Insulin and Oral Hypoglycemic Agents Flashcards

1
Q

Key cell types of endocrine pancreas and secretions

A

alpha cell - glucagon

beta cell - insulin and amylin

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2
Q

What type of hormone is insulin?

A

peptide hormone - ORAL ADMINISTRATION NOT POSSIBLE

binds on the surface of cells

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3
Q

Regulation of insulin release

A

+ - glucose, amino acids, incretins, Epi/Beta-2, Vagus stimulation

(-) –> NE/Alpha-2)

ATP builds up, activates Potassium channel which leads to depolarization and ACTIVATION OF CALCIUM CHANNEL

CALCIUM IS ULTIMATELY WHAT CAUSES INSULIN RELASE

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4
Q

Which glucose transporter is regulated by insulin?

where are these transporters located?

A

GLUT-4

muscle and adipose tissue

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5
Q

Metabolic processes associated with lack of insulin

A

glycogeneolysis
glycolysis
ketogenesis

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6
Q

Type I Diabetes Symptoms (name some)

A
Polyuria/nocturnal enuresis
thirst
blurred vision
weight loss/polyphagia
weakness/dizziness
parasthesias
loss of consciousness
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7
Q

Type II Diabetes Symptoms (name some)

A
Asypmtomatic initially
Infection
Neuropathy
Obesity and Metabolic Syndrome
Classic severe insulin deficiency signs
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8
Q

Normal Fasting Glucose

Diabetes

A

100 or Less, up to 140ish with a meal

Greater than 126, 110 to 125 is pre-diabetes

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9
Q

Most common route of admin of insulin

A

SCI

others are IV and IM

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10
Q

Rapid acting insulin

what is the effect of the amino acid substitution?

duration of action?

A

Insulin lispro
INsulin aspart
INsuline glulisine
Inhaled insulin

substitution to PREVENT COMPLEX FORMATION

3 to 5 hours

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11
Q

Short acting insulin

duration of action?

A

Regular insulin

4 to 12 hours

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12
Q

Intermediate acting insulin

duration of action

A

NPH

10 to 20 hours

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13
Q

Long acting insulin

duration of action?

A

Glargine
Detemir

12 to 20 and 22 to 24 hrs respectively

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14
Q

What type of insulin is better for meals? What is better for basal levels of insulin?

A

Short acting for meals

Long acting for basal level maintenance

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15
Q

Adverse effects of insulin

A
hypoglycemia
hypersensitivity
resistance
lipohypertrophy
lipoatrophy
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16
Q

Treatment for hypoglycemia

A

glucose or glucagon

17
Q

Biguanides (1)

MOA

Adverse

A

Metformin

DECREASES HEPATIC GLUCOSE OUTPUT, increases peripheral glucose utilization

GI disturbances, B12 deficiency

18
Q

Sulfonylureas (3)

MOA

Adverse

A

Glimepiride, Glipizide, Glyburide

inhibition of ATP-sensitive potassium channel on B cell - resulting in INSULIN RELEASE

weight gain, hypoglycemia

19
Q

Meglitinides (2)

MOA

Adverse

A

Repaglinide, Nateglinide

inhibition of ATP-sensitive potassium channel on B cell - resulting in INSULIN RELEASE

weight gain, hypoglycemia

20
Q

Glucosidase inhibitors (2)

MOA

ADverse

contraindications

A

Acarbose, Miglitol

INHIBIT BRUSH BORDER GLUCOSIDASE and subsequent absorption of glucose

abd pain, diarrhea, flatulence

contraindicated in GI diease

21
Q

Thiazolidinediones (TZD’s) (2)

MOA

ADverse

A

Pioglitazone, Rosiglitazone

decrease peripheral resistance by ACTIVATING PPAR-GAMMA AND INCREASING GLUT-4 RECEPTOR LEVELS

peripheral edema, weight gain, hepatotoxicity, fractures, hypoglycemia, CV

22
Q

Amylinomimetic (1), admin? target organ?

MOA

Adverse

A

Pramlintide, must be injected, LIVER

inhibits glucagon release, inhibits gastric emptying, anoretic

nausea, vomiting, anorexia, hypoglycemia, delayed drug absorption

23
Q

Incretins (2) - organ target?

MOA

major adverse effect

A

Exenatide, Liraglutide - target PANCREAS

potentiate insulin secretion
inhibit glucagon release
inhibit gastric emptying
anoretic

N,V, D, hypoglycemia, ACUTE PANCREATITIS

24
Q

DPP Inhibitors (3)

MOA

ADVERSE (3)

A

Sitagliptin, Saxagliptin, Linagliptin - oral admin

inhibit INCRETIN DEGRADATION

ACUTE PANCREATITIS, HEMORRHAGIC OR NECROTIZING PANCREATITIS