Endocrine II Flashcards
Exam 3
What do the Islets of Langerhans produce?
insulin, glucagon
Action of insulins (2)
inhibits catabolic actions, anabolic actions
The effects of this are predominantly opposite to insulin
glucagon
tx goals of diabetes
avoid ketoacidosis, reduce long term complications, reduce hypoglycemic events, prevent diabetes
Types of absorption delayed insulin
neutral protamine hagedorn, ultralente, insulin glargine
types of insulin
speed of onset, duration of onset
Speedy insulins
lispro, aspart
Insulin pumps provide these features (2)
steady injection rate, can program for boluses
Hypoglycemia involves what adverse effects?
reduced cognition, impaired sympathetic response, coma, seizure, brain damage, death
This analog is used to increase satiety and reduce post meal glucagon secretion
amylin analog
What vaccine is in trial to prevent type 1 diabetes?
glutamic acid decarboxylase 65 vaccine
Immunomodulation in type 1 diabetes is achieved via this vaccine
BCG
Hallmarks of type 2 diabetics
insulin resistance, gradual loss of islet beta cells
T/F: ketoacidosis is common in type 2 diabetes
false, but can happen in later stages
These drug classes increase insulin secretion
1st and 2nd generations sulfonylurias, meglitinides
What type of pt do you avoid sulfonylurias in?
hepatic and renal failure pt
1st generation sulfonylurias adverse effects?
drug interactions- sulfa and warafin; hematologic tox; prolonged hypoglycemia; tachyphylaxis
What pt do you avoid 2nd generation sulfonylurias?
CVD and elderly
3 preps of 2nd generation sulfonylureas
glipizide, glyburide, glimepiride
These drugs have a fast onset, short duration and hepatic excretion
meglitinides
Ending of the meglitinides?
-glinide
What drugs are used to reduce insulin resistance?
biguanides, thiazolidinediones
Drug of choice for most type 2 diabetes?
metformin
What are the adverse effects of biguanides?
GI side effects
Biguanide caution about lactic acidosis in these pt
COPD, chronic renal or hepatic disease
How do thiazolidinediones work?
enhance tissue sensitivity to insulin
Which glitazone increases the risk of an MI?
rosiglitazone
How do GLP-1s work?
decrease glucagon secretion, responsible for incretin, increase pancreatic beta cell mass
DPP4 inhibitors do what?
prevents GLP-1 and incretin from being broke down and will stimulate insulin release inhibiting glucagon release
2 GLP-1 Names
Liraglutide (Victoza), Linagliptin (Trajenta)
T/F GLP-1 facilitates weight loss
T
2 names of DPP4 inhibitors
Sitagliptin (Januvia), Saxagliptin (onglyza)
GLP-1 legal issues
pancreatitis and pancreas cancer
T/F DPP-4 are oral pills?
True
FDA warnings of DPP-4?
severe and disabling joint pain
Do DPP-4s have a low risk of hypoglycemia?
yes
T/F alpha-glucosidase inhibitors change microbiome of GI Tract and more CO2 is made.
true
MOA of SLGT- inhibitors
enhance glucose excretion in the urine by blocking na/glucose co-transporter
Empagliflozin (Jardiance), Dapaglifloxin (Farxiaga), Canaglifloxin (invokana) are what type of drugs?
SGLT-2
Adverse effects of gliflozines
increased risk of ketoacidosis, limb amputations, UTI, crotch gangrene
benefits of adding SGLT-2 drugs?
MI and CHF protection
common protocol for type 2 diabetes meds?
lifestyle mods + metformin
