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pharm ii > Endo Pharm (2) Diabetes > Flashcards

Endo Pharm (2) Diabetes Flashcards

1
Q

define Diabetes Mellitus

A

Chronic hyperglycemia caused by relative or absolute deficiency of insulin

OR… caused by a deficiency of insulin action = “insulin resistance”

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2
Q

Type of diabetes that is an autoimmune disorder.

A

DM1
Rapid Beta Islet cell destruction

Trigger may be virus or toxin
Mumps, coxsackie B4 virus

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3
Q

Type of diabetes that has a genetric predisposition and obesity

A

DM II

Gradual loss of beta islet cells (couple decades)

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4
Q

Age for DM I onset

A

< 25

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5
Q

Age for D II onset

A

> 25

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6
Q

Complications of DM

A

Death from Ketoacidosis
CVD
and Opathies

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7
Q

what are the 3 opathies of DM

A

Neuropathy
Nephropathy
Retinopathy

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8
Q

Cells in the pancreas that produce insulin

A

Islets of Langerhans

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9
Q

What do the Islets of Langerhans produce?

A 
INSULIN
GLUCAGONE
Somatostain
Islet Amyloid
Polypeptide
Pancreatic Polypeptide
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10
Q

Insulin Actions

A 
Inhibits Catabolic (breakdown) actions
Inhibits glycogen breakdown
Inhibits aminoacids &amp; fatty acid breakdown into ketones

Anabolic Actions
Promotes glycogen production & storage
Promotes triglyceride synthesis

Effects on Muscle:
Promotes protein synthesis
Facilitates Glucose transport & Glycogen storage

Effects on Adipose Tissue:
Increased Triglyceride storage
Most efficient energy storage form

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11
Q

Glucagon

A

EFFECTS ARE OPPOSITE OF INSULIN

Therefore, reducing glucagon secretion can be a diabetes treatment goal.

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12
Q

Ketoacidosis

A

A serious diabetes complication where the body produces excess blood acids (ketones).

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13
Q

Treatment goals of DM

A

Avoid Ketoacidosis, avoid hyperglycemia > 300

Reduce Long Term Complications

Reduce Hypoglycemic episodes

Prevent diabetes

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14
Q

DM treatment strategies

A

Provide exogenous insulin
Make the most of endogenous insulin: reduce resistance (diet and meds)
Stimulate secretion of endogenous insulin
Reduce Glucagon secretion
Reduce glucose absorption from the GI tract
Increase urinary excretion of glucose

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15
Q

Hypoglycemia

A

Adverse effect of insulin

symptoms:
reduced cognition
Sympathetic system response
tremors, anxiety, tachycardia, mydriasis

In severe cases: Coma, seizure, brain damage, death

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16
Q

Amylin Analog

A

used with as an adjust with insulin to increase satiety.

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17
Q

How do you increase insulin (med)

A

sulfonyluria

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18
Q

Avoid use of sulfonylurias in this

A

hepatic and renal disease

19
Q

drug interaction of 1st gen sulfonylurias

A

sulfa, warfarin increase effect

20
Q

avoid use of 2nd generation sulfonylureas in?

A

Elderly and those with CVD
Glipizide
Glyburide
Glimepiride

21
Q

Caution for all sulfonylureas

A

CONTRAINDICATED IN PATIENTS WITH HEPATIC IMPAIRMENT OR RENAL INSUFFICIENCY

22
Q

meglitinies

A

increase insulin secretions (sulfonyureas also stimulate insulin)

some overlap with Sulfonylurea receptor

23
Q

reduce insulin resistance how?

A

Weight loss
Biguanides: Metformin (glucophage)

Thiazolidinediones (Glitazones)
Rosiglitazone
Pioglitazone

24
Q

Biguanide

A

Metformin (Glucophage)

25
Q

Biguanide mode of action

A

reduce gluoconeogenesis (breakdown of glycogen)

reduced insulin resistance

26
Q

Biguanides side effects

A

May facilitate weight loss

GI SIDE EFFECTS PREDOMINATE
Nausea diarrhea bloating

27
Q

Biguanides contraindications

A

Liver Disease
Chronic Heart Disease
Chronic Renal Disease

28
Q

What vitamin can Biguanide effect?

A

B12

29
Q

Biguanide caution

A

LACTIC ACIDOSIS POSSIBLE ESPECIALLY IN COPD, CHRONIC RENAL OR HEPATIC DISEASE

30
Q

Thiazolidinediones: “Glitazones”

A

Enhanced tissue sensitivity to insulin

Mode of action includes gene regulation
slow onset of action

Improves Lipid Profiles

Monotherapy or in combination with: Sulfonylureas and Metformin

31
Q

Glitazone warnings

A

ROSIGLITAZONE WITH 1.43 TIMES GEATER RESK FOR MYOCARDIAL INFARCTION THAN PLACEBO OR METFORMIN but…

recent study of pioglitazone shows no MI risk but perhaps increase risk of CHF

Fracture rate increased in women on rosiglitazone

32
Q

Incretins

A

Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins are released after eating and augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood glucose-dependent mechanism.

33
Q

Incretin Mimetics

A

Glucagon-Like Peptide-1
secreted like the “L cells” of the intestine
decreases glucagon secretion

Increases insulin secretion
responsible for “incretin effect”

May increase pancreatic beta cell mass

34
Q

GLP=1

A

reduces glucagon secretion

35
Q

enzyme that metabolizes GLP-1

A

DPP-4

36
Q

Use GLP-1 analog as adjunct to:

A

MAY FACILITATE WEIGHT LOSS

37
Q

GLP-1 legal issues

A

Lawsuit underway claiming increased risk of:
Pancreatitis
Pancreatic Cancer

38
Q

FDA Warning: DPP-IV inhibitors

A

SEVERE and DISABLING JOINT PAIN

39
Q

Alpha-Glucosidase Inhibitors

A

Reduce Starch ad Disaccharide Absorption
by competitive inhibition
Take before meals

40
Q

Side effects of Alpha-Glucosidase Inhibitors

A

GI Symptoms:

Flatulence
diarrhea
bloating/abd pain

41
Q

Gliflozins

A

enhance glucose secretion in urine

42
Q

Gliflozin side effects

A

UTI’s

vaginitis

43
Q

FDA warnings gliflozin

A

INCREASED RISK OF KETACIDOSIS
INCREASED RISK OF LIMB AMPUTATIONS

but…

they significantly reduce CV disease risks

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