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Pancreatic hormones and anti diabetic drugs Flashcards

0
Q

insulin dependent DM

A

Type 1

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1
Q

4 categories if Diabetes Mellitus

A

Type1 insulin dependent
Type 2 non insulin dependent
Type 3 juvenile
Type 4 Gestational DM

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2
Q

non insulin dependent DM

A

Type 2

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3
Q

juvenile DM

A

Type 3

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4
Q

Gestational DM

A

Type 4

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5
Q

4 main cell types in pancreas

A

glucagon
insulin
somatostatin
pancreatic polypeptide

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6
Q

alpha pancreatic cells secrete

A

glucagon

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7
Q

beta pancreatic cells secrete

A

insulin

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8
Q

gamma pancreatic cells secrete

A

somatostatin

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9
Q

effects of insulin on liver

A

inhibit glycogenolysis
inhibit conversion of AA and FA to keto acids
inhibit AA to glucose
anabolic action

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10
Q

effects of insulin on muscle

A

increase CHON. synthesis, AA transport, ribosomal synthesis
increase glycogen synthesis, glucose trasport
inhibits phosphorylase

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11
Q

effects of insulin on adipose tissue

A

increase triglyceride stores
lipoprotein lipase induced
glucose transport into cells
inhibits intracellular lipase

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12
Q

rapidly acting insulin

A

Lispro
Aspart
Glulisine

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13
Q

rapidly acting insulin (1) onset of action and (2) peak

A

ONSET: 15 minutes
PEAK: 30-90minutes
taken before meals

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14
Q

duration of action is 3-5 hours

A

rapidly acting insulin

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15
Q

crystalline zinc insulin that is now made by recombinant DNA techniques

A

short acting insulin

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16
Q

short acting insulin onset of action

A

within 30 min

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17
Q

peak of short acting insulin

A

2-4 hours after SQ

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18
Q

short acting insulin duration of action

A

5-8 hours

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19
Q

regular insulin / short acting insulins

A

Novolin

Humulin

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20
Q

regular insulin should be administered within

A

30-45 mins

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21
Q

intermediate acting insulin which combines insulin and protamine

A

Neutral Protamine Hagedorn or isophane insulin

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22
Q

intermediate acting insulin onset of action

A

1-2 hours

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23
Q

intermediate acting insulin peak

A

8 hours

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24
Q

duraton of action is 12-16 hours

A

intermediate acting insulin

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25
Q

usually mixed with regular, lispro, aspart, or glulisine insulin

A

NPH or isophane intermediate acting insulin

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26
Q

duration of action >24 hours

onset of actin 1-2 hrs

A

DETEMIR long acting insulin

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28
Q

soluble “peakless” insulin given once daily

A

GLARGINE Long acting insulin

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29
Q

insulin glargine onset of action

A

slow onset of action 1-1.5 hrs

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30
Q

insulin lispro, aspart, glusine acutely mixed with NPH

A

Pre-mixed insulin (doesnt affect rapid absorption)

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31
Q

available concentration of insulin

A

100 U/ml

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32
Q

external open loop pump for insulin delivery

A

Continuous SQ insulin infusion device (abdomen, flank, thighs)

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33
Q

most recently developed long scting insulin

DOSE dependent

A

DETEMIR insulin

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34
Q

insulin therapy formula

A

(wt in lbs) / (4) or

0.55) x (wt in kg

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35
Q

conventional insulin therapy

A

for DM type 2
fixed dose of intermediate or long acting
vary dos of short or rapidly acting

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36
Q

condition caused by inadequate or absent insulin replacement

A

Diabetic Ketoacidosis (DKA)

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37
Q

Tx for DKA

A

regular insulin IV 0.1IU/kg/h + IV hydration

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38
Q

DM type 2 characterized by HYPERGLYCEMIA and DEHYDRATION

A

Hyperosmolar Hyperglycemic Syndrome (HHS)

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39
Q

Tx for Hyperosmolar Hyperglycemic Syndrome (HHS)

A

aggressive rehydration and restoration of glucose

LOW DOSE Insulin therapy

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40
Q

most common complication of insulin therapy

A

HYPOGLYCEMIA

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41
Q

2 major disorders of insulin therapy

A

insulin allergy

immune insulin resistance

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42
Q

immediate type hypersensitivity, rare condition

A

insulin allergy

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43
Q

disorder where low titer IgG anti insulin antibodies neutralize the action of insulin

A

immune insulin resistance

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44
Q

abnormal or degenerative conditionof the body’s adipose tissue

A

Lipodystrophy

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45
Q

oral anti diabetic agents

A 
Secretagogues
BIGuanides
Thiazolidinediones
Alpha-glucosidase inhibitors
Incretin based therapies
Amylin analogs
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46
Q

insulin secretagogues

A

Sulfonylureas

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47
Q

sulfonylureas MOA

A

increase insulin release
reduce serum glucagon levels
closure of K channels in extrapancreatic tissure

48
Q

first generation of Sulfonylureas

A

Tolbutamide
Chlorpropamide
Tolazamide

49
Q

safest sulfonylureas for elderly diabetics, short halflife

A

TOLBUTAMIDE

rapidly metabolized in liver

50
Q

first gen sulfonylurea prolonged hypoglycemic reactions

A

Chlorpropamide

51
Q

ADR of CHLORPROPAMIDE if given >500mg daily

52
Q

more slowly absorbed than other sulfonylureas
half life: 7hours
duration: 10-14 hours

A

TOLAZAmide

53
Q

Second generation sulfonylureas

A

Glyburide (aka Glibenclamide)
gLIPizide
gLIMEpiride

54
Q

Second gen sulfonylureas used with caution on Px with CV DISEASE and the ELDERLY

A

gLIMEpiride

55
Q

2nd gen sulfonylurea with very loew hypoglycemic effect

A

Glyburide (aka Glibenclamide)

56
Q

dose of Glyburide (aka Glibenclamide)

A

starting dose: 2.5mg/day

maintainance: 5-10 mg/day

57
Q

contraindicated in Glyburide (aka Glibenclamide) therapy

A

hepatic and renal impairment

alcohol intake

58
Q

ADR of Glyburide (aka Glibenclamide) with alcohol intake

59
Q

2nd gen sulfonylurea with delayed absorption when taken with food (take 20min before breakfast)

60
Q

2nd gen sulfonylurea single dose 1mg use as MONOTHERAPY or in combination with insulin

A

gLIMEpiride

61
Q

1st member of MEGLITINIDE group of insulin secretagogue

A

REPAglinide

62
Q

Used for controlling pstprandial glucose excursion

A

REPAGLINIDE

63
Q

latest insulin secretagogue available clinically

A

NATEGLINIDE

64
Q

insulin secretagogue D phenylalanine derivative

A

NATEGLINIDE

65
Q

stimulates very rapid insulin release from beta cells thru CLOSURE of ATP-sensitive K channel

A

NATEGLINIDE

66
Q

Nateglinide metabolism

A

via liver CYP2C9 and CYP3A4

67
Q

reduces glucose production thru AMPK

A

BIGuanides

68
Q

BIGuanide minor MOA

A

IMPAIR renal gluconeogenesis, SLOWS GIT glucose abs
direct stimulation of glycolysis in tissues
INCREASE glucose removal in blood
REDUCE glucagon

69
Q

first line therapy for DM type 2

70
Q

insulin sparing drug

71
Q

METFORMIN dosage

A

500mg to 2.55g daily

72
Q

METFORMIN toxicity

A 
GIT disorders (anorexia, NV, abd pain, diarrhea)
DECREASE vit B12 abs
73
Q

METFORMIN contraindication

A

renal, hepatic disease, alcoholism

predispose to ANOXIA ( bec inc risk of LACTIC ACIDOSIS)

74
Q

they act to decrease insulin resistance

A

THIAZOLIDINEDIONE

75
Q

major site of THIAZOLIDINEDIONE

A

adipose tissue

76
Q

In, THIAZOLIDINEDIONE ligands of peroxisomes proliferatior activates what receptor?

A

Receptor GAMMA

77
Q

current available THIAZOLIDINEDIONE

A

PIOglitazone

ROSIglitazone

78
Q

other THIAZOLIDINEDIONEs pulled from the market due to LIVER TOXICITY

A

TROglitazone

REZULIN

79
Q

insulin sensitizer THIAZOLIDINEDIONE

A

PIOglitazone

80
Q

attaches to insulin receptors throughout the body

A

PIOglitazone (insulin sensitizer!)

81
Q

rapidly absorbed and highly protein bound THIAZOLIDINEDIONE

A

ROSIglitazone

82
Q

not recommended for type 1 DM

MONOTHERAPY for type 2 DM

A

ROSIglitazone

83
Q

ROSIglitazone adverse effects

A 
Fluid retention (presented as MILD ANEMIA, EDEMA)
Bone fracture (decrease osteoblast formation)
84
Q

alpha glucosidase inhibitors

A

ACARBOSE

MIGLITOL

85
Q

competitive inhibitors of of intestinal Alpha GLUOSIDASES

A

ACARBOSE

MIGLITOL

86
Q

Alpha GLUOSIDASES moa

A

reduces post meal glucose excursions

87
Q

sugars that can only be transported out of the GIT

A

glucose and fructose

88
Q

Alpha GLUOSIDASES with side effect of FLATULENCE and DIARRHEA

89
Q

Synthetic analog of AMYLIN

A

PRAMLINTIDE

90
Q

hyperglycemic agent modulates POST PRANDIAL GLUCOSE LEVEL

rapidly absorbed SQ admin

A

PRAMLINTIDE

91
Q

synthetic analog of Glucagon-like polypeptide 1 (GLP-1 agonist)

92
Q

1st INCRETIN therapy for Diabetes

93
Q

Adjunctive therapy in persons with type 2 DM

94
Q

EXENATIDE moa

A 
potentiation of INSULIN SECRETION
supression of POSTPRANDIAL GLUCAGON release
DECREASE gastric emptying
REDUCE appetite
REDUCES liver fat content
95
Q

EXENATIDE adr

A

Nausea, vomiting, diarrhea

risk for THYROID CA, ACUTE PANCREATITIS

96
Q

inhibitor of dipeptidyl petidase 4 (DPP-4)

A

SITAglipin

97
Q

SITAglipin MOA

A

increase GLP-1 and GIP

decreases post prandial glucose excusion

98
Q

SITAglipin common side effects

A

Nasopaharyngitis, URTI, headaches

99
Q

other DPP4 inhibitors

A

SAXAgliptin
LINAgliptin
ALOgliptin
VILDAgliptin

100
Q

What do you give in combination therapy?

A

Initial therapy: BIGuanide

2nd line: Sulfonylureas or insulin (cost-efficient) ; EXENATIDE (aggressive control)

101
Q

for concurrent mealtime administration in type 2 DM for early post prandial glucose excursion

A

combination therapy with PRAMALINTIDE

102
Q

for adjunct to oral anti diabetic therapy in type 2 DM

A

Bedtime insulin

103
Q

NOT approved for Tx of type 1 DM

A

insulin secretagogues, Tzds, biguanides, alpha glucosidase and incretin

104
Q

insulin secretagogues

A

Sulfonylureas, Meglitidines, D phenylalanine derivatives

105
Q

For concurrent meal time administration with type 1 DM who have POOR control despite optimal insulin therapy

A

Combination therapy with PRAMLINTIDE

106
Q

synthesized in alpha cells of pancreas, degraded in liver and kidney

107
Q

GLUCAGON is a precursor intermmediate of 69 AA peptide called

108
Q

Glucentin immuno reactivity found in small intestine and alpha cells

A

Gut Glucagon

109
Q

predominant form of GLP in human intestine

A

glucagon like peptide GLP-1

110
Q

potential therapeutic agent in type 2 D

A

GLP-1 aka INSULINOTROPIN

111
Q

Metabolic effects of glucagon

A

increase gluconeogenesis and ketogenesis

112
Q

clinical uses of glucagon

A 
severe hypoglycemia (for emergency)
endocrine diagnosis
beta adrenoceptor blocker overdose
radiation of bowel
113
Q

glucagon adverse reactions

114
Q

drug interaction with glucagon which result to greater risk of bleeding

115
Q

standard mode of insulin therapy

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