Endocrine Meds: diabetes Flashcards
Explain how insulin resistance can be detected
When the insulin resistance happens, the serum insulin level becomes elevated.
But cells can’t use insulin to absorb glucose, so blood sugar rises and rises.
***high plasma glucose will damage your microvascular circulation
Identify the duct that connects the liver, gallbladder, and pancreas
Common bile duct
Recall the exocrine function of the pancreas
Secretion of pancreatic juices (digestive enzymes & bicarbonate) into common bile duct
**Review
CCK –> acinar cells –> enzymes
secretin –> duct cells –> bicarbonate
List the digestive enzymes produced by the pancreas for digestion
Pancreatic lipase (tri –> mono & 2 FA)
Pancreatic amylase
Recall the endocrine function of the pancreas
Secrete hormones right into the BLOODSTREAM
** islets of Langerhans: alpha cells and beta cells
Recall the endocrine hormones produced by the pancreas
Glucagon
Insulin
Differentiate between type 1 and type 2 diabetes
Type 1 has NO INSULINE –> insulin replacement is necessary (no oral medications, only sub Q)
Type 2 has insulin resistance
Discuss the differences in the monitoring and management of type 1 versus type 2 diabetes
Type 1: always requires frequent blood sugar monitoring and insulin titration
Type 2: patients start off by taking oral meds + when panaceas tire out, they start insulin therapy
Treatment depends on the progression of disease
Name the biggest risk for diabetic patients who receives insulin therapy
Hypoglycemia
Brain & rest of the body loses the source of fuel!
List the signs and symptoms of hypoglycemia
CNS: headache, confusion, seizures, coma
Cardiovascular: palpitations (due to increased SNS activity)
GI: nausea
Others: sweating and tremor
What would happen if a patient is on beta blocker & receives too much insulin?
You will not see a fast heart rate. When plasma glucose is <50, the patient may show confusion and neuro changes
–> remind them to watch their blood sugar closely!!!
Determine how to treat mild-to-moderate hypoglycemia
Give carbohydrate-rich food if patient is able to swallow
Determine how to treat severe hypoglycemia
Administer IV glucose (hospital)
Give subQ glucagon (at home, facilitate glycogen breakdown in the liver, may take 20 min to kick in)
List 3 factors/drugs that exacerbate hypoglycemia
- Beta blockers (BB blocks SNS response, inhibits hepatic glu production)
- Sulfonylureas & meglitinides (anti-diabetic meds that insulin release from pancreas)
- alcohol (consumption stimulates insulin release)
What 3 factors/drugs will put a patient on the risk of elevated sugar
- Thiazide diuretics
- Glucocorticoids
- Sympathomimetics (epinephrine, norepinephrine, etc.)
Identify 2 major routes for anti-diabetic medications
- oral drugs
- non-insulin injectable drugs
**Overview: list the first 4 groups oral anti-diabetic medications
- Biguanides: metformin
- 2nd-gen sulfonylureas: glipizide, glyburide
- Meglitinides (Glinides): nateglinide, repaglinide
- Thiazolidinediones (Glitazones): pioglitazone, rosiglitazone
**Overview: list the next 3 groups of oral antidiabetic medications
- Alpha-Glucosidase inhibitors: acarbose, miglitol
- DPP-4 inhibitors (Gliptins): Linagliptin, saxagliptin
- Dopamine agonist: bromocriptine
Describe the mechanism of action of metformin (guanides)
Increase glucose uptake by muscles & decrease glucose production by liver
–> lower blood sugar!
prescribed as the first step of treatment
lifestyle modifications + metformin
Two common side effects of metformin
- GI distress
- rare metabolic acidosis
List 3 drugs that can cause lactic acidosis with metformin
- cimetidine (other H2 antagonists are fine!)
- alcohol
- iodine based radiocontrast dye (discontinue metformin 1-2 days before the test)
–> combined with metformin, it knocks down kidney and causes metabolic acidosis!
Identify 3 early signs of lactic acidosis
- unusual drowsiness
- hyperventilation (breathing faster to breath CO2 out)
- myalgia
Describe the mechanism of action of the 2nd gen sulfonylureas
Sulfonylureas increase insulin release from the pancreas
List 2 examples of the 2nd-generation sulfonylureas
glipizide
glyburide
Side effects of the 2nd gen sulfonylureas
hypoglycemia
***metformin does not decrease blood sugar a lot, so it does not risk hypoglycemia!
Describe the mechanism of action of meglitinides (glinides) and the difference with sulfonylureas
Stimulate pancreas to secrete more insulin & has a risk of hypoglycemia
Difference: short acting than sulfonylureas
List 2 examples of glinides
Nateglinides
Repagiinides
Specify the precautions to take while taking meglitinides
Patients need to eat within 30 min of taking glinides
The interaction between glinides & gemfibrozil will result in…?
Gemfibrozil (cholesterol medication) slows down the removal of other meds from body
–> when taken with glinides, it causes the increased risk of toxicity!
List 2 examples of thiazolidinediones (glitazones; TZD)
- pioglitazone
- rosiglitazone
Describe the MOA of TZD
Glitazones decreases insulin resistance (help body use insulin that’s there more effectively)
What is the most significant side effect of TZD
If a patient has congestive heart failure (CHF), TZD will cause more fluid retention
Head to toe, what are other side effects of TZD
Headache
Sinusitis
Upper respiratory infection
hepatotoxicity
Women: risk of fracture & ovulation in premenopausal women
Describe the MOA of alpha-glucosidase inhibitors (not used much in the US!)
Alpha-glucosidase is an enzyme that breaks down carbs into monosaccharides
–> AGIs work in the intestine to delay dietary carbohydrate absorption
List 2 examples of alpha-glucosidase inhibitors
Acarbose
Miglitol
Specify the side effects of alpha-glucosidase inhibitors
borborygmus (weird stomach noises)
List 2 examples of DPP-4 inhibitors
suffix: -gliptin
sitagliptin
sexagliptin
linagliptin
Specify the functions of glucagon, incretin, and DPP-4
glucagon: hormone that increases glucose production in the liver
incretin: hormones that stimulate the release of insulin
DPP-4: hormone that inactivates incretin
Describe MOA of gliptin
DPP-4 inhibitors block the breakdown of incretin and increase the insulin release from pancreas
What is a rare but serious side effect of DDP-4 inhibiotr
pancreatits
Describe the mechanism of action of dopamine agonists and name 1 example of a dopamine agonist
MOA: unknown! (may alter glycemic control in hypothalamus?)
bromocriptine
Identify 3 side effects of dopamine agonists
drowsiness
exacerbate psychosis
orthostatic hypotension
Describe the MOA of SGLT-2 inhibitors
SGLT-2 inhibitors block SGLT-2 in the renal tubules and increase glucose excretion in urine
Name 2 SGLT-2 inhibitors
canagliflozin (INVOKANA)
dapagliflozin (farxiga)
J
**Jardiance, too!
List 3 side effects of SGLT-2 inhibitors
Orthostatic hypotension
female mycotic infections (fungal infection)
UTI and polyuria
List 2 non-insulin injectable drugs along with their respective indications
- incretin mimetic: type 2 only
- Amylin mimetics: type 1 & 2
Name 2 examples of incretin mimetics
Exenatide
Exenatide extended release
Describe 4 MOA of incretin mimetics
incretin mimetics are also known as GLP-1 receptor
- slows gastric emptying
- stimulates insulin release
- inhibits glucagon
- suppresses appetite
Describe 3 mechanisms of action of amylin mimetics
Amylin is a peptide hormone that also has the same effects as incretin
Example of amylin mimetics
pramlintide
