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Pharmacology > Insulin And Oral Hypoglycemics > Flashcards

Insulin And Oral Hypoglycemics Flashcards

1
Q

What are the insulin responsive cells

A

Muscle cells and adipose tissue

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2
Q

What is the glucose transporter

A

GLUT 4

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3
Q

What happens in TYPE 1 diabetes mellitus your

A

Autoimmune destruction of beta cells in the pancreas by T cells due to eliminated self tolerance

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4
Q

What is type 2 diabetes mellitus

A

Insulin resistance in peripheral cells hence the pancreas will make even more insulin and over time it will get over worked causing beta cells to atrophy

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5
Q

When is exogenous insulin given in type 2 diabetes

A

Later in the disease

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6
Q

When is exogenous insulin given in type 1 diabetes

A

Immediately since the pancreas can’t make insulin anymore

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7
Q

Whats the quickest area of absorption of insulin

A 
1-abdomen
2-arms 
3-buttocks
4-thighs 
Closest to the pancreas the faster!
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8
Q

What are insulin preparations categorised by

A

Onset of action and duration

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9
Q

What are Rapid acting / short acting insulin

A

Bolus=prandial

Bolus insulin regimen—>given before meals to counter post meal increase in blood glucose

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10
Q

What are intermediat acting and long acting insluins

A

They are basal (fasting) insulin regimen—> to maintain steady level given 1 or 2 times a day to regulate fasting blood glucose

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11
Q

What drugs are inhibitors of insulin release

A

Somatostatin and a2 stimulation

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12
Q

What happens when insulin drops

A

Lipolysis increases—> leading to increase in production of ketone which could lead to ketoacidosis

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13
Q

Symptoms of ketoacidosis

A

Acetone breath, abonormal respiration and electrolyte depletion (vomiting, come and death)

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14
Q

What is the only insulin given IV

A

Regular / human insulin

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15
Q

Why is human insulin given iv

A

Produced and stored as a hexamer to remain stable within the body

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16
Q

Normal insulin onset and duration

A

30 mins
5-8 hours
Peak 3-4 hrs

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17
Q

What are the rapid acting insulin

A

LAG
Lispro
Aspart
Glulisine

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18
Q

Rapid acting insulins duration, onset and peak

A

5-15 mins
3-4 hrs
1hr is the peak

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19
Q

When is rapid acting insulin used

A

Injected before a meal

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20
Q

What’s the insulin of choice for diabetic ketoacidosis

A

Rapid acting insulin

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21
Q

Which insulin’s are used in insulin’s pumps

A

Rapid acting insulin

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22
Q

Whats an intermediate acting insulin

A

NPH - isophane

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23
Q

What are NPH and regular insulins

A

They are human insulins the rest are analogs

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24
Q

NPH onset, duration and peak

A

1-2 hours
10-16 hours
Peak 4-13 hours

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25
Q

What can NPH be used as

A

Can be used as basal insulin

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26
Q

What’s the concentration of most commercial insulin preparations

A

100 U/ml

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27
Q

What are the long acting insulins

A

Glargine, detemir (has a flat peak) and degludec

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28
Q

Which long acting insulin binds to albumin

A

Detemir

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29
Q

Long acting insulins onset , duration and peak

A

1-2 hours
Glargine 24 hrs
Detemir 20 hrs
No peak effect for glargine

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30
Q

Which insulin can’t be mixed with other insulins in one syringe

A

Glargine

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31
Q

Long acting insulins side effects

A

Hypoglycaemia
Lipodystrophy
Weight gain

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32
Q

Where are endogenous and injected insulins metabolised

A

Endogenous insulin - 60% in liver and 40% in kidney

Injected insulin - 60% kidney and 40% liver

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33
Q

Sulfonylurea mode of administration

A

Oral

34
Q

Sulfonylurea mechanism of action

A
  • It works like ATP in pancreas work similarly to ATP leading to depolarisation by closing k+ channels
  • decreases hepatic gluconeogenesis
  • increase peripheral insulin sensitivity
35
Q

1st generation sulfonylurea

A

Chlorpropamide
Tolbutamide
Tolazamide

36
Q

2nd generation sulfonylurea

A

Glipizide, glyburide and glimeperide (3rd gen)

37
Q

Difference between first and second generation sulfonylurea

A

2nd generation is more potent and common

38
Q

What glucose concentration are Sulfonylureas used for

A

Any glucose concentration since it secretes insulin regardless

39
Q

Which oral hypoglycaemic drugs have the highest risk of hypoglycaemia

A

Sulfonylurea

40
Q

Side effects of sulfonylurea

A 
Hypoglycaemia 
Weight gain 
GI disturbances (nausea) 
Allergic reactions (SJS) 
Photosensitivity
41
Q

1st generation sulfonylurea side effects

A

Disulfram like reaction (alcohol intolerance giving hangover like symptoms)

42
Q

Sulfonylurea contraindications

A

DKA and DM1

43
Q

Meglitinides mode of administration

A

Oral

44
Q

Meglitinides mechanism of action

A

Prevent K+ channels from opening

45
Q

List the meglitinides and their onset time

A

Repaglinide 30 mins

Nateglinide 10 mins

46
Q

Meglitinides vs sulfonylurea

A

Meglitinides work faster but for shorter time than sulfonylurea

47
Q

When are meglitinides taken

A

Taken before meals

48
Q

Meglitinides side effects

A

Weight gain

Hypoglycaemia

49
Q

What are incertins

A

Hormones which stimulate insulin release after a meal like GLP1 , which only gets released on an increase in glucose level to release insulin and inhibits glucagon release

50
Q

What oral hypoglycaemics are glucose dependent

A

Incertins

51
Q

List the GLP 1 receptor agonists

A

Exenatide and liraglutide

52
Q

GLP1 agonists mode of administration

A

Subcutaneous

53
Q

GLP1 agonist suffix

A

TIDE

54
Q

GLP 1 agonist Mechanism of action

A

Increase insulin secretion
Decrease glucagon release
Enhance satiety

55
Q

GLP 1 agonist adverse effects

A

GI disturbances
Drop in appetite
Increase in risk for acute pancreatitis
Weight loss

56
Q

Best drug for weight loss

A

GLP 1 agonists

57
Q

List the DPP 4 inhibitors

A

Sitagliptin

Saxagliptin (orally)

58
Q

DPP 4 inhibitors mechanism of action

A

They inhibit DPP-4 which is a protease which breaks down GLP-1
Same effect as incertins

59
Q

DPP4 side effects

A

GI disturbances
Headache
NASOPHARYNGITIS
mild respiratory and urinary infections

60
Q

Which diabetes drugs have beneficial CV effects

A

GLP1 (LIRAGLUTIDE and SEMAGLUTIDE)

SGLT-2 inhibitor (EMPAGLIFLOZIN)

61
Q

DPP4 inhibitors are contraindicated in which people

A

Hepatic and renal impairments

Teratogenic-pregnant women

62
Q

What’s the mechanism of action biguanides and thiazolidinediones

A

Increase insulin sensitivity

Decrease production of glucose

63
Q

List Biguanides

A

Metformin first line drug for type 2 diabetes

64
Q

Metformin mechanism of action

A
  • Inhibits hepatic gluconeogenesis
  • Increases GLUT4 receptors in the cell membrane
  • Decreases intestinal absorption of glucose
65
Q

Metformin side effects

A

GI disturbances
Weight gain
Lactic acidosis

66
Q

Metformin is contraindicated in who

A

Patients with renal dysfunction
Hepatic dysfunction
COPD
In low vit B12

67
Q

What does metformin cause to vitamin B12

A

Decreases it

68
Q

List the thiazolidinediones

A

Rosiglitazone

Pioglitazone

69
Q

Rosiglitazone and Pioglitazone mechanism of action

A

They are insulin sensitisers increasing sensitivity as they bind to PPAR GAMMA which increases the transcription of insulin responsive genes and decreases hepatic gluconeogenesis

70
Q

Thiazolidinediones side effects

A

Increase risk of cardiovascular events MI AND STROKE

Fluids retention causing edema

71
Q

Pioglitazone side effects

A

Increases the risk of bladder cancer and increases risk of osteopenia and fractures and liver failure

72
Q

List alpha glycosides inhibitors

A

Acarbose and miglitol

73
Q

alpha glycosides inhibitors mechanism of action

A

Delay breakdown of starch and carbohydrates to glucose hence it decrease post meal glucose

74
Q

alpha glycosides inhibitors side effects

A

GI disturbances

75
Q

List Synthetic amylin analogs

A

Pramlintide - injectable

76
Q

What is amylin

A

A hormone secreted by B cells alongside insulin

77
Q

Synthetic amylin analogs mechanism of action

A

Lowers blood glucose by delaying gastric emptying and inhibiting glucagon secretion and improving satiety

78
Q

What is the only drug other than insulin used for both DM1 and DM2

A

Synthetic amylin analogs which is PRAMLINTIDE

79
Q

list SGLT2 Inhibitors

A

Canagliflozin
Dapagliflozon
Suffix - gliflozin

80
Q

SGLT 2 inhibitors

A

Decrease glucose concentration and decrease HBA1C concentration

81
Q

What is SGLT 2

A

It’s a transporter in the kidney which accounts for 90% of absorbed glucose
Blocking it causes glucosuria

82
Q

SGLT2 inhibitors side effects

A

It causes glucosurea which leads to UTIs and genital infections

Pharmacology (33 decks)

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