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Pharmacology > Exam 5- Diabetes > Flashcards

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
Q

insulin hypoglycemia

causes, symptoms, treatment

A

-from delayed meal/exercise/overdose

CNS->confusion, coma

reflex autonomic hyperactivity ->tachycardia, sweating

treat w/ glucose or glucagon

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26
Q

type 2 diabetics progress through 3 phases

A
  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

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27
Q

thin pts. with adult onset diabetes have___

A

initial beta cell/insulin deficiency

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28
Q

risk factors for type II diabetes

A
  1. genetic
  2. obesity 80%
29
Q

metformin

A

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
Q

Metformin’s mechanism of action

A

(+)AMPK (AMP activated protien kinase)

= incresedd GLUT 4 expression

=(-) of gluconeogenesis in liver

= decreased mobilization of free fatty acids

=increased insulin sensitivity

31
Q

metfomrin is attractive bc__

A

oral administration

very effective

weight loss

minimal risk for hypoglycemia

cheap

32
Q

metfomrin side effects

A

= mostly GI (30% of pts)

-diarrhea, nausea, vomiting

=rare fatal lactic acidsosis ∴ avoid with kidney issues

33
Q

Thiazolidinediones (TZDs) list (with trade names)

A

rosiglitazone - AVANDIA

pioglitazone - ACTOS

34
Q

TZDs general

A

sensitizing agents -promote insulin’s actions

  • regulate gene expression via PPAR-y
  • equivalent effficacy to metformin

euglycemic (minimal risk for hypoglycemia)

35
Q

TZD adverse effects

A
  • 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
Q

why is Avandia a last resort durg?

A

INCREASED RISK FOR CORONARY HEART DISEASE

37
Q

secretagogue anti-diabetics

A
  • increase insulin release from beta cells
  • can produce hypoglycemia

=sulfonylureas

=meglitinides

38
Q

second line drug for type II

A

sulfonylureas

39
Q

meglitinides

A

short acting oral secretagogues

  • used specifically during mealtimes
  • can cause hpoglycemia

=repaglinide

=nateglinide

40
Q

sulfonylureas are first line drugs in ___

draw diagram of MOA

A

type II pts that have normal body weight but disfunctional beta cells

41
Q

sulfonylureas

A

=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
Q

first generation sulfonylureas

A

no longer used due to severe hypoglecemia risk

43
Q

second generation sulfonylureas

A

lower risk for hypoglycemia

-b.i.d. administration

=glyburide

44
Q

third generation sulfonylureas

A
  • lowest risk for hypoglycemia
  • once daily administration

=glimepiride

45
Q

incretins

A

endogennous incretins=

GLP-1 (glucon like peptide)

GIP (gastric inhibitory protien)

work via GLP-1 receptors

46
Q

incretin effects

A

decrease appetite

decrease gastric emptying

increase insulin secretion

decrease glucagon secretion

increase insulin sensitivity

decrease glucose produciton

47
Q

incretin related drugs

A

=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
Q

GLP-agonists list

A

-all injected

exenatide - x2 a day

extended release exenatide - weekly injection

liraglutide - once daily injection

49
Q

DPP-4 inhibitors list

A

orally administered

once a day

-less effective than the GLP-1 agonists

linagliptin

saxagliptin

sitagliptin

alogliptin

50
Q

insulin and type 2 diabetes is used___

A
  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
Q

alpha-glucosidase inhibitors

A

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
Q

alpha-glucosidases

A

intestinal enzymes that metabolize starches and oligosaccharides into absorbable monosaccharides

53
Q

alpha-glucosidase inhibitors list

A

miglitol

54
Q

SGLT2 Inhibitors

A

= 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
Q

SGLT2 inhibitors list

A

canagliflozin

dapagliflozen

empagliflozin

56
Q

type 2 treatment pathway

A
57
Q

normal body weight, first choice=

A

sulfonylurea

58
Q

overweight first choice

A

metformin

59
Q

problems with hypoglycemia, dont use___

A

sulfonylurea

60
Q

edema and heart failure don’t use___

A

tzd

61
Q

heart disease don’t use____

A

rosiglitazone

62
Q

if pregnant use____

A

insulin

63
Q

impaired kidney/liver fxn use___

A

consider insulin

64
Q

____ may produce bladder cancer

A

pioglitazone

65
Q

concerned about chronic treatment with___

A

incretin and SGLT2 inhibitors

66
Q

diabetes and cholesterol

A

-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
Q

diabetes and hypertension/kidney damage

A

-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
Q

heart disease and diabetes

A

TAKE ASPRIN IF ANY SIGN OF CHD

69
Q

diabetes and neuropathy tx

A

painful consequence of diabetes that is typically not responsive to traditional anti-inflammatory/analgesic drugs

Pharmacology (11 decks)

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