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Therapeutics P2 > Exam 2 Lecture 2 > Flashcards

Exam 2 Lecture 2 Flashcards

1
Q

Hypoglycemia

A

BG less than 60

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2
Q

Modification on insulin detemir

A

Fatty acid added to peptide to prolong action

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3
Q

signs of hypoglycemia

A

Weakness, sweating, hunger, tachycardia, increased irritability, tremor, blurred vision, seizures (neurologic symotoms)

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4
Q

Why are signs of hypoglycemia neurologic symptoms

A

low BG leads to increased sympathetic outout

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5
Q

Why does low BG cause increased sympathetic output

A

It is the brains way of bringing BG back up by mobilizing glucose from liver, which can cause these symptoms

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6
Q

Preferred fuel in nervous symptom

A

glucose

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7
Q

What are some drugs that can increase BG levels in diabetes

A

catecholamines
glucocorticoid
somatotropin (leads to insulin resistance)

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8
Q

How do catecholamine, glucocorticoids and somatotropin increase BG levels in diabetics

A

They have a pro-sympathetic effect on the liver and interfere with trying to keep BG levels down by stimulating release of glucose from liver

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9
Q

Agents with increased risk of hypoglycemia

A

ETHANOL
ACE inhibitor
B blocker
Fluoxetine

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10
Q

How does Ethanol increase the risk of hypoglycemia

A

Inhibits gluconeogenesis (which is one of the two ways that liver can export glucose into bloodstream and bring levels up.)

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11
Q

How do ACE inhibitors, B blockers and fluoxetine cause hypoglycemia

A

Inhibit enhanced sympathetic output from brain

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12
Q

What are adverse effects of insulin with regard to lipids

A

Lipodystrophy- changes in fat at over used inj site
Lipohypertrophy- accumulation of fat in SUbQ tissue

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13
Q

What was the mechanism for insulin glargine

A

It is soluble at acidic PH and insoluble at physiologic PH. Percipitates at site of inj

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14
Q

Which insulin preparation is not genetically modified?

A

NPH (only complexed with protamine) (has action peak)

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15
Q

2 Phases of normal insulin secretion

A

1st- high peak, quick onset
2nd- elevated for long time

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16
Q

Type 2 diabetes is a combination of

A

Insulin resistance and reduced insulin secretion

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17
Q

Why does the decline in glucose utilization in skeletal muscles in T2 diabetics have a big effect on oateint

A

Skeletal muscle accounts for a large percentage of the glucose uptake stimulated by insulin after a meal

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18
Q

How does insulin affect the liver

A

Inhibits glucose output from liver by inhibiting breakdown of glycogen and inhibiting gluconeogenesis

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19
Q

What happens to glucose export in non diabetic patients when insulin is secreted

A

Steep drop

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20
Q

T/F The ability of insulin to shut off exprt of glucose from liver is going to be compromised

A

True

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21
Q

What do pancreatic islet cells do? how does insulin affect this? how is this affected by diabetes

A

They secrete glucagon. Insulin inhibits glucagon secretion. This inhibition is blunted in diabetes T2

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22
Q

How does insulin affect lipolysis. How is this affected in diabetics

A

Insulin suppresses lipolysis. . This is blunted in diabetes

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23
Q

What are the drugs that have the ability to directly stimulate insulin secretion from pancreatic B cell.

A

Sulfonylurea- prolonged duration of action
meglitinides- rapid onset and short duration

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24
Q

Examples of sulfonylureas

A

Tolbutamide, Glipizide, Tolazemide

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25
Examples of meglitinides
Nateglinide, Repaglinide
26
What is the predominant glucose transporter in pancreatic B cells?
GLUT-2
27
What is sepcial about GLUT-2
It has a high KM
28
What does high Km for GLUT-2 entail?
We need a high blood glucose to start uptake into pancreatic B cell
29
What happens after GLUT-2 uptakes glucose into blood stream
Glucose is phosphorylated to G-6-P, producing ATP
30
What happens after ATP is produced from G-6-P
There is a big swing in ratio of ATP to ADP, ADP decreases and ATP increases
31
When does K-ATP channel close? How many subunits of K-ATP?
Closes when bound to ATP, 2 subunits
32
What happens when K-ATP channel is closed?
membrane potential starts to go up
33
What happens when ATP binds K channel?
It closes it and reduces the efflux of potassium from cell. This causes membrane depolarization.
34
What happens when membrane is depolarized?
Opens voltage gated calcium channels. When voltage gated calcium channels open, calcium comes into the cell and stimulates release of insulin
35
What happens when calcium channels open?
Ca stimulates release of insulin
36
Why do we have low efflux of glucose when glucose levels are low?
GLUT-2 has a very high Km
37
What effect does GLUT-2 not uptaking glucose have during low blood glucose
There will be more ADP than ATP, ADP bunds KATP channel
38
During low glucose, when ADP binds K-ATP, what happenss
ADP causes the K-ATP channel to remain open and maintain negative resting potential
39
What is the K-ATP channel?
The key sensor of metabolic activity that regulates electric activity that determines insulin secretion
40
K_ATP channel is made up of how many subunits
2 subunits KIR 6.2- pore forming SUR 1 both have 4 subunits
41
where do sulfonylureas bind
Between KIR 6.2 and SUR 1 subunits in K-ATP channel
42
What are some sulfonylurea drug names
Tolbutamide Glyburide Gluclazide
43
Recognize the sulfonyl urea structure
.
44
Sulfonylurea mechanism
Act like B cell. They bind K-ATP and block it. Causing membrane depolarization
45
Which sulfonylurea has a faster effect? why?
Tolbutamide, it does not have to be metabolized
46
which are the 1st gen sulfonylureas
tolbutamide- lowest potency and duration Chlorpropramide- longest duration
47
What differentiates 1st gen from second gen sulfonylureas
Potency, second is much more potent
48
second gen sulfonyurea drugs
Glipizide glyburide glimepride
49
difference between sulfonylureas and meglitinides
same function (blocking k-atp) different structure. Meglitinides have repaglinide instead of sulfonylurea
50
Name two meglitinides
Nateglinides, prandin
51
DIfferentiate between nateglinide and prandin
Nateglinide is very specific for KATP channels in pancrease compared to CV Nateglinide also has a shorter half life
52
Adverse effects of sulfonylureas
Prolonged HYPOGLYCEMIA due to long t1/2 especially in 2nd gen (glipizide, glimepride) risk of CV events GI problems
53
Why do sulfonylureas lead to loss of B cell mass
They stimulate persistent insulin secretion. This can be stressful on B cells leading to loss of BCM
54
Drugs that may enhance the action of sulfonylureas and risk of hypoglyccemia
Salicylates, sulfonamides
55
Drugs that cause hyperglycemia that may oppose sulfonylureas
OC epinephrine thiazide diuretics corticosteroids
56
What is the incretin effect?
Oral glucose elicits higher response that IV glucose
57
Why does oral glucose stimulate larger insulin response than IV glucose
Small intestine increases the hormones called incretins in response to absorption of glucose. They incremetally increase the secretion of insulin and increase glucose utilization.
58
Name 2 incretin hormones
GLP-1 GIP
59
Difference between the two incretins
GLP-1 is secreted from the ileum and is stimulated by the uptake of glucose from the lumen GIP- is secreted from duodenum
60
Most important effect of incretins
Acutely increase insulin secretion through C-AMP stimulation in pancrease cell
61
How does incretin increase insulin secretion
stimulate c-AMP in B cell in response to glucose
62
How do incretins affect BCM
protect and maintain B cells
63
What is DPP-IV
a protease that degrades GIP and GLP-1
64
What inhibits DPP-IV? What effect does this have?
DPP-IV inhibitor . Helps raise levels of incretin
65
Besides stimulating insulin production, what else do incretins do?
Suppress glucagon secretion slow gastric emptying decrease food intake increase BCM enhance glucose disposal and improves insulin sensitivity
66
Is incretin glucose dependent or independent?
Dependent
67
Why do incretins have a lower risk of hypoglycemia compared to sulfonylureas?
If there is no glucose around to depolarize the membrane potential, incretins will not stimulate insulin secretion. Sulfonyl ureas persistently stimulate insulin secretion
68
does GLP-1 byitself stimulate insulin secretion?
No, it can amplify the ability of glucose to stimulate insulin secretion.
69
Does GLP-1 stimulate membrane depolarization?
No, it increases CAMP inside the cell. This amplifies the effective membrane depolarization. causing more insulin to be secreted in response to glucose
70
Incretins in Type 2 diabetes?
Incretin effect is diminished in t2 diabetes
71
2 startegies to increase the incretin effect in t 2 DM
provide GLP analog prevent degradation of endogenous GLP-1
72
What are some GLP -1 analogs
Exenatide Liraglutide (Victoza) Dulaglutide (trulicity) Lixisenatide (adlyxin) Semaglutide (ozempic) mounjaro (tirzepatide)
73
warning for all GLP-1 analogs
Nausea, vomiting, pancreatitis
74
Contraindication to all GLP-1 analogs
contraindicated in pts with FH of medullary thyroid cancer
75
Liraglutide (victoza) modifications
Fatty acid added to enhance duration of action by binding serum albumin
76
Dulaglutide (trulicity) modifications
GLP-1 peptides slowly released from IgG Fc domain by reduction of disulfide bonds. Can be injected once a week due to ability to circulate for long periods
77
Modifications of Lixisenatide (Adlyxin)
Not a derivative of GLP-1 sequence. It is a derivative of exenatide with a polylysine tail. Inj daily. No fatty acid, no serum binding
78
Which position is most susceptible to proteolysis
Position next to histidine
79
Ozempic (semaglutide) half life?
1 week, binds serum albumin
80
semaglutide (ozempic) modification
Has an artificial aa next to histidine, reducing susceptibility to cleavage. Has a hydrophobic spacer and fatty acid.
81
How does semaglutide (ozempic) affect appetite
They have receptors in CNS that affect appetite, reducing food intake
82
Only GLP-analog that is orally active
Semaglutide (rybelsus), poor oral bioavailability.
83
semaglutide (rybellus) modifications
unnatural aa after histidine, hydrophobic spacer and fatty acid called salcaprozate (makes it absorbable from GI tract)
84
What is salcaprozate
fatty acid in semaglutide (rybella) that makes it absorbable from GI tract
85
How does mounjaro (tirzepatide work)
Reduces internalization (desensitization) of GLP-1 receptor to maintain effect.
86
How does moounjaro affect GIP and GLP-1
Full agonist for GIP biased agonist for GLP-1
87
How does mounjaro reduce desensitization
activates CAMP over b-arrestin, b arrestin causes desensitization
88
What is DPP-IV and what does DPP-IV inhibitor do?
DPP-IV cleaves hormones on luminal side of capillary. The inhibitor allow greater release of GLP-1 and GIP after a meal because we inhibit their breakdown
89
What is amylin? main action?
A peptide secreted from B cell along with insulin that regulates the absorption of nutrients from the GI tract. main action- inhibits glucagon secretion
90
Amylin drug
pramlintide(symlin)
91
What does pramlintide do?
Blunts post prandial rise in BG
92

Therapeutics P2 (41 decks)

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