects that can be seen with diazoxide?

What are 4 less commonly seen side effects?

A
  • Hypersalivation, anorexia, vomiting, diarrhea

- Tachycardia, hematologic changes, diabetes, fluid retention

47
Q

What does Diazoxide activate?

A

K+ channels in islet cells.

48
Q

What channels does Diazoxide switch off?

What does this inhibit?

A
  • Voltage-gated Ca2+ channels.

- To inhibit the release of insulin.

49
Q

What does Diazoxide increase in the liver?

A

Glycogenolysis

50
Q

What effect does Diazoxide have on glucose?

A

Inhibits tissue uptake of glucose.

51
Q

Does Diazoxide alter synthesis of insulin?

A

No

52
Q

Does Diazoxide treat the neoplasia?

A

No

53
Q

What cells produce somatostatin?

A

Gamma cells of the Islets of Langerhans

54
Q

What are 6 things somatostatin inhibits the release of?

A
  • INsulin
  • Glucagon
  • Growth hormone
  • CCK
  • Secretin
  • Gastrin
  • VIP
55
Q

What is an example of a somatostatin analogue?

A

Octreotide

56
Q

Octreotide is sometimes used for what in dogs and ferrets?

A

Insulinomas

57
Q

Octreotide is sometimes used for what in dogs and cats?

A

Gastrinomas and Chylothorax

58
Q

Octreotide is sometimes used for what in dogs?

A

Acromegaly

59
Q

How is Streptozotocin administered?

A

IV infusion

60
Q

What is a chemotherapeutic drug that selectively destroys beta cells in the pancreas or metastatic sites?

A

Streptozotocin

61
Q

Does Streptozotocin have a narrow or wide therapeutic index?

A

Narrow

62
Q

Is Streptozotocin nephrotoxic?

A

Yes

63
Q

What should be given prior to administration of Streptozotoocin?

A

Saline diuresis

64
Q

What side effect can be seen in about 30% of patients administered Streptozotocin?

A

Vomiting

65
Q

How does the median survival of patients on Streptozotocin compare to other therapies?

A

Median survival may not be significantly improved over other therapies.

66
Q

Too much insulin can cause what?

A

Hypoglycemia

67
Q

Too little insulin can cause what?

A

Hyperglycemia

68
Q

What are 7 differentials to consider with hyperglycemia?

A
  • Physiologic hyperglycemia
  • Diabetes Mellitus
  • Hyperadrenocorticism
  • Pheochromocytoma
  • Pancreatitis/Exocrine pancreatic neoplasia
  • Some drugs/toxins
  • Head trauma
69
Q

What are 3 examples of causes physiologic hyperglycemia?

A
  • Stress
  • Postprandial
  • Diestrus
70
Q

What is an example of a drug that can cause hyperglycemia?

A

Amitraz

71
Q

What are the 2 types of diabetes mellitus?

A
  • Type I: Insulin-dependent (IDDM)

- Type II: Non-insulin dependent (NIDDM)

72
Q

What are 2 possible causes of diabetes mellitus?

A
  • Insulin resistance

- Insulin deficiency

73
Q

Absolute deficiency of insulin from destruction (autoimmune) of pancreatic beta cells causes what type of diabetes mellitus?

A

Type I: Insulin-dependent (IDDM)

74
Q

What type of diabetes mellitus is not generally seen in dogs?

A

Type II: Non-insulin dependent (NIDDM)

75
Q

Which type of diabetes mellitus can be seen in cats, horses and humans?

A

Type II: Non-insulin dependent (NIDDM)

76
Q

Relative insulin deficiency and insulin resistance can be seen with which type of diabetes mellitus?

A

Type II: Non-insulin dependent (NIDDM)

77
Q

What are 3 things insulin stimulates?

A
  • Glycogenesis
  • Lipogenesis
  • Protein synthesis
78
Q

What are 3 processes that insulin inhibits?

A
  • Glycogenolysis
  • Gluconeogenesis
  • Lipolysis
79
Q

Cellular “starvation” is caused by what?

A

Lack of insulin.

80
Q

What are 4 things that can be caused by lack of insulin?

A
  • Decreased tissue utilization of glucose
  • Stimulation of liver glycogenolysis
  • Proteolysis - AAs - Gluconeogenesis
  • Lipolysis - FFAs - Ketoacidossi, hepatic lipidosis
81
Q

What are the 4 cardinal signs of diabetes?

A
  • Muscle loss
  • Weight loss
  • Accumulation of glucose in the blood (PU/PD)
  • Lack of glucose entering “satiety center” of the brain leads to polyphagia
82
Q

What are 3 things that happen with accumulation of glucose in the blood?

A
  • Exceeds renal tubular resorption
  • About 100-220 mg/dL
  • Glucose in urine causes osmotic diuresis (PU/PD)
83
Q

What are 5 goals of hyperglycemia treatment?

A
  • Reduce hyperglycemia
  • Reverse catabolic effects
  • Reverse ketosis
  • Control clinical signs
  • Maintain patient in a mild hyperglycemic state (150-200 mg/dL) for the most of the day.
84
Q

What are 3 general forms of treatment for Diabetes Mellitus?

A
  • General management
  • Diet
  • Pharmacologic management
85
Q

What are 2 examples of general management practices when dealing with diabetes mellitus?

A
  • Weight management

- Exercise

86
Q

What kind of a diet should a dog with diabetes mellitus be put on?
A cat?

A
  • Dog: high fiber (Hill’s R/D or W/D, Purina DCO)

- Cat: low carb (Hill’s M/D, Purina DM)

87
Q

What are 3 examples of pharmacologic management for diabetes mellitus?

A
  • Acarbose
  • Oral hypoglycemic agents
  • Insulin
88
Q

Is Acarbose a hypoglycemic agent?

A

No

89
Q

What does Acarbose inhibit?

A

Alpha amylases and brush border oligo/disaccharides.

90
Q

How does Acarbose work?

A
  • Digest starch and cleaves off glucose.

- Inhibition delays absorption of glucose from the GI tract to decrease postprandial rise in glucose.

91
Q

What does Acarbose reduce?

A

Postprandial hyperglycemia after carbohydrate intake.

92
Q

Acarbose is sometimes used as an adjunct in what 2 species?

A
  • Dogs

- Cats

93
Q

What are 2 possible side effects of Acarbose?

A
  • Diarrhea

- Weight loss

94
Q

What are 3 categories of oral hypoglycemics?

A
  • Sulfonylureas
  • Biguanides
  • Thiazolidinediones
95
Q

Which oral hypoglycemic is a secretagogue?

A

Sulfonylureas

96
Q

Which oral hypoglycemics are sensitizers?

A
  • Biguanides

- Thiazolidinediones

97
Q

What are 6 examples of Sulfonylureas?

A
  • Glipizide
  • Glyburide
  • Glicazide
  • Glimepiride
  • Chlorpropamide
  • Toluamide
98
Q

Which oral hypoglycemic agent stimulates insulin secretion by blocking potassium channels in the beta cells, increased Ca2+ and increases release of insulin?

A

Glipizide

99
Q

What drug has the opposite effect of Glipizide?

A

Diazoxide

Pharmacology 2 (10 decks)

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