Endo: Diabetes Medications Flashcards

1
Q

Beta cells produce insulin in response to beta-____ stimulation (among many other things).

A

2 (think of LangerHansel with the beta-2-tuba)

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2
Q

The most potent stimulator of insulin release is ________.

A

glucose (like LangerHansel’s candy that is super large)

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3
Q

Glucose increases _________ in beta cells.

A

ATP (from glycolysis)

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4
Q

Increased intracellular ATP leads to ________ of potassium channels.

A

closing

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5
Q

____________ open in response to closing of potassium channels.

A

Voltage-sensitive calcium channels (think of the calci-yum ice-cream flowers bending over the fence when Gretel grabs the candy)

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6
Q

Insulin binds to a __________.

A

tyrosine kinase (just like the tyrosine tire swing)

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7
Q

Insulin induces ___________ translocation.

A

GLUT4 (think of the four door)

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8
Q

Insulin does what in liver cells?

A

Increases glycogen storage (think of the liver-shaped jar being filled with glycogen candies)

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9
Q

In the muscles, insulin stimulates __________.

A

glycogen and protein synthesis (think of the glycogen glaze)

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10
Q

In adipocytes, insulin ___________.

A

stimulates the conversion of carbohydrates into fat

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11
Q

Remember that insulin administration causes a drop in __________.

A

potassium (just like the banana bitten off by the old hags)

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12
Q

List the rapid-acting, short-duration insulin analogs (great for postprandial needs).

A

Glulisine, aspart, and lispro (“Girls And Lads” sign on the tall tower –like the tall peak in insulin)

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13
Q

Why are the glulisine, aspart, and lispro agents fast-acting?

A

They don’t polymerize like insulin because of amino-acid modifications.

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14
Q

The two intermediate-acting insulin analogs are ___________. (These form dimers.)

A

regular insulin and NPH (neutral protamine hagedorn) insulin (Think of the “Rest Now” sign above the more gradual peak on the witch’s house.)

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15
Q

The only insulin drug that can be given IV is ________. Subcutaneous insulin is harder to control.

A

regular insulin (like the IVy under the “Rest” sign)

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16
Q

The two long-acting insulins are _______________.

A

detemir and glargine (“Don’t Go”)

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17
Q

Hypoglycemia presents with signs similar to ___________.

A

autonomic hyperactivity (tachycardia, palpitations, sweating, and nausea)

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18
Q

“Glucagon… for when your glucose __________.

A

is gone.”

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19
Q

How does sulfonylurea work?

A

It binds and closes the potassium channels in beta cells, stimulating the depolarization that causes release of insulin. (Think of the sulfonylurea swan in the beta cell pond.)

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20
Q

The first-generation sulfonylurea drugs end in the ______ suffix.

A

-amide (tolbutamide and chlorpropamide), just like how the sulfonylurea swan is in A MaID outfit

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21
Q

The second-generation sulfonylurea drugs are __________.

A

glyburide, glipizide, and glimepiride (think of the TWO little swans RIDing on the big swan’s back)

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22
Q

__________ has the shortest half-life of the second-generation sulfonylurea drugs.

A

Glipizide (glipi-zig-zagging around)

23
Q

What drug class works the same way as the sulfonylureas?

A

The meglitinides (like the goose GLIDing above the swan): rapaglinide and nateglinide

24
Q

The meglitinides do not contain __________ and are thus ideal for patients with allergies.

A

sulfa (because the father goose – GLIDing above –does not lay stinky sulfur eggs)

25
Q

The main side effect of sulfonylurea and meglitinide is ___________.

A

hypoglycemia particularly in the long-acting forms

26
Q

Why do meglitinides and sulfonylureas cause weight gain?

A

Because insulin –induced to release –causes growth

27
Q

Do not __________ while taking first-generation sulfonylureas.

A

drink alcohol (because it can lead to a disulfiram-like reaction)

28
Q

The GLP-1 analogs are ____________.

A

exenatide and liraglutide (the witch with her ExenaTide detergent)

29
Q

GLP is released from __________.

A

intestinal L cells

30
Q

What does GLP-1 do?

A

Induces satietyStimulates insulin releaseReducing glucagon releaseDelaying gastric emptying(The falling packets of glucagon; the stopped up stomach;

31
Q

DPP-4 is _____________.

A

dipeptidyl peptidase 4

32
Q

The DPP-4 inhibitors end in ___________.

A

-gliptin: sitagliptin, saxagliptin, and linagliptin

33
Q

What does glucagon do?

A

Stimulates gluconeogenesis and glycogenolysis (processes that increase blood sugar)

34
Q

What side effects can the DPP-4 inhibitors have?

A

Nasopharyngitis, URIs (the clip on the witch’s nose), and acute pancreatitis (witch squeezing the pancreas sponge)

35
Q

True or false: the DPP-4 inhibitors can cause hypoglycemia.

A

False. Their glucose-releasing effects stop when glucose normalizes.

36
Q

The first line treatment for type 2 diabetes is _____________.

A

metformin

37
Q

What is the mechanism of metformin?

A

It decreases hepatic gluconeogenesis by inhibiting the mitochondrial enzyme glycerophosphate dehydrogenase (think of the girl –whom the METaphOR-wielding boy is trying to woo –who is biting a mitochondria-shaped candy). Also, it activates AMPK, an enzyme that also works to inhibit gluconeogenesis. (Think of the AMPKandy bag.) Lastly, it increases peripheral insulin sensitivity (like the open Valentine’s mailbox on the bench by the metformin metaphor boy).

38
Q

What side effects can metformin cause?

A

Lactic acidosis from impaired gluconeogenesis (think of the spilled, spoiled milk). This needs to be thought of in patients with renal failure, because metformin is just excreted unmodified by the kidneys (think of the cracked, kidney-shaped tray that the lactic acid is on). Also, GI upset can be caused (like the green-faced girl about to barf at the metformin boy).

39
Q

What are the thiazolidinedione drugs?

A

Rosiglitazone and pioglitazone (think of the girl reading “ROSes are red” on the GLITter-covered card)

40
Q

What is the mechanism of thiazolidinediones?

A

They act on peroxisome proliferator-activated receptor gamma (PPAR-gamma), an intracellular nuclear receptor that increases glucose uptake and decreases glucose production (like the “life of the PPARy” shirt that the thiazolidinedione boy is wearing). One of the proteins expressed is adiponectin (like his turtleneck). Another protein is GLUT4 (like the GLUT4 mailbox).

41
Q

Explain the unique relationship between the thiazolidinediones and weight gain.

A

Thiazolidinediones lead to increased fatty-acid storage in adipocytes differentiation of adipocytes, leading to decreased triglyceride levels and weight gain. (Think of the boy eating doughnuts to represent fat storage.)

42
Q

True or false: thiazolidinediones take days to weeks to become effective.

A

True. Because it works by increasing gene expression, it takes time.

43
Q

Which non-insulin-raising diabetic meds increases weight gain?

A

The thiazolidinediones –”they put extra GLIT in your ZONE”

44
Q

What big side effect do you need to worry about with the thiazolidinediones (not related to weight gain)?

A

Peripheral edema due to increased fluid retention (like the thiazolidinedione boy’s baggy pants) – do not give to patients with CHF (like the baggy heart being crushed by the boy’s chair)

45
Q

The non-insulin-raising drug that acts on the peroxisome proliferator-activator receptor gamma can cause which side effect that is especially common in older women?

A

Osteoporosis (think of the boy’s chair, which has a femur-shaped leg that is breaking)

46
Q

What cells normally secrete amylin?

A

The pancreatic islet cells that also secrete insulin! Amylin is secreted with insulin and acts to decrease glucagon and delay gastric emptying (just like the full, stomach-shaped water cooler and torn glucagon packets next to the furious AMY and LyNn who were asked out by the same boy). The analogue is pramlintide.

47
Q

Pramlintide can be used to treat the _______________ in both types of diabetes.

A

postprandial glucose spike

48
Q

The two main side effects with pramlintide are _____________.

A

hypoglycemia (the falling candy jar that AMY is kicking) and nausea (Brayden getting sick at the embarassment)

49
Q

These two drugs work by inhibiting intestinal-brush-border alpha glucosidase: _________________.

A

acarbose (A-Carb candies) and miglitol (wIgGLer candies)

50
Q

The alpha glucosidase work to ____________.

A

delay glucose absorption (just like the frustrated boy is delayed in eating his Wiggler gummy worms)

51
Q

What are the main side effects of alpha glucosidase inhibitors?

A

Diarrhea and flatulence –both related to the massive load of undigested disaccharides that hits the colon

52
Q

What are the SGLT-2 inhibitors?

A

The -flozins: canagliflozin and dapagliflozin (just like the teacher FLOssing the salty/sweet kettle corn – sodium and glucose – out of his teeth)

53
Q

True or false: the SGLT-2 inhibitors work by decreasing glucose absorption in the small intestine.

A

False. They prevent glucose re-uptake in the proximal convoluted tubule.

54
Q

What are two (totally logical) side effects of SGLT-2 use?

A

Vaginal candidiasis, because of the increased glucose in the ureter (think of the CANadian boy throwing a snowball – white like candida – at the substitute’s crotch)And osmotic diuresis causing hypotension (the falling boy and the cracked kidney tray symbolizing contraindication in renal failure)