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Exam 5- Diabetes Flashcards

1
Q

beta cells release___

alpha cells release____

A

beta= insulin and amulin

alpha= glucagon

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2
Q

Mechanism of insulin released from beta cell

A
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3
Q

insulin’s cellular effects

A

(+) gene expression and growth regulation

(+) GLUT4 expression

(+) glucose utilization- glycogen/lipid/protien produciton

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4
Q

insulin’s effects on

brain

muscle

liver

and fat

A

brain- DOESN’T insulin to use glucose

muscle- glucose uptake

liver- storage of glucose as glycogen and (-) gucose synthesis

fat- (+) fatty acid storage in adiposte tissue

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5
Q

lack of insulin effects on

brain

muscle

liver

fat

A

brain- gets energy anyway

muscle- no glucose uptake

liver-glucose is synthesized and released from glycogen

fat- broken down to generate ffa -> ketone bodies

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6
Q

____ opposes the effects of insulin

A

glucagon

epinephrine

glucocorticoids

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7
Q

type 1 diabetes=

A

insulin dependent diabetes mellitus

-5%

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8
Q

type II diabetes

A

non-insulin dependent diabetes

>90% of all cases

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9
Q

acute symptoms of hyperglycemia

A

fatigue

increases urination

dehydration

weight loss

blurred vision

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10
Q

ketoacidosis is associated with type ___

A

one only

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11
Q

hemoglobin A1c

A

=gylycated/glycosylated hmoglobin

-gives info on average blood glucose levels ofver previous months

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12
Q

hyperglycemia’s effect on eyes

A

retinopathy, glaucoma, cateracts

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13
Q

diabetes effect on heart

A

atherosclerosis

coronary disease

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14
Q

hyperglycemia’s effect on circulation

A

high blood pressure

2/3 of diabetics are hypertensive

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15
Q

hyperglycemia’s effect on the kidneys

A

kidney damage and failure

diabetes is the leading cause of kidney failure

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16
Q

diabetes effect on feet

A

poor circulation and neuropathy =ulcerations and infection

diabetics account for 65% of foot amputations

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17
Q

____ causes type 1 diabetes

A

autoimmune destruction of beta cells

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18
Q

treatment of type 1 diabetes=

A

insulin

also synthetic amyin

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19
Q

insulin as a tx

source__

administration___

A

source is human insulin from recombinant DNA

administration = subcutaneoulsy or suspension

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20
Q

ultra short acting insulin

A

insulin lispro

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21
Q

short acting insulin

A

regular insulin

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22
Q

intermediate acting insulin

A

NPH insulin

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23
Q

long acting insulin

A

insulin glargine

insulin detemir

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24
Q

insulin administration and the rate of sc blood flow

A

increased blood flow (ie. exercise) = increased absorpiton and increased risk for insulin-induced hypoglycemia

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25
insulin hypoglycemia causes, symptoms, treatment
-from delayed meal/exercise/overdose CNS-\>confusion, coma reflex autonomic hyperactivity -\>tachycardia, sweating treat w/ glucose or glucagon
26
type 2 diabetics progress through 3 phases
1. insulin resistance and increased hepatic glucose production along with normal insulin secretion 2. insulin resisatance with compensatry increases in insulin secretion 3. insulin resistance with depleated insluin response (beta cells wear out) NO KETOACIDOSIS
27
thin pts. with adult onset diabetes have\_\_\_
initial beta cell/insulin deficiency
28
risk factors for type II diabetes
1. genetic 2. obesity 80%
29
metformin
FIRST CHOICE DRUG FOR TYPE II - sensitizing agent- promotes insulin's action - produces weight loss - **highly efficacious**: 20% reduction in blood glucose and increased survival - 30% reduction in complications vs insulin or slufonylureases and 40% reduction vs. dietary regulation
30
Metformin's mechanism of action
(+)AMPK (AMP activated protien kinase) = incresedd GLUT 4 expression =(-) of gluconeogenesis in liver = decreased mobilization of free fatty acids =increased insulin sensitivity
31
metfomrin is attractive bc\_\_
oral administration very effective weight loss minimal risk for hypoglycemia cheap
32
metfomrin side effects
= mostly GI (30% of pts) -diarrhea, nausea, vomiting =rare fatal lactic acidsosis ∴ avoid with kidney issues
33
Thiazolidinediones (TZDs) list (with trade names)
rosiglitazone - AVANDIA pioglitazone - ACTOS
34
TZDs general
**sensitizing agents** -promote insulin's actions - regulate gene expression via **PPAR-y** - equivalent effficacy to metformin **euglycemic** (minimal risk for hypoglycemia)
35
TZD adverse effects
- liver toxicity potential - weight gain - increased LDL - increased bone fractures in post-menopausl women - RISK OF CONGESTIVE HEART FAILURE ∴ AVOID IN DIABETICS WITH CHF
36
why is Avandia a last resort durg?
INCREASED RISK FOR CORONARY HEART DISEASE
37
secretagogue anti-diabetics
- increase insulin release from beta cells - can produce hypoglycemia =sulfonylureas =meglitinides
38
second line drug for type II
sulfonylureas
39
meglitinides
short acting oral secretagogues - used specifically during mealtimes - can cause hpoglycemia **=repaglinide** **=nateglinide**
40
sulfonylureas are first line drugs in \_\_\_ draw diagram of MOA
type II pts that have normal body weight but disfunctional beta cells
41
sulfonylureas
=oral secretagogue anti-diabetics -second line for type II teratogenic (avoid preggers) - side effects=hypoglycemia and weight gain - can produce secondary beta cell failure with chronic use
42
first generation sulfonylureas
no longer used due to severe hypoglecemia risk
43
second generation sulfonylureas
lower risk for hypoglycemia -b.i.d. administration =**glyburide**
44
third generation sulfonylureas
- lowest risk for hypoglycemia - once daily administration =**glimepiride**
45
incretins
endogennous incretins= **GLP-1 (**glucon like peptide) **GIP** (gastric inhibitory protien) work via **GLP-1 receptors**
46
incretin effects
decrease appetite decrease gastric emptying increase insulin secretion decrease glucagon secretion increase insulin sensitivity decrease glucose produciton
47
incretin related drugs
=mimic or promote the actions of incretins at the GLP-1 receptor - all produce weight loss - minimal hypoglycemia - very expensive $$$ two classes: **1. GLP-1 agonists** =synthetic peptide analogues need to be injected **2. DPP-4 (dipeptidyl peptidase-4 ) inhibitors** -inhibit the enzyme that metabolizes DPP-4 can be taken orally
48
GLP-agonists list
-all injected ## Footnote **exenatide - x2 a day** **extended release exenatide - weekly injection** **liraglutide - once daily injection**
49
DPP-4 inhibitors list
orally administered once a day -less effective than the GLP-1 agonists **linagliptin** **saxagliptin** **sitagliptin** **alogliptin**
50
insulin and type 2 diabetes is used\_\_\_
1. adjunctive use with other medications - most type 2 diabetics end up on insulin - mealtime/bedtime 2. monotherapy when other medications are no longer effective or intolerable due to kidney/heart/pregnancy/infections
51
alpha-glucosidase inhibitors
prevent breakdown and∴ absorption of monosaccharides= reduced absorption of glucose precuresors - used at mealtime - GI SIDE EFFECTS= flatulence and diarrhea (if treating these patients for hypoglycemia they must be given glucose)
52
alpha-glucosidases
intestinal enzymes that metabolize starches and oligosaccharides into absorbable monosaccharides
53
alpha-glucosidase inhibitors list
miglitol
54
SGLT2 Inhibitors
= sodium-glucose co-transporter 2 prevents glucose reabsorption in the proximal tubule (90% of filtered glucose is reabsorbed here) - side effect= vaginal yeast and UTI (15%) - not first line - weight loss - used for type 2 (type 1 tba)
55
SGLT2 inhibitors list
canagliflozin dapagliflozen empagliflozin
56
type 2 treatment pathway
57
normal body weight, first choice=
sulfonylurea
58
overweight first choice
metformin
59
problems with hypoglycemia, dont use\_\_\_
sulfonylurea
60
edema and heart failure don't use\_\_\_
tzd
61
heart disease don't use\_\_\_\_
rosiglitazone
62
if pregnant use\_\_\_\_
insulin
63
impaired kidney/liver fxn use\_\_\_
consider insulin
64
\_\_\_\_ may produce bladder cancer
pioglitazone
65
concerned about chronic treatment with\_\_\_
incretin and SGLT2 inhibitors
66
diabetes and cholesterol
-diabetics at a high risk for high cholesterol ∴ may want to use a statin drug -however statins can increase blood glucose-\> type II diabetes
67
diabetes and hypertension/kidney damage
-damage to kidneys is worsened by hypertension =ACE inhibitors (captopril) are the first choice for hypertensive diabetics -evidence that beta-blockers can worsen diabetes
68
heart disease and diabetes
TAKE ASPRIN IF ANY SIGN OF CHD
69
diabetes and neuropathy tx
painful consequence of diabetes that is typically not responsive to traditional anti-inflammatory/analgesic drugs

Pharmacology (11 decks)

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