Drugs For DM

Question 1

What is the diagnostic criteria for DM?

Answer 1

Increased plasma glucose levels (fasting levels >125)

Question 2

What are the effects of the insulin receptor-PI3K-Akt pathway?

Answer 2

Effects on glucose, lipid and protein metabolism via regulation of enzyme activities or gene expression —> synthesis of lipids, proteins and glycogen + cell survival and proliferation + GLUT4 translocation to membrane surface

Question 3

What are the effects of the insulin receptor-MAP kinase pathway?

Answer 3

Regulation of gene transcription and cell proliferation —> cell growth and gene expression

Question 4

What are the anabolic effects of insulin on carb metabolism?

Answer 4

Promotes intracellular glucose transport and utilization; GLUT4 translocation to cell membrane in skeletal M, cardiac myocytes and adipocytes; activation of glycolysis and glycogen synthesis

Question 5

Which cellular processes does insulin inhibit?

Answer 5

Inhibition of gluconeogenesis and glycogenolysis

Question 6

How can insulin treat severe hyperkalemia?

Answer 6

Insulin + glucose (to prevent hypoglycemic shock) + furosemide (eliminates K from the body in the meantime); insulin rapidly activates Na/K/ATPase to shift K from ECF into cells; this effect is transient (several hours)

Question 7

What is the standard delivery of insulin?

Answer 7

Subcutaneous injection using disposable needles and syringes

Question 8

What are examples of insulin delivery systems?

Answer 8

Standard delivery, portable pen injectors and insulin pumps (continuous SC infusion devices)

Question 9

What is an artificial or bionic pancreas?

Answer 9

Allows for continuous glucose sensing; consists of controlling device (microchip) and insulin pump

Question 10

What is the effect of Gs coupled GPCRs on insulin secretion?

Answer 10

Increase secretion by activating AC which —> cAMP—> PKA —> ca influx —> insulin exocytosis

Question 11

What is the effect of Gi coupled GPCRs on insulin secretion?

Answer 11

Decreases secretion via AC inhibition

Question 12

What are the endogenous factors that regulate insulin secretion?

Answer 12

Glucose and other energy substances; GPCR-Gs ligands (beta2-AR agonists and GLP1 receptor agonists); GPCR-Gi ligands (somatostatin and a2 AR agonists)

Question 13

What are incretins?

Answer 13

A group of GI hormones that cause a decrease in blood glucose levels

Question 14

Which drugs enhance the hypoglycemic effect of sulfonylureas by displacing them from binding with plasma proteins?*

Answer 14

Sulfonamides, clofibrate, salicylates and other NSAIDs

Question 15

Which drugs enhance the hypoglycemic effect of sulfonylureas by inhibiting CYP enzymes?*

Answer 15

Azole antifungals, gemfibrozil, cimetidine, etc

Question 16

What is another example of a drug that enhances the hypoglycemic effect of sulfonylureas?

Answer 16

ethanol

Question 17

Which drugs decrease the glucose lowering effect of sulfonylureas by inhibiting insulin secretion?*

Answer 17

Beta blockers and CCBs

Question 18

Which drugs decrease the glucose lowering effect of sulfonylureas by inducing hepatic CYP enzymes?*

Answer 18

Phenytoin, griseofulvin, rifampin, etc