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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
What is the effect of glucose on Glycogen stores?
Increase degradation and release
26
What is the effect of glucose on Fat stores?
Increase Keto acids
27
What is the effect of glucose on glycolysis?
Decreases
28
What is type 1a DM? 1b?
``` 1a = autoimmune 1b = idiopathic ```
29
What genetic conditions lead to DM?
Mutations in the insulin receptors
30
What is the major endocrinopathy that leads to DM?
Somatostatinoma
31
What happens in early in the onset of DM II with insulin levels?
Initially increase
32
What causes the blurred vision with DM?
Hyperosmolar state
33
What are the ssx of DM II?
Infections, neuropathies Could get classic insulin deficiency signs, but rare
34
What is the normal range of fasting glucose levels?
DM = more than 126 | Pre DM = more than 110
35
What are the levels of casual plasma glucose in DM?
Greater than 200
36
Why is it important to bypass the liver with insulin administration?
Less preferential metabolic effects on the liver
37
What is the therapeutic goal of insulin treatment?
BG between 90 -120
38
How many units should be given to a pt?
Varies between pts, with weight and personal
39
How do we prevent/encourage insulin from sticking to each other? Why do this?
Alter amino acids in the B chain. Alters pharmacokinetics
40
What is the onset of duration of action for rapid acting insulin?
10-30 mins | 3-5 hours
41
What is the onset and duration of action for short acting insulin?
30-60 mins | 4-12 hours
42
What is the onset and duration of action for intermediate acting insulin?
12- hours 10-20 hours
43
What is the onset and duration of action for long acting insulin?
1-4 hours 12-20 hours
44
What is the chemical alteration for rapid acting insulin?
Amino acid alteration in the C terminal tail of the B peptide, preventing complex formation
45
Rapid, short, intermediate, or long acting: insulin lispro
Rapid
46
Rapid, short, intermediate, or long acting: insulin aspart
Rapid
47
Rapid, short, intermediate, or long acting: insulin glulisine
Rapid
48
Rapid, short, intermediate, or long acting: inhaled insulin
Rapid
49
Rapid, short, intermediate, or long acting: regular insulin
Short
50
Rapid, short, intermediate, or long acting: NPH
Intermediate
51
Rapid, short, intermediate, or long acting: Glargine
Long
52
Rapid, short, intermediate, or long acting: Detemir?
Long
53
What is the chemical alteration with long acting insulin?
Amino acid substitution that results in precipitate formation at a more neutral pH in the body
54
What is the chemical alteration in intermediate acting insulin?
Protamine-insulin complex
55
What are the insulin types that a pump holds?
Rapid and short acting
56
What combination of insulin do people who inject insulin regularly (not a pump) use?
Short and long acting
57
Trying to mimic basal levels of BG, what type of insulin should be used?
Long acting
58
Handling a meal is best for what type of insulin?
rapid
59
What are the two rare adverse effects of insulin?
Hypersensitivity and resistance
60
What are the injection site adverse effects of insulin?
Lipohypertrophy and lipoatrophy
61
What is the most common side effect of insulin use?
Hypoglycemia--insulin therapy too effective
62
What is the treatment for hypoglycemia in DM I pts?
Use glucagon or feed
63
What are the ssx of hypoglycemia?
``` Tachycardia Sweating Tremors Nausea Hunger ```
64
What are the neuroglycopenic symptoms?
Irritability, confusion, HA | Blurred vision
65
True or false: use glucagon liberally if ssx of hypoglycemia are present
True
66
What is the MOA of metformin (2)?
Decreases hepatic glucose output Increases peripheral glucose utilization
67
Does metformin cause a hypoglycemia?
No
68
What are the adverse effects of metformin? (2, short/long term)
GI disturbances | Vit B12 deficiency with long term use
69
What are the adverse effects of Sulfonylureas and Meglitindies?
Weight gain | Hypoglycemia
70
What are the sulfonylureas? MOA?
Glimepiride Glipizide Glyburide Inhibit K channel, causing insulin release
71
What are the Meglitinides? MOA?
Repaglinide Nateglinide Inhibit K channel, causing insulin release
72
What is the MOA of acarbose? Adverse effects?
Inhibit brush border glucosides enzyme and subsequent absorption of glucose GI distubances
73
What is the MOA of Miglitol? Adverse effects?
Inhibit brush border glucosides enzyme and subsequent absorption of glucose GI disturbances
74
What are the two Thiazolidinediones? MOA?
piolitazone rosiglitazone Increase GLUT 4 transcription
75
What are the two major DM II drugs that cause hypoglycemia?
Sulfonylureas | Thiazolidinediones
76
What is the one amylinomimetic drug?
Pramlintide
77
What is the MOA of pramlintide? Side effects?
Inhibit glucagon release and gastric emptying n/v hypoglycemia Delayed drug absorption
78
What are the two incretins?
Exenatide | Liraglutide
79
What are the three DPD inhibitors?
Sitagliptin Saxagliptin Linagliptin
80
What is the MOA of DPDs? Adverse effects?
Inhibit incretin degradation Acute pancreatitis (hemorrhagic or necrotizing)
81
What is the MOA of Glimepiride? Use? Adverse effects?
Sulfonylurea-inhibits ATP sensitive K channels, causing insulin release DM II Weight gain and hypoglycemia
82
What is the MOA of Glipizide? Use? Adverse effects?
Sulfonylurea-inhibits ATP sensitive K channels, causing insulin release DM II Weight gain and hypoglycemia
83
What is the MOA of Glyburide? Use? Adverse effects?
Sulfonylurea-inhibits ATP sensitive K channels, causing insulin release DM II Weight gain and hypoglycemia
84
What is the MOA of Repaglinide? Use? Adverse effects?
Meglitinide-inhibits ATP sensitive K channels, causing insulin release DM II Weight gain and hypoglycemia
85
What is the MOA of Nateglinide? Use? Adverse effects?
Meglitinide-inhibits ATP sensitive K channels, causing insulin release DM II Weight gain and hypoglycemia
86
What is the MOA of Acarbose? Use? Adverse effects?
Glucosidase inhibitor DM II Diarrhea, flatulence
87
What is the MOA of Miglitol? Use? Adverse effects?
Glucosidase inhibitor DM II Diarrhea, flatulence
88
What is the MOA of Pioglitazone? Use? Adverse effects?
Thiazolidinedione--Increases translation of GLUT4 DM II Hepatotoxic, cardio effects
89
What is the MOA of Rosiglitazone? Use? Adverse effects?
Thiazolidinedione--Increases translation of GLUT4 DM II Hepatotoxic, cardio effects
90
What is the MOA of metformin? Use? Side effects?
Decreases glucose output from liver, increases insulin sensitivity DM II GI disturbances
91
What is the MOA of Pramlintide? Use? Side effects?
Inhibit glucagon release and gastric emptying DM II n/v hypoglycemia
92
What is the MOA of Exenatide? Use? Side effects?
incretin--increases insulin release, inhibits glucagon DM II Pancreatitis, hypoglycemia
93
What is the MOA of Liraglutide? Use? Side effects?
incretin--increases insulin release, inhibits glucagon DM II Pancreatitis, hypoglycemia
94
What is the MOA of Sitagliptin? Use? Side effects?
DPP-Inhibits incretin degradation DM II Acute pancreatitis
95
What is the MOA of Saxagliptin? Use? Side effects?
DPP-Inhibits incretin degradation DM II Acute pancreatitis
96
What is the MOA of Linagliptin? Use? Side effects?
DPP-Inhibits incretin degradation DM II Acute pancreatitis

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