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Oral Hypoglycemic Agents Flashcards

1
Q

What are the cells in the pancreas that secrete: glucagon?

A

Alpha cells

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2
Q

What are the cells in the pancreas that secrete: insulin and amylin

A

Beta cells

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3
Q

What are the cells in the pancreas that secrete: Somatostatin

A

Delta cells

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4
Q

What are the cells in the pancreas that secrete: Gastrin

A

G cells

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5
Q

What are the cells in the pancreas that secrete: polypeptide

A

F cells

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6
Q

What are the areas in the pancreas that house beta cells?

A

Islets of langerhans

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7
Q

Why is oral administration of insulin not an option

A

Will degrade the peptide hormone

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8
Q

What are the components of insulin?

A

A chain and B chain linked by a disulfide bond

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9
Q

What is the use of C peptide?

A

Biologic marker of insulin secretion

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10
Q

What are the chemical that increase the secretion of insulin?

A

Glucose
Amino acids
Incretin (hormone)
Epi/B2

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11
Q

What nerve innervation will increase insulin secretion?

A

Vagal stimulation

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12
Q

What is the effect of NE/alpha 2 compounds on insulin release?

A

Decreases release

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13
Q

What is the effect of amylin on insulin release?

A

Decreases release

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14
Q

What is the signal for insulin release?

A

Glucose comes in, causing an increase in ATP/ADP ratio. This will close a Na channel, and open a voltage dependent Ca channel. This Ca will cause release of the insulin vesicles

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15
Q

What is the MOA of insulin?

A

Binds extracellular receptor, (Y kinase), and causes increase in GLUT 4 transporters to the membrane

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16
Q

Where is GLUT 1 transporters found, and what is its function?

A

All cells

Basal glucose uptake

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17
Q

Where is GLUT 2 transporters found, and what is its function?

A

Pancreatic Beta cells, liver

Insulin release

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18
Q

Where is GLUT 3 transporters found, and what is its function?

A

Brain, kidney

Neuronal uptake

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19
Q

Where is GLUT 4 transporters found, and what is its function?

A

Muscle adipose tissue

Insulin mediated uptake

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20
Q

Where is GLUT 5 transporters found, and what is its function?

A

Gut, kidney

Fructose uptake

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21
Q

Which GLUT transporter is regulated by insulin?

A

GLUT 4

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22
Q

What is the effect of insulin on triglycerides?

A

Increase FA synthase

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23
Q

What is the effect of insulin on glycogen?

A

Increases synthesis and storage

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24
Q

What is the effect of insulin on proteins?

A

Increases synthesis

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25
Q

What is the effect of glucose on Glycogen stores?

A

Increase degradation and release

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26
Q

What is the effect of glucose on Fat stores?

A

Increase Keto acids

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27
Q

What is the effect of glucose on glycolysis?

A

Decreases

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28
Q

What is type 1a DM? 1b?

A 
1a = autoimmune
1b = idiopathic
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29
Q

What genetic conditions lead to DM?

A

Mutations in the insulin receptors

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30
Q

What is the major endocrinopathy that leads to DM?

A

Somatostatinoma

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31
Q

What happens in early in the onset of DM II with insulin levels?

A

Initially increase

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32
Q

What causes the blurred vision with DM?

A

Hyperosmolar state

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33
Q

What are the ssx of DM II?

A

Infections, neuropathies

Could get classic insulin deficiency signs, but rare

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34
Q

What is the normal range of fasting glucose levels?

A

DM = more than 126

Pre DM = more than 110

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35
Q

What are the levels of casual plasma glucose in DM?

A

Greater than 200

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36
Q

Why is it important to bypass the liver with insulin administration?

A

Less preferential metabolic effects on the liver

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37
Q

What is the therapeutic goal of insulin treatment?

A

BG between 90 -120

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38
Q

How many units should be given to a pt?

A

Varies between pts, with weight and personal

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39
Q

How do we prevent/encourage insulin from sticking to each other? Why do this?

A

Alter amino acids in the B chain.

Alters pharmacokinetics

40
Q

What is the onset of duration of action for rapid acting insulin?

A

10-30 mins

3-5 hours

41
Q

What is the onset and duration of action for short acting insulin?

A

30-60 mins

4-12 hours

42
Q

What is the onset and duration of action for intermediate acting insulin?

A

12- hours

10-20 hours

43
Q

What is the onset and duration of action for long acting insulin?

A

1-4 hours

12-20 hours

44
Q

What is the chemical alteration for rapid acting insulin?

A

Amino acid alteration in the C terminal tail of the B peptide, preventing complex formation

45
Q

Rapid, short, intermediate, or long acting: insulin lispro

46
Q

Rapid, short, intermediate, or long acting: insulin aspart

47
Q

Rapid, short, intermediate, or long acting: insulin glulisine

48
Q

Rapid, short, intermediate, or long acting: inhaled insulin

49
Q

Rapid, short, intermediate, or long acting: regular insulin

50
Q

Rapid, short, intermediate, or long acting: NPH

A

Intermediate

51
Q

Rapid, short, intermediate, or long acting: Glargine

52
Q

Rapid, short, intermediate, or long acting: Detemir?

53
Q

What is the chemical alteration with long acting insulin?

A

Amino acid substitution that results in precipitate formation at a more neutral pH in the body

54
Q

What is the chemical alteration in intermediate acting insulin?

A

Protamine-insulin complex

55
Q

What are the insulin types that a pump holds?

A

Rapid and short acting

56
Q

What combination of insulin do people who inject insulin regularly (not a pump) use?

A

Short and long acting

57
Q

Trying to mimic basal levels of BG, what type of insulin should be used?

A

Long acting

58
Q

Handling a meal is best for what type of insulin?

59
Q

What are the two rare adverse effects of insulin?

A

Hypersensitivity and resistance

60
Q

What are the injection site adverse effects of insulin?

A

Lipohypertrophy and lipoatrophy

61
Q

What is the most common side effect of insulin use?

A

Hypoglycemia–insulin therapy too effective

62
Q

What is the treatment for hypoglycemia in DM I pts?

A

Use glucagon or feed

63
Q

What are the ssx of hypoglycemia?

A 
Tachycardia
Sweating
Tremors
Nausea
Hunger
64
Q

What are the neuroglycopenic symptoms?

A

Irritability, confusion, HA

Blurred vision

65
Q

True or false: use glucagon liberally if ssx of hypoglycemia are present

66
Q

What is the MOA of metformin (2)?

A

Decreases hepatic glucose output

Increases peripheral glucose utilization

67
Q

Does metformin cause a hypoglycemia?

68
Q

What are the adverse effects of metformin? (2, short/long term)

A

GI disturbances

Vit B12 deficiency with long term use

69
Q

What are the adverse effects of Sulfonylureas and Meglitindies?

A

Weight gain

Hypoglycemia

70
Q

What are the sulfonylureas? MOA?

A

Glimepiride
Glipizide
Glyburide

Inhibit K channel, causing insulin release

71
Q

What are the Meglitinides? MOA?

A

Repaglinide
Nateglinide

Inhibit K channel, causing insulin release

72
Q

What is the MOA of acarbose? Adverse effects?

A

Inhibit brush border glucosides enzyme and subsequent absorption of glucose

GI distubances

73
Q

What is the MOA of Miglitol? Adverse effects?

A

Inhibit brush border glucosides enzyme and subsequent absorption of glucose

GI disturbances

74
Q

What are the two Thiazolidinediones? MOA?

A

piolitazone
rosiglitazone

Increase GLUT 4 transcription

75
Q

What are the two major DM II drugs that cause hypoglycemia?

A

Sulfonylureas

Thiazolidinediones

76
Q

What is the one amylinomimetic drug?

A

Pramlintide

77
Q

What is the MOA of pramlintide? Side effects?

A

Inhibit glucagon release and gastric emptying

n/v hypoglycemia
Delayed drug absorption

78
Q

What are the two incretins?

A

Exenatide

Liraglutide

79
Q

What are the three DPD inhibitors?

A

Sitagliptin
Saxagliptin
Linagliptin

80
Q

What is the MOA of DPDs? Adverse effects?

A

Inhibit incretin degradation

Acute pancreatitis (hemorrhagic or necrotizing)

81
Q

What is the MOA of Glimepiride? Use? Adverse effects?

A

Sulfonylurea-inhibits ATP sensitive K channels, causing insulin release

DM II

Weight gain and hypoglycemia

82
Q

What is the MOA of Glipizide? Use? Adverse effects?

A

Sulfonylurea-inhibits ATP sensitive K channels, causing insulin release

DM II

Weight gain and hypoglycemia

83
Q

What is the MOA of Glyburide? Use? Adverse effects?

A

Sulfonylurea-inhibits ATP sensitive K channels, causing insulin release

DM II

Weight gain and hypoglycemia

84
Q

What is the MOA of Repaglinide? Use? Adverse effects?

A

Meglitinide-inhibits ATP sensitive K channels, causing insulin release

DM II

Weight gain and hypoglycemia

85
Q

What is the MOA of Nateglinide? Use? Adverse effects?

A

Meglitinide-inhibits ATP sensitive K channels, causing insulin release

DM II

Weight gain and hypoglycemia

86
Q

What is the MOA of Acarbose? Use? Adverse effects?

A

Glucosidase inhibitor

DM II

Diarrhea, flatulence

87
Q

What is the MOA of Miglitol? Use? Adverse effects?

A

Glucosidase inhibitor

DM II

Diarrhea, flatulence

88
Q

What is the MOA of Pioglitazone? Use? Adverse effects?

A

Thiazolidinedione–Increases translation of GLUT4

DM II

Hepatotoxic, cardio effects

89
Q

What is the MOA of Rosiglitazone? Use? Adverse effects?

A

Thiazolidinedione–Increases translation of GLUT4

DM II

Hepatotoxic, cardio effects

90
Q

What is the MOA of metformin? Use? Side effects?

A

Decreases glucose output from liver, increases insulin sensitivity

DM II

GI disturbances

91
Q

What is the MOA of Pramlintide? Use? Side effects?

A

Inhibit glucagon release and gastric emptying

DM II

n/v hypoglycemia

92
Q

What is the MOA of Exenatide? Use? Side effects?

A

incretin–increases insulin release, inhibits glucagon

DM II

Pancreatitis, hypoglycemia

93
Q

What is the MOA of Liraglutide? Use? Side effects?

A

incretin–increases insulin release, inhibits glucagon

DM II

Pancreatitis, hypoglycemia

94
Q

What is the MOA of Sitagliptin? Use? Side effects?

A

DPP-Inhibits incretin degradation

DM II

Acute pancreatitis

95
Q

What is the MOA of Saxagliptin? Use? Side effects?

A

DPP-Inhibits incretin degradation

DM II

Acute pancreatitis

96
Q

What is the MOA of Linagliptin? Use? Side effects?

A

DPP-Inhibits incretin degradation

DM II

Acute pancreatitis

Pharm (73 decks)

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