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Pharm 6 > Insulin and Oral Hypoglycemic Agents > Flashcards

Insulin and Oral Hypoglycemic Agents Flashcards

1
Q

Type I diabetes

A

Insulin dependent

Little to no insulin production

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2
Q

Type II diabetes

A

Non-insulin dependent

Insulin resistance

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3
Q

What is insulin?

What does it do?

Mech?

A

Central control for metabolism of glc

Protein hormone secreted from B cells of islets of Langerhans (pancreas)

Anabolic hormone-increase storage and uptake of nutrients

Glc and AA, etc.

In absence of insulin we have tissue breakdown into glc

Mech: binds to cell surface receptor + increase glc cell uptake

Muscle and fat cells

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4
Q

Effects of diabetes

A

General

  • Decrease insulin→ decrease glc uptake

Short term

  • Polyuria-increase urine output
    • Due to glc in urine (brings H2O w/ it)
  • Polydipsia-increase thirst
  • Polyphagia-increase appetit

Long term

  • Glycosylation of proteins
  • Altered signal pathways and cell death
  • Cardio dysfunctions
    • Compromised circ→organ death
    • Atherosclerosis
    • Diabetic neuropathy
      • Leading cause of kidney failure
  • Vision changes
    • Diabetic retinopathy–blood vv in eye damaged
    • Ocular edema
    • Glaucoma, cataracts, etc.
  • Peripheral neuropathy-neurons lack energy
  • Infections–bacterial overgrowth b/c glc so available
    • Kidney
    • Bladder
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5
Q

What’s the most important factor to control diabetes?

A

_*DIET*_

This will be on the exam

We also use insulin injections

and other agents

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6
Q

What does crystal size matter w/ regards to insulin?

What is used to increase size?

A

Duration of action proportional to size

Larger crystals=longer to dissolve

Protamine increases size in protamine insulin

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7
Q

Lispro

A

Tx: Diabetes

Designer insulin

Short acting (2-5 hrs)

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8
Q

Regular human insulin

A

Tx: Diabetes

Designer insulin

Short acting (2-5 hrs)

Afrezza is the inhaled form

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9
Q

Aspart

A

Tx: Diabetes

Designer insulin

Short acting (2-5 hrs)

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10
Q

Glulisine

A

Tx: Diabetes

Designer insulin

Short acting (2-5 hrs)

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11
Q

Detemir

A

Tx: Diabetes

Designer insulin

Long acting (24+ hrs)

Determined to get large (that a long time)

Detemir +glargine=long acting insulins

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12
Q

Glargine

A

Tx: Diabetes

Designer insulin

Short acting (24+ hrs)

Determined to get large (that a long time)

Detemir +glargine=long acting insulins

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13
Q

Isophane

A

Tx: Diabetes

Designer insulin

Protamine insulin

Intermediate acting

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14
Q

What are the short acting designer insulins?

A

Regular human insulin

Lispro

Aspart

Glulisine

2-5 hrs

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15
Q

What are the long acting designer insulins?

A

Detemir

Glargine

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16
Q

Tolbutamide

A

Tx: Diabetes

Oral hypoglycemic agents

First gen sulphonylureas

Mech: K channel blockers

Block K channels on B cells →Increase Ca→Insulin secretion

Duration: 6-12 hrs

Contra/Indications:

  • Do not use if you have renal or hepatic damage
  • Not overweight
  • Have some islet fxn

SE:

  • Hypoglycemia and hypoglycemia coma
    • More common in drugs w/ longer duration
  • Can be teratogenic
  • Can increase death due to cardiovascular problems
17
Q

Tolazamide

A

Tx: Diabetes

Oral hypoglycemic agents

First gen sulphonylureas

Mech: K channel blockers

Block K channels on B cells →Increase Ca→Insulin secretion

Duration: 12-60 hrs

Contra/Indications:

  • Do not use if you have renal or hepatic damage
  • Not overweight
  • Have some islet fxn

SE:

  • Hypoglycemia and hypoglycemia coma
    • More common in drugs w/ longer duration
  • Can be teratogenic
  • Can increase death due to cardiovascular problems
18
Q

Chlorpropamide

A

Tx: Diabetes

Oral hypoglycemic agents

First gen sulphonylureas

Mech: K channel blockers

Block K channels on B cells →Increase Ca→Insulin secretion

Duration: 60+ hrs

Contra/Indications:

  • Do not use if you have renal or hepatic damage
  • Not overweight
  • Have some islet fxn

SE:

  • Hypoglycemia and hypoglycemia coma
    • More common in drugs w/ longer duration
  • Can be teratogenic
  • Can increase death due to cardiovascular problems
19
Q

Gli–ide

or

Gly–ide

A

Glipizide

Glyburide

**Glimepiride **(most potent)

Tx: Diabetes

Oral hypoglycemic agents

Second gen sulphonylureas

More rapid onset and longer duration

Mech: K channel blockers

Block K channels on B cells →Increase Ca→Insulin secretion

Contra/Indications:

  • Do not use if you have renal or hepatic damage
  • Not overweight
  • Have some islet fxn

SE: Less than 1st gen

  • Hypoglycemia and hypoglycemia coma
    • More common in drugs w/ longer duration
  • Can be teratogenic
  • Can increase death due to cardiovascular problems
20
Q

-glinide

A

Repaglinide

Nateglinide

Tx: Diabetes

Oral hypoglycemic agents

Sulphonylurea-like agents

Rapid onset, short duration

Mech: K channel blockers

Bind diff site on K channel

Block K channels on B cells →Increase Ca→Insulin secretion

Contra/Indications:

  • Do not use if you have renal or hepatic damage
  • Not overweight
  • Have some islet fxn

SE:

  • Hypoglycemia and hypoglycemia coma
    • More common in drugs w/ longer duration
  • Can be teratogenic
  • Can increase death due to cardiovascular problems
21
Q

Exenatide

A

Tx: Diabetes

Incretin enhancer

Mech: Bind to and activate receptors on B cell

Analog of GLP-1 (incretin)

Not broken down by DPP-4

Injection 2x/day

SE:

  • Pancreatitis
22
Q

-glutide

A

**Liraglutide **(Inj 1x/day)

Albiglutide (Inj. 1x/week)

Tx: Diabetes

Incretin enhancer

Mech: Bind to and activate receptors on B cell

Incretin analog

SE:

  • Thyroid tumor
  • I want my glutes to be as hard as concrete*
  • -glutide to be as hard as incretin*
23
Q

-gliptin

or

-glyptin

A

Sitagliptin

Saxagliptin

Linaglyptin

Alogliptin

Tx: Diabetes

Incretin enhancer

Mech: Inh DPP-4 Enzyme →prevent incretin metab

Orally

Often used in combo w/ other drugs

  • Put a lip of dip in (oral). Dip comes in a tin*
  • G-_LIP_-TIN are DPP inh. Taken orally.*
24
Q

Metformin

A

Tx: Diabetes

Insulin enhancers

Mech: Act. protein kinase→

Increased glc abs. by muscle

Decreased glc production by liver

SE:

  • Lactic acidosis (potentially fatal)
  • Weight loss due to anorexia
  • George Foreman was an American Professional (Kick)boxer *
  • Metformin Activates Protein Kinase*
  • He worked out so hard he had lactic acidosis and had to be anorexic to make his weight class*
25
Q

-glitazone

A

Rosiglitazone

Pioglitazone

Tx: Diabetes

Insulin enhancers

Mech: Act. PPAR→

Increased insulin receptor response

Increased # insulin receptors

Increased glc uptake by cells

SE:

  • Wt gain
  • Edema
  • Fractures of arms and legs
  • Macular edema
  • Cardio problems
    • MI
26
Q

Acarbose

A

Tx: Diabetes

Glucose abs. delayers

Mech: Inh. alpha glucosidase

Prevents breakdown of complex carbs in gut

SE:

  • Unabsorbed carbs ferment in gut
    • Cramps
    • Diarrhea
    • Flatulence
  • A-carb-ose*
  • No-carb-abs.*
27
Q

Miglitol

A

Tx: Diabetes

Glucose abs. delayers

Mech: Inh. alpha glucosidase

Prevents breakdown of complex carbs in gut

SE:

  • Unabsorbed carbs ferment in gut
    • Cramps
    • Diarrhea
    • Flatulence

Mig--litol

_Midg_ets (Mack) are little b/c they don’t absorb any carbs

28
Q

Pramlintide

A

Tx: Diabetes

Amylin analogs

Mech: Activate amylin receptor→

Decrease gastric emptying

Decrease appetite

Route: SubQ before meals

SE:

  • Severe hypoglycemia
  • prAMLINtide=AMyLIN analog*
29
Q

-gliflozin

A

Canagliflozin

Dapagliflozin

Empagliflozin

Tx: Diabetes

Inh. of glc resorption by kidney

**Mech: **Inh. SGLT2 (Na-glc cotransporter)

in PCT–allows kidney to eliminate blood glc

SE:

  • Hypotension
  • Hypokalemia
    • Due to increased urine output
  • Gential fungal inf
    • Urine loaded w/ glc

Pharm 6 (7 decks)

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