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Endocrine DM Flashcards

1
Q

MOA -Flozin

A

SGLT2 Inhibition

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2
Q

Define Impaired fasting glucose

A

> or equal to 6.1 but< 7.0 mmol/l
offered an oral glucose tolerance test

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3
Q

Define impaired glucose tolerance (IGT)

A

fasting plasma glucose > 7.0 mmol/l
OGTT 2-hour : > or = to 7.8 mmol/l but < 11.1 mmol/l

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4
Q

Rx DM1 and a BMI > 25

A

Metformin

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5
Q

In pregnancy what is fasting glucose & 2-hour glucose cut off?

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

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6
Q

Increase levels of incretins such as GLP-1 and GIP

A

DPP-4 inhibitors
-Gliptan

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7
Q

bind to an ATP-dependent K+ channel on the cell membrane of pancreatic beta cells; blking channel = stimulation of insulin release

A

Sulfonylurea

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8
Q

average plasma glucose using HbA1c

A

average plasma glucose = (2 * HbA1c) - 4.5

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9
Q

HNF-1 alpha is ass w/

A

MODY

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10
Q

drug & class= increasing urinary glucose excretion

A

Gliflozins - SGLT2 inhibitors

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11
Q

To be given w/ risk of CVD or chronic heart failure

A

In patients with T2DM, SGLT-2 should be introduced at any point

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12
Q

Insulin in DKA

A

started at a rate of 0.1 units/kg/hour.
If falls below 15mmol/L but the pt is still acidotic w/ ketones then an infusion of 5% dextrose & and cont 0.9% sodium chloride, and insulin.

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13
Q

Fluids in DKA

A

1L 0.9% sodium chloride over an hour, followed but 2x 1L 0.9% sodium chloride over 2 hours etc

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14
Q

Insulin in hyperglycaemic hyperosmolar state (HHS)

A

0.05 units/kg/hour

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15
Q

AntiDms that Stimulate the secretion of insulin from pancreatic
β cells (Insulinotropic agents )
-Glucose-dependent 2
-Glucose-independent (2)

A
  1. Glucose-dependent (GLP-1 agonists, DPP-4 inhibitors): Insulin secretion is stimulated by elevated bl glucose levels (postprandially).
  2. Glucose-independent (sulfonylurea, meglitinides): Insulin is secreted regardless of the blood glucose level, → risk of hypoglycemia

Depend on residual β-cell function

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16
Q

Sulfonylureas MOA

A

-ide
Trigger the closure/ blockage of ATP-sensitive K+ channels,= stim insulin exocytosis
Increase insulin secretion from pancreatic β cells

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17
Q

SE Sulfonylureas (4)

A
  1. Risk of hypoglycemia (2nd gen)
  2. Weight gain
  3. Disulfiram-like reaction
    (first generation)
  4. Hematological changes: agranulocytosis, hemolysis
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18
Q

Contraindications of Sulfonylureas (4)

A
  1. Severe cardiovascular comorbidity
  2. Obesity
  3. Severe renal or liver failure
  4. Sulfonamide allergy (particularly long-acting substances)
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19
Q

MOA Meglitinides

A

Increase insulin secretion from pancreatic β cells

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20
Q

SE Meglitinides
Nateglinide
Repaglinide

A

Risk of hypoglycemia
Weight gain

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21
Q

MOA DPP4 - gliptin

A

-gliptin
Inhibit GLP-1 degradation → ↑ glucose-dependent insulin secretion
↓ glucagon secretion,
slow gastric emptying (↑ feeling of satiety, ↓ weight)

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22
Q

SE DPP4 - gliptin(6)

A
  1. GI symptoms
  2. Pancreatitis
  3. Nasopharyngitis URTI
  4. Headache, dizziness
  5. Arthralgia
  6. Edema
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23
Q

MOA: Glucagon-like peptide-1
(GLP-1) agonists (incretin mimetic drugs) - tide- ( gulptide)

A

tide-
Stimulate the GLP-1receptor directly

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24
Q

SE: GLP-1 agonists
tide-(gulptide)

A
  1. ↑ Risk of pancreatitis and possibly 2. pancreatic cancer
  2. Nausea
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25
Contraindications GLP-1 agonists **tide**-(*gulptide*)
Preexisting, symptomatic gastrointestinal motility disorders
26
MOA Biguanides
acts by activation of the AMP-activated protein kinase (AMPK) Enhances the effect of insulin 1. Increase glucose up take 2. Increase glucose sensitivity 3. decrease glycogenesis
27
SE Biguanides (4)
1. Lactic acidosis 2. Weight loss 3. GI (diarrhea, abdominal cramps) 4. ↓ Vitamin B12 absorption
28
Contraindications Biguanides
1. CKD 2. paused before administration of iodinated contrast medium and major surgery.
29
MOA: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors -gliflozin
-gliflozin Increase glucose excretion with urine through the inhibition of SGLT-2 in the kidney
30
SE: SGLT-2 inhibitors *-gliflozin*
*-gliflozin* 1. Genital yeast infections and UTIs Glucosuria 2. Polyuria & dehydration 4.DKA 2. Weight loss 3. ?breast cancer, bladder cancer
31
Contraindications: SGLT-2 inhibitors *-gliflozin*
*-gliflozin* Recurrent urinary tract infections CKD
32
Interactions with GLP-1 agonists **tide**-(*gulptide*)
Warfarin: ↑ INR
33
MOA Thiazolidinediones -glitazones
-glitazones -Reduce insulin resistance through the stimulation of peroxisome proliferator-activated receptors (PPARs) - Increase transcription of adipokines
34
SE: Thiazolidinediones -glitazones
1.Edema 2. Cardiac failure 3. Weight gain 4.↑ Risk of bone fractures (osteoporosis) 5.↑ LDL
35
MOA: Alpha-glucosidase inhibitors - Acarbose
Inhibit alpha-glucosidase (a brush border enzyme expressed by intestinal epithelial cells) → delayed - & ↓ intestinal glucose absorption - & ↓ carbohydrate breakdown, - resulting in ↓ hyperglycemia after food ingestion
36
SE: Acarbose
1. GI sx (flatulence, bloating, abdominal discomfort, diarrhea)
37
Contraindications to Acarbose
1. Severe renal failure 2. IBD 3. Conditions associated with malabsorption
38
Fx insulin
Stim uptake of glucose in Liver, Mscl & fat = decrease glucose in the blood
39
What is sugar stored as in the liver and how is it stored in cells
Liver Glycogen Cells - ATP
40
What the Fx GLP
Stim b- cells to release insulin
41
What happens when there is not enough sugar in the blood
Glucagon is released by alpha cells which breaks down stored glycogen
42
Most common form of Mody & genetics
MODY 3 60% of cases due to a defect in the HNF-1 alpha gene is associated with an increased risk of HCC
43
RX MODY
very sensitive to sulfonylureas, insulin is not usually necessary
44
2 drugs that increase insulin sensitivity & reduce production of glucose
Biguanies Thiazolidinediones
45
MOA metfotmin
46
How does metformin increase insulin sensitivity
Ampk inhibits genes that promotes gluconeogenesis Causes gult 4 to inbed in plasma membrane of skeletal & fat tissue =allow glucose to enter
47
How does meformin (3)
1. Via ampk inhibits glconeogenesis 2. Via AMPK increases insulin sensitivity of tissues by causing the Gult4 in mscl & fat to imbed Into plasma membranes =increase uptake of glucose 3. decrease intestinal abs of glucose
48
MOA thiazolidinediones “glitazones” ?
Via ppar gamma receptor that regulates tanscription = increase of insulin sensitivity in mscl , fats, liver 2. Increase syn. Of protein in lipid metabolism = decrease in triglycerides increase HDL & **LDL**
49
SE glitazones
50
Describe release of insulin
Sugar in blood cause glut2 receptors on cell to open & glucose to made into ATP ATP closes k+ channels = build of of K which = open is ca2+ channel Ca2+ = exocytosis of insulin
51
Effect of sulfonylureas on K channels
Closes k= build up of k=ca2+ channels open = release of insulin
52
SE sulfonylureas
53
Which is the drug that acts like sulphurias
54
Fx and example of incretins
Hormones like glp1 cause reduced bl glucose after a meal by stim insulin release
55
Fx of glp 1 agonists
56
What is the fx of dpp4?
Breakdown of glp1
57
Se dpp4 inhibitor (4)
58
Explain the transportation of lipids (lipoprotein)
**Chylomicrons** - travel from gut to liver **VLDL**- carrying triglycerides & cholesterol to body from liver **LDL**carry cholesterol to the body from liver **HDL** is secreted from the liver to pick up excess cholesterol and bring them back to the liver
59
How do stains work?
Inhibit cholesterol synthesis via HMG-CoA reductase No cholesterol will cause increased hepatocyte receptors for LDL, vLDL
60
MOA Fibrates
61
SE fibrates

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