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FRCA Pharmacology > Hypoglycaemics > Flashcards

Hypoglycaemics Flashcards

1
Q

Metformin:

Undergoes liver metabolism

A

False. Metformin is not metabolised and is excreted unchanged in the urine. It is undetectable in plasma at 24 hours after a single dose.

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2
Q

Metformin:

Is effective in overweight diabetics

A

True. It does not cause weight loss but decreases weight gain in combination with lifestyle modifications.

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3
Q

Metformin:

Overdose can lead to lactic acidosis

A

True

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4
Q

Metformin:

Has a half life of 6 hours

A

True. Peak concentrations are reached within one to three hours, but it’s duration of action is between 8 & 12 hours, and is therefore administered up to 3 times a day.

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5
Q

Metformin:

Causes ketonuria

A

True

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6
Q

Biguanides:

Stimulate pancreatic insulin secretion

A

False. Biguanide action involves decreased gluconeogenesis, increased glycolysis & decreased intestinal glucose reabsorption.

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7
Q

Biguanides:

Are teratogenic

A

False. They are not recommended in pregnancy, though are not teratogenic.

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8
Q

Biguanides:

Are used in all ages of diabetics

A

False. Ketonuria can occur in young diabetics treated with Insulin & Biguanides, and so Metformin is usually only used in adult onset diabetes.

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9
Q

Biguanides:

Metformin has an oral bioavailability of 50-60%

A

True

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10
Q

Biguanides:

Metformin is highly protein bound

A

False. Metformin has negligible protein binding.

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11
Q

Sulphonylureas:

Are used in adult onset diabetes

A

True

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12
Q

Sulphonylureas:

Can cause hypoglycaemia

A

True. Sulphonylureas, such as Gliclazide, unlike Metformin, can cause hypoglycaemic episodes and blood sugars must be checked regularly.

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13
Q

Sulphonylureas:

Cause lactic acidosis in toxicity

A

False. Unlike Metformin, they do not cause lactic acidosis.

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14
Q

Sulphonylureas:

Act by increasing insulin release

A

True. They also enhance Insulin’s effect of taking up glucose into muscle & fat. Other examples include glibenclamide, tolbutamide &, the older preparation, chlopropramide.

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15
Q

Sulphonylureas:

Act by increasing insulin production

A

False. They act by increasing insulin release (not production) from the pancreatic beta cells, by binding to specific receptors.

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16
Q

Sulphonylurea hypoglycaemics:

Tend to cause weight loss

A

False
They act by binding to a receptor coupled to increased Calcium entry into the pancreatic beta cells, which enhances Insulin secretion.

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17
Q

Sulphonylurea hypoglycaemics:

Can be used to treat ketoacidosis

A

False. Oral hypoglycaemics have no role in the management of acute diabetic ketoacidosis.

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18
Q

Sulphonylurea hypoglycaemics:

Are safe for use in pregnancy

A

False

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19
Q

Sulphonylurea hypoglycaemics:

Are potentiated by Sulphonamides

A

True

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20
Q

Sulphonylurea hypoglycaemics:

Have shorter half lives than Biguanides

A

False

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21
Q

Sulphonylureas:

Have a hypoglycaemic effect potentiated by thiazide diuretics

A

False. Sulphonylureas’ hypoglycaemic effect is antagonised by thiazide diuretics.

22
Q

Sulphonylureas:

Are highly protein bound

A

True

23
Q

Sulphonylureas:

Displace bound Insulin from pancreatic islet 13 cells

A

True. Act by displacing bound Insulin from the pancreas &, therefore, they are only effective if endogenous insulin still exists (i.e. not absolute insulin loss/pancreatic beta cell destruction, as in type 1 DM).

24
Q

Sulphonylureas:

Include the drug Phenformin

A

False. Phenformin is a Biguanide similar to Metformin.

25
Q

Sulphonylureas:

Include the drugs Chlorpropramide & Metoclopramide

A

False. Despite the identical suffix (-pramide), Metoclopramide is a Benzamide anti-emetic.

26
Q

Sulphonylureas:

Are effective orally & parenterally

A

False. Sulphonylureas are only effective when administered orally. There is no IV preparation.

27
Q

Sulphonylureas:

Can cause pancytopenia

A

True. Tolbutamide & Chlorpropramide can cause leucopenia, agranulocytosis and thrombocytopenia in rare cases.

28
Q

Sulphonylureas:

Chlorpropramide is metabolised & excreted by the kidneys

A

False. Chlorpropramide undergoes no significant metabolism & is excreted, very slowly, largely unchanged in the urine.

29
Q

Sulphonylureas:

Gliclazide protects pancreatic beta cells from hyperglycaemic damage

A

True

30
Q

Sulphonylureas:

Gliclazide reduces atheromatous build up

A

True

31
Q

Insulin:

Neutral insulin has a pH of 7

A

True

32
Q

Insulin:

Different preparations exist lasting from less than 2 hrs to more than 36 hours

A

True

33
Q

Insulin:

60 - 80% of insulin can be lost due to binding to the IV fluid container & tubing

A

True

34
Q

Insulin:

80% of the secreted insulin is degraded by the liver & kidneys

A

True. The liver enzyme, hepatic glutathione transhydrogenase breaks the insulin molecule down into it’s constituent peptide chains.

35
Q

Insulin:

Half life of endogenous insulin is 45 mins

A

False. Endogenous insulin has a very short half life of 10 - 20 mins and is fixed to many tissues, except RBCs & brain.

36
Q

Regarding insulin:

It’s action involves a second messenger system

A

True

Insulin decreases cAMP in the liver

37
Q

Regarding insulin:

It is a polypeptide formed of 4 chains

A

False. It is formed of 2 chains, A and B.

38
Q

Regarding insulin:

It increases cAMP levels in the liver

A

False

Insulin decreases cAMP in the liver

39
Q

Regarding insulin:

Insulin increases potassium uptake into cells

A

True

40
Q

Regarding insulin:

Insulin increases protein synthesis in ribosomes

A

True
It also inhibits hormone sensitive lipase, increases protein synthesis in ribosomes and increases glucose uptake in the peripheral tissues.

41
Q

Insulin facilitates glucose uptake into:

The pituitary

A

True

42
Q

Insulin facilitates glucose uptake into:

Red Blood Cells

A

False

43
Q

Insulin facilitates glucose uptake into:

Peripheral tissues inc. muscle & fat

A

True

44
Q

Insulin facilitates glucose uptake into:

Fibroblasts

A

True

45
Q

Insulin facilitates glucose uptake into:

Intestinal mucosa

A

False. It decreases reabsorption in the intestine, which can lead to glycosuria.

46
Q

Insulin secretion:

Can be blocked by Atropine

A

True

whereas the anticholinergics, including Atropine, can block it’s release.

47
Q

Insulin secretion:

Is inhibited by the hormone Somatostatin

A

True

48
Q

Insulin secretion:

Is inhibited by the phosphodiesterase inhibitor Theophylline

A

False. Theophylline stimulates Insulin secretion but Somatostatin opposes it’s secretion.

49
Q

Insulin secretion:

Is stimulated by leucine

A

True

50
Q

Insulin secretion:

Is increased by Beta 2 adrenergic receptor activation

A

True. The Sympathetic nervous system has conflicting effects on Insulin release, Alpha 2 agonists decrease Insulin release, whilst Beta 2 agonists increase it’s secretion.

FRCA Pharmacology (13 decks)

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