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Pancreatic Hormones Flashcards

1
Q

Prohormone of insulin

A

proinsulin

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2
Q

Result of proinsulin cleavage

A

insulin and C-peptide

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3
Q

Uses of C-peptide

A

differentiate DM Type 1 and Type 2
diagnose MEN
rule out factitious hypoglycemia
assess PCOS insulin resistance

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4
Q

C-peptide in insulinoma

A

Elevated

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5
Q

C-peptide in factitious hypoglycemia

A

Not elevated

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6
Q

Glucose receptors in the brain

A

Glut 1 and Glut 3

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7
Q

Glucose receptors in the red cells

A

Glut 1

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8
Q

Glucose receptors in the pancreas, liver, kidney and gut

A

Glut 2

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9
Q

Glucose receptors in the brain, kidney and placenta

A

Glut 3

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10
Q

Glucose receptors in the brain and RBC

A

Glut 1

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11
Q

Glucose receptors in muscle or adipose

A

Glut 4

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12
Q

Glucose receptors in the gut and kidnet

A

Glut 5

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13
Q

Insulin-mediated glucose uptake

A

Muscle and Adipose (Glut 4)

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14
Q

Rapid acting Insulin

A

Lispro, Aspart, Glulisine

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15
Q

Short acting Insulin

A

Regular

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16
Q

Intermediate acting Insulin

A

NPH, Lente

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17
Q

Long acting Insulin

A

Ultralente, Glargine, Detemir, Lantus

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18
Q

Side effect of insulin at injection site

A

lipodystrophy

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19
Q

Masks signs of hypoglycemia (tachycardia, tremor, sweating)

A

Beta-blockers

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20
Q

Contained in ALL insulin preparations

A

Zinc

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21
Q

Rapid acting insulin peak

A

0.25 - 0.50

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22
Q

Short acting insulin peak

A

0.5 - 3

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23
Q

Intermediate insulin acting peak

A

8 - 12

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24
Q

Long acting insulin peak

A

8 - 16

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25
Q

Ultralong acting insulin peak

A

No peak

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26
Q

Duration of Rapid acting insulin

A

3 - 4

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27
Q

Duration of Short acting insulin

A

5 - 7

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28
Q

Duration of Intermediate acting insulin

A

18 - 24

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29
Q

Duration of Long acting insulin

A

18 - 28

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30
Q

Duration of Ultralong acting insulin

A

> 24

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31
Q

Paradoxical improvement of DM in patients with ESRD

A

Prolonged half life due to decreased clearance

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32
Q

Hypoglycemia resulting from CNS glucose deprivation

A

Neuroglycopenic Symptoms

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33
Q

Hypoglycemia resulting from CNS-mediated sympathoadrenal discharge

A

Neurogenic Symptoms

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34
Q

Risk for hypoglycemia with insulin

A

ESRD
Elderly
< 7 years old

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35
Q

Early morning hyperglycemia:
High evening dose intermediate insulin peak at 3 am (hypoglycemia) stimulating counter-regulatory hormones causing pre-breakfast hyperglycemia

A

Somogyi Effect

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36
Q

Early morning hyperglycemia:
Low evening dose of intermediate insulin stimulating early counter-regulatory hormones therefore mild hyperglycemia at 3 am and pre-breakfast

A

Waning of Insulin Dose

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37
Q

Early morning hyperglycemia:

Growth hormone spike at 6 am to 7 am cause insulin resistance and eventual pre-breakfast hyperglycemia

A

Dawn Phenomenon

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38
Q

Early morning hyperglycemia:
Low evening dose of intermediate insulin stimulating early counter-regulatory hormones therefore hyperglycemia at 3 am and moderate hyperglycemia pre-breakfast due to growth hormone spike

A

Combined Waning of insulin dose and Dawn Phenomenon

39
Q

Somogyi Effect treatment

A

decrease evening insulin dose

40
Q

Waning of Insulin Dose treatment

A

increase evening insulin dose

41
Q

Dawn Phenomenon treatment

A

increase evening insulin dose

42
Q

Period in DM Type 1 where insulin therapy causes insulin requirements of the body to decrease due to its TRANSIENT activation of residual pancreatic beta cells

A

Honeymood period

43
Q

Strategy for insulin therapy:

Fixed long acting insulin + Pre-meal short acting insulin

A

BASAL-BOLUS

44
Q

Strategy for insulin therapy:

Continuous long acting insulin + Varied short acting insulin depending on preprandial CBG

A

Sliding Insulin Scale

45
Q

Route of administration of Insulin

A

IV and subcutaneous

46
Q

Exubera

A

Inhaled insulin at Phase III trial

47
Q

Route of Insulin administration comparable to IV and SC routes

A

Inhalation

48
Q

Insulin secretagogues

A

Sulfonylurea and Meglitinide

49
Q

Insulin secretagogues MOA

A

Closes K channel of pancreatic B cells stimulating depolarization and release of endogenous insulin

50
Q

First generation Sulfonylurea

A

Chlorpropamide, Tolbutamide, Tolazamide

51
Q

Second generation Sulfonylurea

A

Glipizide, Gimepiride, Glibenclamide, Gliclazide

52
Q

Contraindicated in hepatic and renal impairment

A

2nd generation Sulfonylurea and Biguanides

53
Q

T/F: Hypoglycemia is less in 2nd generation sulfonylurea

54
Q

Meglitinide

A

Repaglinide, Nateglinide, Mitiglinide

55
Q

Insulin secretagogue use for patients with sulfa allergies

A

Meglitinide

56
Q

Insulin secretagogue with least incidence of hypoglycemia

A

Nateglinide

57
Q

Insulin secretagogue that may be used in CKD

A

Nateglinide

58
Q

Biguanide

59
Q

Biguanide MOA

A

Slows gut absorption of glucose
Inhibit hepatic and renal gluconeogenesis
Increase peripheral glucose uptake and glycolysis
Reduce plasma glucagon and DM risk

60
Q

First line drug for DM Type 2

61
Q

Diabetes risk reduction drug

A

Metformin, Thiazolidinedione, Alpha Glucosidase Inhibitor

62
Q

PCOS DOC

63
Q

Obese Diabetics DOC

64
Q

Positive side effect of Biguanides

A

Weight loss

65
Q

Thiazolidinedione

A

Pioglitazone, Rosiglitazone, Troglitazone

66
Q

Thiazolidinedione MOA

A

Increase insulin sensitivity binds PPAR-Y receptor
Inhibit hepatic gluconeogenesis
Increase peripheral glucose uptake
Reduce DM risk

67
Q

Reduces fasting and post prandial hyperglycemia

A

Biguanide and Thiazolidinedione

68
Q

Thiazolidinedione withdrawn from market

A

Troglitazone and Rosiglitazone

69
Q

Side effect of Troglitazone and Rosiglitazone

A

Congestive Heart Failure

70
Q

Contraindication of Thiazolidinedione

A

Liver disease
Prengnacy
CHF

71
Q

Thiazolidinedione that reduce cardiovascular events and mortality

A

Pioglitazone

72
Q

Alpha Glucosidase Inhibitors

A

Acarbose, Miglitol, Voglibose

73
Q

Alpha Glucosidase Inhibitors MOA

A

Inhibits intestinal alpha glucosidases enzyme (cannot convert complex carbs to monossacharides)
Reduce post prandial hyperglycemia ONLY

74
Q

T/F: Acarbose has a low glucose-lowering effect

75
Q

Side effect of alpha glucosidase inhibitor

A

Gastrointestinal disturbance

Hypoglycemia

76
Q

Treatment of alpha glucosidase inhibitor induced hypoglycemia

A

IV dextrose

77
Q

Contraindication of alpha glucosidase inhibitor

A

Renal impairment

78
Q

Amylin analog antidiabetic

A

Pramlintide

79
Q

Pramlintide MOA

A

Supress glucagon release
Reduce appetite
Delay gastric emptying

80
Q

Incretin modulator

A

GLP-1 agonist and DPP-4 inhibitor

81
Q

GLP-1 agonist

82
Q

Exenatide route of administration

A

Injectable

83
Q

Antidiabetic with anorectic effect

A

Pramlintide

84
Q

Antidiabetic combined with insulin as injectable

A

Pramlintide

85
Q

Exenatide MOA

A

Inhibit glucagon secretion
Augment glucose-stimulated insulin release
Delay gastric emptying
Produce SATIETY

86
Q

Most common side effect of GLP-1 agonist

A

Acute pancreatitis

87
Q

DPP-4 inhibitor

A

Sitagliptin

88
Q

DPP-4 inhibitor MOA

A

Degrades GLP-1 and other incretins

89
Q

Most common side effect of DPP-4 inhibitor

90
Q

Hormone for beta-blocker overdose

91
Q

Hormone for bowel imaging

92
Q

Hormone for SEVERE hypoglycemia

93
Q

Glucagon Effects

A

Increase HR and contractility
Increase hepatic gluconeogenesis
Increase hepatic glycogenolysis

Pharmacology (31 decks)

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