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Test 9 > Pharm 6 Diabetes > Flashcards

Pharm 6 Diabetes Flashcards

1
Q

2 methods of insulin secretion

A
  • Pulsatile pacemaker B cells open Ca channels

- Glucose through GLUT2 -> ATP -> block KIR channel -> Ca opens

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2
Q

Insulin molecule

A

A + B chain, C-peptide is cleaved

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3
Q

Insulin metabolism

A

50% degraded in liver, 50% in other target tissues

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4
Q

Insulin receptor MOA (GLUT4)

A

Tetramer

-Insulin binds to a-subunits -> b-subunits autophosphorylate -> tyrosine kinase

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5
Q

Insulin receptor MOA (mitogen)

A

MAP-kinase phosphorylation

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6
Q

Insulin in liver

A
  • Glycogen/triglyceride synthesis

- Inhibit glycogenolysis/gluconeogenesis

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7
Q

Insulin in fat

A
  • Glucose uptake, triglyceride storage

- Inhibit lipolysis

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8
Q

Insulin in general

A

Promote anabolism, inhibit catabolism

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9
Q

Insulin deficiency acidosis mechanism

A

Increase lipolysis -> ketoacids -> acidosis

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10
Q

Glucose intolerance with onset during pregnancy

A

GDM - Gestational Diabetes Mellitus

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11
Q

Instant type I diabetes cause

A

Total pancreatectomy

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12
Q

Drug therapy provoking chronic hyperglycemia

A

Steroid therapy

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13
Q

Rate limiting step for insulin absorption

A

Subcutaneous dissociation from hexamers into dimers and then monomers

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14
Q

-Lispro-

A

Lysine-Proline switched, can’t form aggregates

  • Ultra fast
  • Take after starting meal
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15
Q

-Aspart-

A

Proline replaced with aspartic acid, can’t form aggregates

-Ultra fast

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16
Q

-Insulin-

A

Can be given IV

-Fast

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17
Q

-NPH insulin-

A

Regular plus protamine zinc insulin (positively charged)

-Intermediate

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18
Q

-Glargine-

A

Ultra slow, peakless

-Single bedtime dose

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19
Q

-Determir-

A

Binds to albumin

-Ultra slow

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20
Q

Insulin pump benefit

A

Controls “dawn phenomenon”

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21
Q

Injection to accelerate insulin absorption

A
  • Intramuscular
  • Heat (exercise)
  • Abdomen or buttock (blood flow)
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22
Q

Compromised renal function effect on insulin

A

Reduced clearance, prolonged effectiveness

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23
Q

-Pramlintide-

A

Amylin analog

  • Slows postprandial glucose levels
    • Slow stomach, inhibit glucagon
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24
Q

-Pramlintide-
Contraindications
Adverse Effects

A
  • Gastroparesis

- Delayed onset of action of oral drugs

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25
Q

-Exenatide-
MOA
indication

A

Incretin mimetic

  • Stimulate Insulin, inhibit Glucagon
  • Suppress postprandial hyperglycemia
  • From lizard
26
Q

GLUT4 recruiting without insulin

A

5’AMP-K

-From exercise

27
Q

Sulfonylurea MOA

A

Directly inhibit KIR -> Insulin secretion

-(normally inhibited by GLUT2 glucose)

28
Q

2 Sulfonylurea drugs

A

Glipizide

Glyburide

29
Q

Sulfonylurea binding site

A

SUR1 on inwardly-rectifying potassium channel

30
Q

Sulfonylurea effect

A

Raise insulin secretion -> correct hyperglycemia

  • Increase insulin sensitivity
  • Improve B-cell responsiveness
31
Q

Exenetide, Pramlintide main purpose

A

Suppress postprandial hyperglycemia

32
Q

-Glipizide-

A

Fastish Sulfonylurea

-Bind KIR

33
Q

-Glyburide-

A

Slower Sulfonylurea

  • Bind KIR
  • Doesn’t cross placenta
34
Q

Glipizide, Glyburide

-Preferred drugs for what

A

Renal dysfunction

-(2nd gen are fecal excretion)

35
Q

Glipizide, Glyburide

-Bad drugs for what

A

Type I DM

36
Q

Drug for pregnancy

A

Glyburide

37
Q

Sulfonylurea Adverse effects

A
  • Severe Hypoglycemia (overdose)

- Weight gain

38
Q

Drug to use for surgery, severe infections, severe stress or trauma, severe hepatic or renal failure

A

Insulin ONLY

39
Q

The Glinides

A

Repa and Nate

40
Q

Repaglinide, Nateglinide class

A

Meglitinides

41
Q

Repaglinide, Nateglinide MOA

A

Inhibit KIR, rapid insulin release

42
Q

Repaglinide, Nateglinide indication

A

Tx postprandial hyperglycemia

-Reduced risk of long-lasting hypoglycemia

43
Q

Biguanide drug

A

Metformin

44
Q

-Metformin- good for

A

Rarely produces lactic acidosis

45
Q

-Metformin-

MOA

A

Induces 5’AMPK

  • no effect on insulin
    • no hypoglycemia
46
Q

-Metformin-

indication

A

Obese diabetics, prediabetics

-(weight loss, beneficial effect on lipids)

47
Q

-Metformin-

also good for

A

Polycystic ovarian syndrome

-Hyperandrogenism insulin resistance

48
Q

Thiazolidinedione drugs

A

Glitazone

  • Pioglitazone
  • Rosiglitazone
49
Q

-Pioglitazone, Rosiglitazone-

MOA

A

PPARy ligand

-(peroxisome proliferator-activated receptor) nuclear hormone

50
Q

-Pioglitazone, Rosiglitazone-

target genes

A

GLUT4 and GLUT1 increase

-Increase insulin sensitivity

51
Q

-Rosiglitazone, Pioglitazone-

AE

A

Black Box for heart failure

-Rosiglitazone - angina, MI

52
Q

-Acarbose, Miglitol-

MOA

A

a glucosidase inhibitors

-Delay carb digestion, absorption

53
Q

-Acarbose, Miglitol-

administration

A

taken with first bite of meal

54
Q

-SitaGLIPTIN, SaxaGLIPTIN-

MOA

A

DPP-4 inhibitors

-slow stomach emptying

55
Q

-Diazoxide-

MOA

A

Hyperglycemic agent

  • opposite effect of sulfonylureas (KIR)
  • inhibits insulin release, not synthesis
56
Q

Sulfonylurea drugs

A

Glipizide

Glyburide

57
Q

-Diazoxide-

indication

A

Insulinomas

58
Q

-Glucagon-

MOA

A

G-protein -> liver glycogenolysis, gluconeogenesis

59
Q

-Glucagon-

indication

A

Severe hypoglycemia due to DM Tx

60
Q

-Orlistat-

MOA

A

Inhibit GI lipases and TG hydrolysis

-inhibit fat absorption

61
Q

-Pramlintine, Exenetide-

MOA

A

Slow gastric emptying

Test 9 (17 decks)

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