Pancreatic Hormones Flashcards
1
Q
Prohormone of insulin
A
proinsulin
2
Q
Result of proinsulin cleavage
A
insulin and C-peptide
3
Q
Uses of C-peptide
A
differentiate DM Type 1 and Type 2
diagnose MEN
rule out factitious hypoglycemia
assess PCOS insulin resistance
4
Q
C-peptide in insulinoma
A
Elevated
5
Q
C-peptide in factitious hypoglycemia
A
Not elevated
6
Q
Glucose receptors in the brain
A
Glut 1 and Glut 3
7
Q
Glucose receptors in the red cells
A
Glut 1
8
Q
Glucose receptors in the pancreas, liver, kidney and gut
A
Glut 2
9
Q
Glucose receptors in the brain, kidney and placenta
A
Glut 3
10
Q
Glucose receptors in the brain and RBC
A
Glut 1
11
Q
Glucose receptors in muscle or adipose
A
Glut 4
12
Q
Glucose receptors in the gut and kidnet
A
Glut 5
13
Q
Insulin-mediated glucose uptake
A
Muscle and Adipose (Glut 4)
14
Q
Rapid acting Insulin
A
Lispro, Aspart, Glulisine
15
Q
Short acting Insulin
A
Regular
16
Q
Intermediate acting Insulin
A
NPH, Lente
17
Q
Long acting Insulin
A
Ultralente, Glargine, Detemir, Lantus
18
Q
Side effect of insulin at injection site
A
lipodystrophy
19
Q
Masks signs of hypoglycemia (tachycardia, tremor, sweating)
A
Beta-blockers
20
Q
Contained in ALL insulin preparations
A
Zinc
21
Q
Rapid acting insulin peak
A
0.25 - 0.50
22
Q
Short acting insulin peak
A
0.5 - 3
23
Q
Intermediate insulin acting peak
A
8 - 12
24
Q
Long acting insulin peak
A
8 - 16
25
Ultralong acting insulin peak
No peak
26
Duration of Rapid acting insulin
3 - 4
27
Duration of Short acting insulin
5 - 7
28
Duration of Intermediate acting insulin
18 - 24
29
Duration of Long acting insulin
18 - 28
30
Duration of Ultralong acting insulin
> 24
31
Paradoxical improvement of DM in patients with ESRD
Prolonged half life due to decreased clearance
32
Hypoglycemia resulting from CNS glucose deprivation
Neuroglycopenic Symptoms
33
Hypoglycemia resulting from CNS-mediated sympathoadrenal discharge
Neurogenic Symptoms
34
Risk for hypoglycemia with insulin
ESRD
Elderly
< 7 years old
35
Early morning hyperglycemia:
High evening dose intermediate insulin peak at 3 am (hypoglycemia) stimulating counter-regulatory hormones causing pre-breakfast hyperglycemia
Somogyi Effect
36
Early morning hyperglycemia:
Low evening dose of intermediate insulin stimulating early counter-regulatory hormones therefore mild hyperglycemia at 3 am and pre-breakfast
Waning of Insulin Dose
37
Early morning hyperglycemia:
| Growth hormone spike at 6 am to 7 am cause insulin resistance and eventual pre-breakfast hyperglycemia
Dawn Phenomenon
38
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
Combined Waning of insulin dose and Dawn Phenomenon
39
Somogyi Effect treatment
decrease evening insulin dose
40
Waning of Insulin Dose treatment
increase evening insulin dose
41
Dawn Phenomenon treatment
increase evening insulin dose
42
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
Honeymood period
43
Strategy for insulin therapy:
| Fixed long acting insulin + Pre-meal short acting insulin
BASAL-BOLUS
44
Strategy for insulin therapy:
| Continuous long acting insulin + Varied short acting insulin depending on preprandial CBG
Sliding Insulin Scale
45
Route of administration of Insulin
IV and subcutaneous
46
Exubera
Inhaled insulin at Phase III trial
47
Route of Insulin administration comparable to IV and SC routes
Inhalation
48
Insulin secretagogues
Sulfonylurea and Meglitinide
49
Insulin secretagogues MOA
Closes K channel of pancreatic B cells stimulating depolarization and release of endogenous insulin
50
First generation Sulfonylurea
Chlorpropamide, Tolbutamide, Tolazamide
51
Second generation Sulfonylurea
Glipizide, Gimepiride, Glibenclamide, Gliclazide
52
Contraindicated in hepatic and renal impairment
2nd generation Sulfonylurea and Biguanides
53
T/F: Hypoglycemia is less in 2nd generation sulfonylurea
True
54
Meglitinide
Repaglinide, Nateglinide, Mitiglinide
55
Insulin secretagogue use for patients with sulfa allergies
Meglitinide
56
Insulin secretagogue with least incidence of hypoglycemia
Nateglinide
57
Insulin secretagogue that may be used in CKD
Nateglinide
58
Biguanide
Metformin
59
Biguanide MOA
Slows gut absorption of glucose
Inhibit hepatic and renal gluconeogenesis
Increase peripheral glucose uptake and glycolysis
Reduce plasma glucagon and DM risk
60
First line drug for DM Type 2
Metformin
61
Diabetes risk reduction drug
Metformin, Thiazolidinedione, Alpha Glucosidase Inhibitor
62
PCOS DOC
Metformin
63
Obese Diabetics DOC
Metformin
64
Positive side effect of Biguanides
Weight loss
65
Thiazolidinedione
Pioglitazone, Rosiglitazone, Troglitazone
66
Thiazolidinedione MOA
Increase insulin sensitivity binds PPAR-Y receptor
Inhibit hepatic gluconeogenesis
Increase peripheral glucose uptake
Reduce DM risk
67
Reduces fasting and post prandial hyperglycemia
Biguanide and Thiazolidinedione
68
Thiazolidinedione withdrawn from market
Troglitazone and Rosiglitazone
69
Side effect of Troglitazone and Rosiglitazone
Congestive Heart Failure
70
Contraindication of Thiazolidinedione
Liver disease
Prengnacy
CHF
71
Thiazolidinedione that reduce cardiovascular events and mortality
Pioglitazone
72
Alpha Glucosidase Inhibitors
Acarbose, Miglitol, Voglibose
73
Alpha Glucosidase Inhibitors MOA
Inhibits intestinal alpha glucosidases enzyme (cannot convert complex carbs to monossacharides)
Reduce post prandial hyperglycemia ONLY
74
T/F: Acarbose has a low glucose-lowering effect
True
75
Side effect of alpha glucosidase inhibitor
Gastrointestinal disturbance
| Hypoglycemia
76
Treatment of alpha glucosidase inhibitor induced hypoglycemia
IV dextrose
77
Contraindication of alpha glucosidase inhibitor
Renal impairment
78
Amylin analog antidiabetic
Pramlintide
79
Pramlintide MOA
Supress glucagon release
Reduce appetite
Delay gastric emptying
80
Incretin modulator
GLP-1 agonist and DPP-4 inhibitor
81
GLP-1 agonist
Exenatide
82
Exenatide route of administration
Injectable
83
Antidiabetic with anorectic effect
Pramlintide
84
Antidiabetic combined with insulin as injectable
Pramlintide
85
Exenatide MOA
Inhibit glucagon secretion
Augment glucose-stimulated insulin release
Delay gastric emptying
Produce SATIETY
86
Most common side effect of GLP-1 agonist
Acute pancreatitis
87
DPP-4 inhibitor
Sitagliptin
88
DPP-4 inhibitor MOA
Degrades GLP-1 and other incretins
89
Most common side effect of DPP-4 inhibitor
URTI
90
Hormone for beta-blocker overdose
Glucagon
91
Hormone for bowel imaging
Glucagon
92
Hormone for SEVERE hypoglycemia
Glucagon
93
Glucagon Effects
Increase HR and contractility
Increase hepatic gluconeogenesis
Increase hepatic glycogenolysis
