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Endocrinology > Pancreas > Flashcards

Pancreas Flashcards

1
Q

The insulin receptor shares a common enzyme with one seen in what type of cancer?

A
  • Tyrosine Kinase!

- CML and occasionally ALL, a t(9;22) for the bcr-abl protein (Philly chromosome)

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2
Q

The 3 types of cells in the Islets of Langerhans are what/make what?

A
  • alpha cells make glucagon
  • beta cells make insulin
  • delta cells make somatostatin
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3
Q

What are the physiologic functions of Somatostatin?

A
  • he never met another hormone he liked

- decreases levels of GH+TSH+PRL; insulin+glucagon, gastric acid+CCK+secretin

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4
Q

What 2 drugs are somatostatin analogues?

A
  • Octreotide

- Lanreotide

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5
Q

What are the most common uses for somatostatin analogs?

A
  • Acromegaly/gigantism

- Neuroendocrine tumors (Carcinoid syndrome)

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6
Q

What stimulates release of Insulin?

A
  • Blood Glucose is #1
  • amino acids (Arg)
  • Intestinal hormones (GLP, GIP)
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7
Q

What stimulates released of Glucagon?

A
  • Hypoglycemia

- amino acids

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8
Q

Where are Insulin receptors found, and what type are they?

A
  • cell surface

- intrinsic Tyrosine Kinase activity

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9
Q

Where are Glucagon receptors found, and what type are they?

A
  • predominantly found on the LIVER

- G protein couple, G(as)

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10
Q

Describe the functions of Glucagon.

A
  • it is a stress hormone, to INCREASE BLOOD GLUCOSE

- how? via stimulating liver (gluconeogenesis, glycogenolysis, lipolysis)

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11
Q

What metabolic products will increase as a result of Glucagon stimulation?

A
  • Ketones (from hi lipolysis)

- Urea (from hi gluconeogenesis)

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12
Q

What effect does glucagon have on insulin?

A

-mild INCREASE in production (whaaaaat)

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13
Q

Describe the keys steps that occur inside a beta cell to release insulin.

A
  • Glucose enters thru GLUT2
  • cell makes lots of ATP
  • hi ATP closes the K channel
  • membrane depolarizes, opens the voltage gated Ca
  • Ca influx, exocytosis of insulin granules
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14
Q

In general, contrast the types of enzymes stimulated by glucagon/insulin.

A
  • Glucagon stimulates kinases (adds Pi)

- Insulin stimulates phosphatases (removes Pi)

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15
Q

What tissues in the body do NOT uptake glucose by facilitated diffusion?

A
  • Skeletal muscle and Adipose tissue

- REQUIRE insulin to shove GLUT4 into their cell membrane

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16
Q

What is the relationship with Insulin and Potassium?

A

Insulin drives K into cells with Glucose (hence why it can treat hyperkalemia!)

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17
Q

Urea is to protein as Ketones are to _________

A

fatty acids (the metabolic byproducts)

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18
Q

Insulin increases the action of what hormone on the endothelial cell wall that empties VLDL and chylomicrons of TG?

A
  • Lipoprotein Lipase

- cleaves TG, brings into cell as FFA

19
Q

Insulin decreases the action of what lipolytic hormone inside adipose tissue?

A

-hormone sensitive lipase

20
Q

Describe insulin’s effect on glycogen enzymes.

A
  • promotes de-phosphorylation
  • this activates Glycogen Synthase+Glucokinase (liver)
  • this inactivates Glycogen Phosphorylase+Glucose-6-Phosphatase (liver)
21
Q

What other substrates hit receptors that have tyrosine kinase activity?

A
  • Insulin, IGF-1, any growth factor (VEGF, EGF, etc.)

- DON’T confuse with receptors ASSOCIATED with tyrosine kinase (PRL, GH, cytokines)

22
Q

Glucagon, through pkA, does what to glycogen enzymes?

A
  • promotes Phosphorylation!
  • this INACTIVATES Glycogen Synthase+Glucokinase (liver)
  • this ACTIVATES Glycogen Phosphorylase +Glucose-6-Phosphatase (liver)
23
Q

Glucagon increases Gluconeogenesis by promoting what reactions?

A

Pyruvate–>PEP

F1,6BP–>F6P

24
Q

Glucagon increases lipolysis through what enzyme?

A
  • INHIBITS Acetyl CoA carboxylase

- this decreases formation of malonyl CoA

25
Q

What KEY enzyme involved in fatty acid synthesis is stimulated by insulin?

A
  • Acetyl CoA Carboxylase

- an ABC carboxylase (needs ATP, biotin, and CO2)

26
Q

What 4 enzymes involved in fat+CHO metabolism are turned on by Insulin?

A
  • PFK2 (glycolysis)
  • Glycogen synthase (liver, muscle)
  • Glucokinase (liver)
  • Acetyl CoA Carboxylase (FA synthesis in liver)
27
Q

What general treatments are implemented for a type I vs type II diabetic?

A
  • lo sugar diet and Insulin (type I)

- diet, exercise, orals (type II)

28
Q

Lispro and Aspart are __________ acting insulin replacements.

A

-SHORT acting (5-15 min onset)

29
Q

Besides type I DM, what emergency indication do the short acting insulin replacements have?

A

-indicated for life-threatening HYPERKALEMIA

30
Q

What are the long acting insulin replacements?

A
  • Glargine

- Detemir

31
Q

Metformin’s primary MOA is what?

A

-decrease GLUCONEOGENESIS
(probably bypasses insulin R, turns on PPAR)
-in turn, glycolysis and insulin sensitivity will increase

32
Q

What are two benefits of Metformin over other oral DM treatments?

A
  • does NOT produce hyperinsulinemia

- does NOT produce hypoglycemia

33
Q

What is the mechanism of action of Sulfonylureas?

A
  • they block the K channel on beta cells of pancreas

- this is exactly what happens physiologically in the path to insulin release

34
Q

Name the second generation Sulfonylureas.

A
  • Glyburide
  • Glimepiride
  • Glipizide
35
Q

Sulfonylureas are ________ as effective as metformin, and how do the side effects stack up?

A
  • equally as effective

- Sulfonylureas can produce hyperinsulinemia/hypoglycemia

36
Q

Thiazolidinediones all end in what?

A
  • GLITAZONE

ex: pioglitazone, rosiglitazone

37
Q

How do alpha-glucosidase inhibitors work?

A
  • they competitively, reversibly inhibit absorption of sugars
  • block the brush border a-glucosidase
38
Q

What are the names of the a-carboxylase inhibitors?

A
  • Acarbose

- Miglitol

39
Q

What class of oral diabetes drug has the unique side effects of weight gain, edema, hepatotoxicity, and CHF?

A

–glitazones (pioglitazone, rosiglitazone)

40
Q

Glyburide/Glimepiride/Glipizide mimic the effects of ______________ on _________

A

-mimic effects of ATP on K channels in beta cells

41
Q

Two classes of oral anti-diabetes drugs work by BYPASSING the insulin receptor and stimulating PPAR. Neither causes hypoglycemia. What are they and how are they different?

A
  • Metformin: lactic acidosis (rare)

- Glitazones: weight gain, Edema, hepatotoxic, CHF (rare)

42
Q

What class of drug for type II diabetes works in the pancreas?

A

-Sulfonylureas

43
Q

Metformin/Glitazones will _________ glucose secretion by liver and __________ uptake of glucose by muscle and adipose.

A
  • decrease
  • increase

(same effects as insulin, just skips the insulin R!)

44
Q

What class of drug for type II DM works in the gut?

A

a-glucosidase inhibitors (acarbose, miglitol)

Endocrinology (7 decks)

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