Drugs For Diabetes

Question 1

What are the 4 hormones increasing blood sugar?

Answer 1

Epi, glucagon, thyroid, and glucocorticoids

Question 2

What are the 4 categories of insulins?

Answer 2

Short acting, rapid acting, intermediate, and long acting

Question 3

What is the 1 short acting and the 3 rapid acting insulin’s?

Answer 3

Short acting: regular insulin

Rapid acting: Aspart, Lispro, and Glulisine

Question 4

What is the 1 intermediate insulin and what is the only way to administer it?

Answer 4

NPH

Only subcutaneously

Question 5

What are the two long acting insulin’s and what is the only way they should be administered?

Answer 5

Detemir and glargine

Subcutaneously

Question 6

What are two delivery systems that he talked about being in the near future?

Answer 6

Basically an artificial pancreas

Beta cell transplantation

Question 7

What is amylin and what are its 4 functions?

Answer 7

It is a hormone released with insulin from the beta cells.
1. Decreases gastric emptying
2. Increase satiety
3. Inhibits glucagon
4 increases insulin sensitivity

Question 8

Explain biochemically what is going on in a beta cell to release insulin?

Answer 8

GLUT 2 transporter brings in glucose and it is metabolize to ATP. The ATP shuts the potassium channels to depolarize the cell. Then the G protein receptor GS gives us AC to cAMP to PKA, and PKA opens calcium voltage gates channels to initiate exocytosis of insulin from the beta cell.

Question 9

What 2 things stimulate the GS G protein receptor?

Answer 9

Beta 2 agonists and incretins like GLP1.

Question 10

What stimulates the GI G protein receptor?

Answer 10

Somatostatin and Alpha 2 agonists

Question 11

5 functions of GLP1?

Answer 11

Promotes B cell proliferation
Promotes insulin gene expression
Promotes glucose dependent insulin secretion 
Inhibits glucagon
Decreases gastric emptying

Question 12

What cells synthesis GLP1 and what is a pharmacodynamic feature that is important of GLP1?

Answer 12

Super short half life so not a very effective drug.

Question 13

What are the two drug families that mimic incretins?

Answer 13

Long acting GLP1

DPP4 inhibitors

Question 14

What is the role of DPP4?

Answer 14

DPP4 enzymes inactivate GLP1, so by blocking them, you are allowing tons of GLP1 to do its job of helping lower blood glucose

Question 15

What is the MOA for sulfonylureas?

Answer 15

They bind to the SUR and block the Kir6.2 potassium channel, and leads to depolarization of the cell.

Question 16

What is the MOA of Biguanides (metformin)?

Answer 16

Activates AMP dependent protein kinase which down regulates gluconeogensis.

Question 17

What is the mechanism of action for thiazolidinediones?

Answer 17

They are ligand for PPAR gamma receptors

Question 18

What 4 tissues is the PPAR gamma nuclear receptors expressed primarily?

Answer 18

Muscle, fat, liver and endothelium

Question 19

What is the overall effect of these thiazols?

Answer 19

They increase insulin sensitivity in these tissues by increasing GLUT 4 receptor

Question 20

What is the MOA of the SGLT2 inhibitors?

Answer 20

Block reabsorption of glucose so you piss it out.

Question 21

What is the mechanism of action for alpha glucosidase inhibitors?

Answer 21

Inhibit alpha glucosidase from breaking down carbs to monosaccharides which will prevent the digestion of carbs.

Question 22

What is an important effect of the alpha glucosidase inhibitors?

Answer 22

Lower postrandial hyperglycemia which creates an insulin sparing effect

Question 23

What 3 things do you give for severe hyperkalemia because of diabetes?

Answer 23

Insulin, glucose, and furosemide

Question 24

What is the effect of insulin and furosemide on hyperkalemia?

Answer 24

Insulin stimulates potassium to go into cells and the loop diuretic eliminates the potassium from the body