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Pharamcology Endocrine > Insulin > Flashcards

Insulin Flashcards

1
Q

What are the types of neurons supplied to the pancreas release insulin

A
  1. Para sympathetic
  2. sympathetic
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2
Q

What type of sympathetic receptors present on insulin and what are their effects

A
  1. Beta - 2 increases insulin blood glucose level falls
  2. alpha-2 causes hyperglycaemia by inhibiting the release of insulin
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3
Q

Which hormones Promote the secretion of insulin

A
  1. Glycogen like peptide one
  2. gastrointestinal inhibitory peptide
  3. gastrin
  4. secretin
  5. cholecystokinin
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4
Q

What are the actions of insulin

A
  1. Inhibits hepatic glycogenolysis and gluconeogenesis. Inhibits Lipolysis in adipose tissues
  2. it has is it enhances the entry of amino acids into muscles and promotes protein synthesis.
  3. pronounce peripheral utilization of glucose and K+ uptake into the cells
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5
Q

What is the mechanism of action of insulin

A
  1. Insulin binds to specific receptors on the cell membrane. 2-alpha and 2-beta receptor subunits. Binding of alpha subunit activates tyrosine kinase activity of beta subunits result in phosphorylation of tyrosine residues in the receptor
  2. this results in a complex series of phosphorylation dephosphorylation reactions, promote entry of glucose into the cell and mediates various actions of glucose.
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6
Q

Why is insulin not effective orally

A

Because it is destroyed by proteolytic enzymes in the gut

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7
Q

Classified Insulin preparations based on duration of action

A
  1. Rapid acting insulin
  2. short acting insulin
  3. intermediate acting insulin
  4. long acting insulin
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8
Q

Name types of rapid acting insulins

A
  1. Insulin lispro
  2. Insulin aspart
  3. Insulin glulisine 
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9
Q

Name types of short acting insulin

A

Regular soluble insulin (crystalline)

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10
Q

Name Intermediate acting insulin

A

NPH (isophane)

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11
Q

Name types of long acting insulin

A
  1. Insulin Glargine
  2. insulin Detemir
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12
Q

Which type of insulin gives us a cloudy solution and is complex with protamine and zinc

A

Intermediate acting insulin NPH

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13
Q

Which type of insulin should be avoided In pregnant diabetics and cannot be mixed with other insulins because of its pH

A

Long acting insulin- insulin Glargine

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14
Q

What protein does insulin detemir bind to 

A

Albumin

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15
Q

Name mixed insulin preparation

A
  1. Intermediate acting insulin + regular insulin/rapid acting insulin
  2. NPH + regular acting insulin
  3.  NPL + lispro
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16
Q

Name the premixed combinations of NPL and insulin lispro

A
  1. 75% NPL/ 25% insulin lispro
  2. 50% NPL/50% insulin lispro
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17
Q

What are the Indications for using insulin

A
  1. Type one diabetes Mellitus
  2. Diabetic ketoacidosis
  3. nonketotic hypoglycaemic coma
  4. diabetes during pregnancy
  5. stress of surgery, infections and trauma in diabetics
  6. patient with type two diabetes mellitus in addition to oral anti diabetic drugs
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18
Q

What are the sites of administration for insulin

A

Subcutaneously In the
1. Abdomen
2. buttocks
3. anterior thigh
4. dorsal arm

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19
Q

What is the treatment of hypo glycaemia in diabetics

A
  1. 50 ML of 50% dextrose IV
  2. glucagon 1 mg IV or adrenaline 0.2 mg s.c
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20
Q

What are the complications of insulin therapy

A
  1. Hypoglycaemia
  2. allergic reactions
  3. lipodystrophy
  4. insulin resistance
  5. oedema
21
Q

What is diabetic ketoacidosis

A

It is a complication of type one diabetes mellitus and its a medical emergency. Its precipitating factors are:
1. infection
2. trauma
3. severe stress
4. etc.

22
Q

What is the clinical features of diabetic ketoacidosis

A
  1. Anorexia
  2. nausea, vomiting
  3. polyuria
  4. abdominal pain
  5. hypotension
  6. tachycardia, hyperventilation
  7. altered consciousness
  8. coma 
23
Q

Name is steps for management of diabetic ketoacidosis

A
  1. Insulin replacement: Regular insulin IV 0.2 to 0.3 U/kg followed by 0.1 U/kg/hr IV
  2. Fluid replacement: Normal saline infused IV at 1 L/hr . Rate is slowly decreased. When blood glucose rages 250 mg/dL, 5% glucose in 1/2 Saline is administered to prevent cerebral oedema and hypoglycaemia
  3. Potassium to correct acidosis. KCl 10 to 20 mEq/hr administered after four hours of insulin therapy
  4. Sodium bicarbonate IV if required
  5. Phosphate, if hypo phosphate anaemia is present
  6. Antibiotics if there is infection
24
Q

What is hyperosmolar nonketotic diabetic coma. What is the treatment

A

It’s a medical emergency. Severe hyperglycemia, hyper osmolarity and dehydration. 
Same as diabetic keto acidosis except the patient needs more and faster fluid replacement

25
Q

What are the drug interactions of insulin

A
  1. Betta blockers
  2. silicylates
26
Q

What happens if insulin and Beta blockers are used at the same time

A

The blockers cause delay recovery from hypoglycaemia

27
Q

What is the interaction between insulin and salicylates

A

Suicide Lakesex exert hypoglycaemic effect by increasing sensitivity of pancreatic Beta cells to glucose and potentiating insulin secretion

28
Q

Name oral Antidiabetic drugs

A
  1. Sulfonylureas -
    i) First generation: tolbutamine, choloropropamide
    ii) Second generation: Glyburide, Glipizide, gliclazide, glimrpiride
  2. Biguanide - MetFormin
  3.  Meglitinide Analogue - repaglinide
  4. D- phenylalanine Derivative - Nateglinide
  5. Thiazonlidinediones- pioglitazone , rosiglitazone
  6. Alpha- glucosidase inhibitors acarbose, Miglitol, voglibose. 
29
Q

Name newer antidiabetic drugs

A
  1. GLP-1 analogue: exenatide
  2. DPP-4 inhibitors: sitagliptin, saxagliptin
  3. Others: pramlintide
30
Q

What is the mechanism of action of sulphonylureas

A
  1. Stimulates in secretion from beta cells of pancreas
  2. Increase the sensitivity of peripheral tissues to insulin by increasing number of insulin receptors
  3. Reduce the release of glucagon 
31
Q

Which drug increases the release of ADH it is useful in neurogenic diabetes insipidus

A

Chloropropamide

32
Q

Which active metabolite accumulates in Renal failure

A

Glibenclamide (glyburide)

33
Q

Which drug can be used in type two diabetes but not in type one

A

MetFormin

34
Q

What are the contraindications of using metFormin

A

Hepatic insufficiency and alcoholism

35
Q

Which drug causes fluid retention, weekend in precipitate CHF

A
  1. Rosiglitazone
  2. Pioglitazone
36
Q

Which drugs side effects include flatulence, fullness and diarrhoea

A

Acarbose

37
Q

Which drug may cause allergic reaction

A
  1. Sitagliptin
  2. Saxagliptin 
38
Q

What are the adverse effects of Sulfonylureas drugs

A
  1. Hypoglycaemia
  2. G.I. disturbances like nausea, vomiting, diarrhoea and flatulence
  3. Weight gain
  4. allergic reactions including photosensitivity, skin rashes, itching
  5. Teratogenicity
  6. intolerance to alcohol
39
Q

What are the drugs That cannot be taken with Sulfonylureas

A
  1. Salicylates/ sulphonamides
  2. propranolol
  3. rifampicin, phenobarbitone
  4. warfarin, Sulphonamides
40
Q

What is the effect of taking Sulfonylureas  With salicylates/sulfonamides

A

Increase free plasma concentration of sulfonyureas can cause hypoglycaemia

41
Q

Why can’t sulphonylureas be taken with propanol

A

Inhibits glycogenolysis inhibits recovery from hypoglycaemia

42
Q

Why can’t rifampicin and phenobarbitone be given with sulphonylurea

A

They are enzyme inducers and accelerate the metabolism of sulphonylureas and reduce its effects

43
Q

What is the interaction of warfarin and sulphnomides with sulfonylurea

A

Inhibit metabolism of sulfonylurea can cause hypoglycaemia

44
Q

What is the mechanism of action of metaformin

A

Activate enzyme AMP dependent protein Kinase.

45
Q

What Is the effect of AMP On the body

A
  1. Decreased hepatic gluconeogenesis
  2. Increased peripheral utilization of glucose in skeletal muscles and fat. Increased glycogen storage in skeletal muscles and fat.
  3. Inhibition of alimentary absorption of glucose
46
Q

What are the adverse effects of metaformin

A
  1. Metallic taste
  2. lactic acidosis
  3. vitamin B 12 deficiency due to malabsorption
  4. anorexia, nausea, vomiting, diarrhea, weight loss and skin rashes
47
Q

Which drug also has the effect to reduceserum triglycerides and increase HDL levels

A

Pioglitazone

48
Q

Which drug may give the adverse effect of bladder cancer and hepatotoxicity

A

Pioglitazone 

49
Q

Which class of into diabetics reduces intestinal absorption of carbohydrates and should be given before food

A

Alpha glucosidase inhibitors

Pharamcology Endocrine (9 decks)

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