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Applied Pharmacology bs > Insulin and Hypoglycaemics > Flashcards

Insulin and Hypoglycaemics Flashcards

1
Q

Beta cells help control blood glucose by producing insulin. What helps to produce glucagon?

A

alpha cells

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2
Q

What are the functional effects of insulin?

A
  • changes glucose in to glycogen or fat
  • turns glucose into amino acids and amino acids into proteins
  • decrease glucose formation
  • stimulates glut4 which moves glucose upto the cell membrane and therefore
  • leads towards hypoglycaemia
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3
Q

What is the difference in definition of type 1 and type 2 diabetes?

A

type 1 - insulin producing cells are destroyed and insulin MUST be provide
type 2 - insulin producing cells are failing tissues or insensitive to insulin
blood glucose levels elevated because body can not utilize it properly

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4
Q

What are the risk factors for type 2 diabetes?

A
  • age
  • obesity
  • ethnicity
  • family history
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5
Q

When treating people with type 1 diabetes there is 3 basic insulin preparations. What are they?

A
  • short duration - rapid onset
  • intermediate action
  • longer lasting- slower in onset (contains zinc)
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6
Q

Examples of short acting insulins used to treat type 1 diabetes are insulin aspart, insulin glulisine and insulin lispro. What are the timings of these drugs?

A
  • rapid on set - 30-60 minutes
  • peak action: 2-4 hours
  • duration: 8 hours
    injected just before, with or just after food and only lasts long enough for the meal at which it is taken for.
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7
Q

What are examples of intermediate and longer duration insulins used to treat type 1 diabetes?

A 
insulin detemir 
insulin glargine 
insulin suspension 
isophane insulin 
protamine zinc insulin
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8
Q

What are biphasic insulins?

A

biphasic insulin preparation

  • mixture of intermediate and fast acting
  • they have rapid onset
  • longer-lasting actions
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9
Q

insulin can be administered subcut, via pens or via portable infusion pump. What is the difficulty with the infusion pump?

A
  • it is a close loop system and therefore can not help if glucagon is needed in a hypoglycaemic episode
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10
Q

Hypergylcaemia- inducing drugs must be used when blood glucose goes to low. these are given via injections. what do they do and what are their side effects?

A
  • acutely raises plasma glucose levels
  • side effects include headache and nausea
  • they must be reconstituted prior to use
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11
Q

What is the mode of action for secretagogues ?

A
  • boost insulin release
  • enhances the normal physiology of glucose-stimulated insulin secretion
  • acts as antagonist of the potassium pumps
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12
Q

How do meglitinides such as repaglinide and nateglinide work? *secretagogues 1

A
  • small molecule antagonist of the potassium channel
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13
Q

How long do meglitinides such as repaglinide and nateglinide last? and what is a benefit of these? *secretagogues 1

A
  • they are short acting

- may have a decreased risk of hypoglycaemia compared with SUs, particularly in the elderly

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14
Q

What is the specific mode of action in secretagogues 2 such as exenatide and liraglutide?

A
  • peptide agonist of the GLP-1 receptor and not broken down by DPP4
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15
Q

What are examples of secretagogues 2.

A
  • exenatide
  • liraglutide
  • byetta
  • victoza
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16
Q

What is a benefit of secretagogues 2?

A

much reduced risk of hypoglycaemia compared to sulphonylureas
- can be combined with metformin

17
Q

What are the action of secretagogues 3 such as gliptins, sitagliptin and vildagliptin?

A

inhibitors of DPP4

raises the half- life of serum GLP1

18
Q

How are secretagogues 3 such as gliptins, sitagliptin and vildagliptin administered?

A

oral tablet

19
Q

What are the actions of Diazoxide?

A

small molecule agonist of the potassium channel

- it is a hyperglycaemia therapy

20
Q

How is the hyperglycaemia therapy diazoxide administered?

A

orally and must be with chlorothiazide because promotes water absorption!

21
Q

What is dioxide used to treat?

A

severe hyperglycaemia

congenital hyperinsulinism in infancy

22
Q

What do insulin sensitizers do ?

A

help improve the sensitivity of target organs to insulin

23
Q

What two types of drugs are part of insulin sensitizers?

A
  • biguanides

- Thiazolidins

24
Q

What are the modes of action in biguanides?

A
  • prevents hepatic production of glucose

- overcomes insulin resistance by improving sensitivity

25
Q

What is an example of a biguanide?

A

metformin

26
Q

What are the benefits of metformin (a biguanide)

A
  • can be used in combination with other drugs to treat type 2 diabetes
  • best choice of drug for people who also have heart failure
27
Q

What are the actions of thiazolidinediones/ glitazones?

A

activates PPARy- a regulatory protein involved in the transcription of insulin-sensitive genes which regulate glucose and fat metabolism.
principle target = adipocytes

28
Q

What are examples of thiazolidinediones/ glitazones?

A
  • Rosglitizone
    also combined with metformin
  • avandamet
29
Q

What are the actions of modifying glucose breakdown drugs??

A
  • a-glucosidase converts oligosaccharides to glucose
  • acarbose inhibits this enzyme
  • absorption of starchy foods is slowed (slowing down rise in blood glucose following a meal)
30
Q

What are the actions of enhancing glucose release drugs?

A
  • glucose reabsorption
  • SGLT2 (sodium-coupled glucose transporter) inhibitors cause excess glucose to be elimated in the urine ; reducing hyperglycaemia
31
Q

What are potential advantages of enhancing glucose release drugs / SGLT2 inhibitors?

A

weight loss
insulin independent
low risk of hypoglycaemia
osmotic diuresis reduces hypertension

32
Q

What are examples of SGLT2 inhibitors/ enhanced glucose release drugs ?

A

dapaglifozin
canagliflozin
empagliflozin
* all end in flozin

33
Q

What are the treatment options for type 1 diabetes?

A
  • insulin therapy
  • islet/pancreas transplantation
  • prevention: immune-mediated destruction of B-cells

Applied Pharmacology bs (10 decks)

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