Pancreatic Hormones and Anti-Diabetic Drugs Flashcards
soluble crystalline zinc insulin that is now made by recombinant DNA techniques to produce a molecular identical to that of human insulin
regular insulin
Total daily insulin requirement in units is equal to the weight in pounds divided by 4; The type of therapy prescribed in patients with type 1 DM and as well as some type 2 DM
INTENSIVE Insulin Therapy
safest sulfonylureas for elderly diabetics
Tolbutamide
MOA of Thiazolidindiones
decrease insulin resistance; Ligands of peroxisomes proliferator activated receptor gamma (PPAR-y)
Drug Interaction of Pioglitazone
Gemfibrozil
in alpha glucosidase inhibitor treatment, only 2 sugars can be transported out of the human lumen. What are these?
Glucose Fructose
If Chlorpropamide is given >500mg daily, it increases the risk of
jaundice
Chlorpropamide is contraindicated in
Elderly
Approved for use for pre-prandial use in person with type 1 & 2 DM
Pramlintide
Rosiglitazone adverse effect
Fluid retention, Heart Failure, Bone fracture
this appears to be reduced during long term metformin therapy
Absorption of Vit B12
intermediate acting insulin analogs
Neutral protamine hagedorn/isophane insulin
MOA of insulin secretagouges
Increase insulin release from the pancreas Reduction of serum glucagon levels Closure of K channels in extrapancreatic tissue
Soluble “peakless” insulin analog
Insulin Glargine
1st Generation sulfonylureas that is well absorbed but rapidly metabolized in the liver
Tolbutamide
1st Generation sulfonylureas that is slowly metabolized in the liver
Chlorpropamide
promotes glucose uptake in adipose tissues and utilization and modulates synthesis of lipid hormones or cytokines
Thiazolidinediones
Stimulates very rapid and transient release of insulin from beta cells thru closure of ATP-sensitive K channel
Nateglinide
alpha glucosidase inhibitors
Acarbose Miglitol
a condition where low titer of circulating Ig G anti insulin antibodies that neutralize the action of insulin to neglible extent develops in most insulin treated patient
Immune insulin resistance
for controlling postprandial glucose excursion
Repaglinide
delays the digestion and absorption of starch and disaccharides
alpha glucosidase inhibitors
MOAof Sitagliptin
Inhibits Dipeptidyl Peptidase Increases circulating levels of GLIP1 and GIP
delayed absorption when taken with food
Glipezide
First incretin therapy to become available for treatment of diabetes
Exenatide
diagnosed in person with type 2 DM , characterized by profound hyperglycemia and dehydration
Hyperosmolar Hyperglycemic Syndrome
in combination therapy, what is the initial therapy?
Biguanides
short acting insulin analog
Regular insulin
Insulin sensitizer
Pioglitazone
First line therapy for type 2 DM
Metformin
an abnormal or degenerative condition of the body’s adipose tissue
Lipodystrophy
Second Generation Sulfonylureas with shortest half life
Glipezide
Most recently developed long acting insulin analogue Dose dependent onset of action
Insulin Detemir
1st Generation sulfonylureas
Tolbutamide Chlorpropamide Tolazamide
Complications of insulin therapy
Hypoglycemia Immunopathology of Insulin therapy Lipodystrophy
More slowly absorbed than other sulfonylureas
Tolazamide
Reduces Cardiovascular events in Diabetes
Acarbose
Categories of Oral Anti-Diabetic Agents
- Secretagougues: (Sulfonylureas, Meglitinide, D-phenylalanine derivatives) 2. Biguanides 3.Thiazolidinediones 4. a-glucosidase inhibitors 5. Incretin based 6. Amylin analog
Minor MOA of Biguanides
Impairment of renal gluconeogenesis, slowing of glucose absorption from GIT Increase glucose to lactate conversion by enterocytes Direct stimulation of glycolysis in tissues Increased glucose removal from blood Reduction of plasma glucagon levels
ADR of Acarbose
Flatulence, diarrhea and abdominal pain
MOA of Glucagon-like Polypeptide (GLP-1) receptor agonist
Potentiation of glucose mediated insulin secretion
Rapid acting insulin analogs
Insulin Lispro Insulin Aspart Insulin Glulisine
Second Generation Sulfonylureas that causes flushing with alcohol ingestion
Glyburide
in combination therapy, what is the 2nd line of therapy?
Insulin Insulin Secretagogues TZD Incretin based therapy Amylin analog Glucosidase inhibitor
Glucagon-like Polypeptide (GLP-1) receptor agonist
Exenatide
Major MOA of Biguanides
Activation of AMP kinase to reduce hepatic glucose production
most common complication of insulin therapy and usually results from inadequate carbohydrate consumption, unusual physical exertion or too large dose of insulin
Hypoglycemia
Nateglinide is important in treatment of
isolated post prandial fasting glucose level
Drug interaction of glucagon
Warfarin
does not increase weight and provoke hypoglycemia (insulin sparing drug)
Metformin
long acting insulin analogs
Insulin detemir Insulin Glargine
Prescribed only for certain people with type 2 DM who are felt not to benefit from intensive glucose control
Conventional Insulin Therapy
Single dose of 1mg has been shown to be effective
Glimepiride
Not recommended for use in type 1 DM; Approved for use as monotherapy for type 2 DM
Rosiglitazone
Referred as sliding scale regimen
Conventional Insulin Therapy
adjunctive therapy in persons with type 2 DM treated with metformin or metformin plus sulfonylureas with suboptimal glycemic control
Exenatide
Provide reproducible, convenient background insulin replacement
Insulin Glargine
Treatment for DKA
Aggressive IV infusion and Insulin therapy
Shown to lower HvA1c level by 0.7%
Sitagliptin
Clinical consequences of regular insulin administration
early postprandial hyperglycemia late postprandial hypoglycemia
Glucagon precursor intermediate made up of 69 amino acid peptide
Glucentin
Synthetic analog of Amylin
Pramlintide
Second Generation Sulfonylureas
Glyburide (Glibenclamide) Glipezide Glimepiride
major site of action of TZD’s
Adipose Tissue
insulin delivery systems
Standard mode of insulin treatment (SQ) Portable Pen Injections Continuous Subcutaneous insulin infusion device (CSIID)
