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Pharmacology II > LEC 5 - Drugs Effecting Glucose Metabolism > Flashcards

LEC 5 - Drugs Effecting Glucose Metabolism Flashcards

1
Q

What cell type in the pancreas is responsible for glucose regulation?

A

Pancreatic islet

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2
Q

What cell type in the pancreas is responsible for the release of digestive enzymes?

A

Pancreatic acini

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3
Q

How does the liver play a role in glucose regulation?

A

Stores glucose as glycogen when glucose is high

Delivers glucose to plasma when levels drop

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4
Q

What are the two pathways in the liver that allow for glucose to enter blood when levels are low?

A

Glycogenolysis

– and –

Gluconeogenesis

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5
Q

What are the glucose releasing hormones?

A

Glucagon

Catecholamines

Cortisol

Growth hormones

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6
Q

What cell types releases insulin?

A

Beta cells

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7
Q

What cell types release glucagon?

A

Alpha cells

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8
Q

How do the beta cells know when to release insulin?

A

Glucose through GLUT

Stimulates Na channels and Ca channels

Cell depolarizes

Insulin released

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9
Q

How do the alpha cells know to release glucagon?

A

No glucose through GLUT channel

Allow for Na and Ca channesl to be placed

Glucose is inhibitory in this cell type

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10
Q

What are the signs of diabetes mellitus?

A

PU/PD

Weight loss even iwth polyphagia

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11
Q

What do dogs get with chronic DM?

A

Cataracts

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12
Q

What do cats get with chronic DM?

A

Neuropathy

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13
Q

What is seen in clinical chemistry with DM?

A

Blood glucose higher than normal

Glucouria

Increased fructosamine levels

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14
Q

Why do you see glucouria with DM?

A

Blood glucose higher than the capacity that the kidney can shuttle back into the ody

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15
Q

What type of DM is most common in dogs?

A

Type 1

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16
Q

What is the progonosis of a dog with type 1 DM?

A

Surive 2 to 3 years

Cataracts within 5 to 6 months

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17
Q

What causes type 1 DM?

A

Loss of functioning beta cells

(90% have to be lost for symptoms to be seen)

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18
Q

What are the etiologies of type 1 DM?

A

Autoimmune

Genetics

Acute, severe pancreatitis

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19
Q

What is the cause of Type 2 DM?

A

Acquired resistance of tissues to insuling

Problems binding to receptor

Problems with function of the receptor

Problems with downstream signaling

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20
Q

Common causes of Type 2 DM?

A

Obesity

Concurrent dz

Chronic inflammation

Renal/Hepatic/Cardiac insuffiency

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21
Q

What can cause severe peristant insulin resistance?

A

Diestrus induced increase in GH

Cushing’s disease

Diabetogenic drugs

Acromegaly

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22
Q

What are the drugs that can cause insulin resistance?

A

Progestin

Glucocorticoids

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23
Q

How can dogs get type 2 DM?

A

Have several of the predisposing causes

Can occur in Type 1

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24
Q

What is the irreverisble part of insulin resistance?

A

Deposition of toxinc amyloid in islets

Reduced insulin secretion

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25
Q

What is the reversible part of insulin resistance?

A

High blood glucose

leads to gluco/lipotoxicity

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26
Q

What is remission in cats associated with?

A

Insulin choice

low carb diet

strict monitoring

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27
Q

What does remission in a cat require?

A

Presence of functioning beta cells

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28
Q

What type of DM do horses tend to get?

A

Type 2

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29
Q

What are the treatment goals of DM?

A

Eliminate clinical signs

Prevent complications

Good quality of life

NOT TO MAINTAIN GLUCOSE IN NORMAL RANGE

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30
Q

What are the classes of insulin?

A

Short acting

Intermeidate acting

Long acting

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31
Q

What are the characteristics of long acting insulin?

A

laast 12 to 24 hours

32
Q

What are the characteristics of intermediate acting insulins?

A

8 to 18 hours

Used for maintence

Admin SC

Give with meal

33
Q

What are the characterisitics of short acting insulin?

A

1 to 4 hours

given iV

Used in emergencies

34
Q

What is insulin metabolized by?

A

liver and kidney

35
Q

What are adverse reactions to insulin?

A

Hypoglycemia

Hyperglycemia

Local/systemic immune reactions

36
Q

What is porcine zinc suspension type?

A

Intermediate

37
Q

What are the characteristics of porcine insulin zinc suspension?

A

Two peaks of activity - has long and short action

zinc crystals slow absorption

38
Q

Why is porcine insulin handled by dogs better?

A

Same AA sequence

39
Q

What type of insulin is neutral protamine hagedorn insulin?

A

Intermediate

40
Q

What are the characteristics of neutral protamine hagedorn insulin?

A

Protamine slows absorption

Single peak of activity

Human recombinant

41
Q

What type of insulin is protamin zinc insulin?

A

Long acting

42
Q

What is the composition of protamine zinc insulin?

A

90% beef - 10% pork

immune reaction seen in dogs

which leads to insulin resistance

43
Q

What type of insulin is glargine insulin?

A

Long acting

44
Q

What is the problem with glargine insulin

A

High concentration so easy to overdose

Cn precipitate when given

45
Q

What is great about glargine insulin?

A

Can cause remission in cats

46
Q

What type of insulin is determir insulin?

A

Long action

47
Q

What is so good about detemir insulin?

A

Allows for remission in cats

With no precipitation

Increased plasma protein binding = decreased elimination

48
Q

What is the polypol pathway responsible for/

A

Cataracts

Neuropathy

49
Q

What is the polypol pathway?

A

Glucose > Sorbitol

Sorbitol causes glycationof protein NH2 groups

50
Q

What can sorbitol glycation be detected by?

A

Fructosamine

A1C

51
Q

What does fructosamine detect?

A

Glycated albulmin

52
Q

What does A1C detect?

A

Glycated hemoglobin

53
Q

Which sorbitol test is done for animals?

A

Fructosamine

54
Q

When should insulin resistance be considered?

A

Glucose control is erratic

Insulinn doses constantly changing

Glucose levels < 300

Can’t get them below that

55
Q

What can be fatal when adjusting insulin doses?

A

Hypoglycemia

56
Q

What causes DKA/

A

Uncontrolled hyperglycemia

Chronic ketone body formation by liver

Ketone body = strong acid

Severe metabolic acidosis

57
Q

What are the signs of DKA?

A

Lethargy / depression / coma

Dehydration

Muscle wasting

Heptaomegaly

Plantigrade stance in cats

58
Q

What is the order of treatment for DKA?

A

Correct dehydration

Admin short acting insulin

Correct electrolyte imbalances

Correct acidosis

59
Q

What electrolyte imbalance is most common with DKA?

A

Hypokalemia

60
Q

How does insulin help with hypokalemia?

A

Increase activity of Na-K ATPase in cell membrane leading to cellular uptake of potatssium

61
Q

When is glupizide given?

A

Possible alternative to someone who doesnt want to give injections

Cat on well maintained low dose of insulin

62
Q

Where does glipizide act?

A

K channel in beta cell

63
Q

How is glipizide handled in the body?

64
Q

What are the adverse reactions seen with glipizide

A

Promotes formation of toxic amylin fibers = death of beta cells

Reduce changes of remission

Hepatotoxic

Hypoglycemia

65
Q

How does metaformin work?

A

Reduces glucose output by the liver

increase glucose uptake

inhibit gluconeogenenesis by opposing glucagon signals

66
Q

When is metaformin used?

A

Type 2 DM

Cats

67
Q

What are the adverse reactions to metaformin?

A

Vomiting, lethargy, weight loss

Overdose = lactic acidosis

do not use with cats in renal dz

68
Q

What is the use of kinostat?

A

Prevents cataracts in dogs

69
Q

How does kinostat work?

A

Inhibits aldose reductase

Stops glucose to sorbitol in eye

70
Q

What is the treatment for hypoglycemia?

A

Karo sryup on gums ASAP

IV fluids with dextrose in hospital once there

71
Q

What is octreotide used for?

A

Insulinomas in ferrets and dogs

72
Q

How does octreotide work?

A

Inhbits insulin gene expression

73
Q

What is diazoxide used for?

A

Insulinomas in dogs and ferrets

74
Q

How does diazoxide work?

A

Increased potassium permeability in beta cells

75
Q

why is diazoxide a bad choice for most owners?

A

1/2 life = 5 hours

have to give 4 times a day

Pharmacology II (20 decks)

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