Pharm 6 Diabetes

Question 1

2 methods of insulin secretion

Answer 1

• Pulsatile pacemaker B cells open Ca channels

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

Question 2

Insulin molecule

Answer 2

A + B chain, C-peptide is cleaved

Question 3

Insulin metabolism

Answer 3

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

Question 4

Insulin receptor MOA (GLUT4)

Answer 4

Tetramer

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

Question 5

Insulin receptor MOA (mitogen)

Answer 5

MAP-kinase phosphorylation

Question 6

Insulin in liver

Answer 6

• Glycogen/triglyceride synthesis

- Inhibit glycogenolysis/gluconeogenesis

Question 7

Insulin in fat

Answer 7

• Glucose uptake, triglyceride storage

- Inhibit lipolysis

Question 8

Insulin in general

Answer 8

Promote anabolism, inhibit catabolism

Question 9

Insulin deficiency acidosis mechanism

Answer 9

Increase lipolysis -> ketoacids -> acidosis

Question 10

Glucose intolerance with onset during pregnancy

Answer 10

GDM - Gestational Diabetes Mellitus

Question 11

Instant type I diabetes cause

Answer 11

Total pancreatectomy

Question 12

Drug therapy provoking chronic hyperglycemia

Answer 12

Steroid therapy

Question 13

Rate limiting step for insulin absorption

Answer 13

Subcutaneous dissociation from hexamers into dimers and then monomers

Question 14

-Lispro-

Answer 14

Lysine-Proline switched, can’t form aggregates

• Ultra fast
• Take after starting meal

Question 15

-Aspart-

Answer 15

Proline replaced with aspartic acid, can’t form aggregates

-Ultra fast

Question 16

-Insulin-

Answer 16

Can be given IV

-Fast

Question 17

-NPH insulin-

Answer 17

Regular plus protamine zinc insulin (positively charged)

-Intermediate

Question 18

-Glargine-

Answer 18

Ultra slow, peakless

-Single bedtime dose

Question 19

-Determir-

Answer 19

Binds to albumin

-Ultra slow

Question 20

Insulin pump benefit

Answer 20

Controls “dawn phenomenon”

Question 21

Injection to accelerate insulin absorption

Answer 21

• Intramuscular
• Heat (exercise)
• Abdomen or buttock (blood flow)

Question 22

Compromised renal function effect on insulin

Answer 22

Reduced clearance, prolonged effectiveness

Question 23

-Pramlintide-

Answer 23

Amylin analog

• Slows postprandial glucose levels
  
  • Slow stomach, inhibit glucagon

Question 24

-Pramlintide-
Contraindications
Adverse Effects

Answer 24

• Gastroparesis

- Delayed onset of action of oral drugs

Question 25

-Exenatide- MOA indication

Answer 25

Incretin mimetic - Stimulate Insulin, inhibit Glucagon - Suppress postprandial hyperglycemia - From lizard

Question 26

GLUT4 recruiting without insulin

Answer 26

5'AMP-K | -From exercise

Question 27

Sulfonylurea MOA

Answer 27

Directly inhibit KIR -> Insulin secretion | -(normally inhibited by GLUT2 glucose)

Question 28

2 Sulfonylurea drugs

Answer 28

Glipizide | Glyburide

Question 29

Sulfonylurea binding site

Answer 29

SUR1 on inwardly-rectifying potassium channel

Question 30

Sulfonylurea effect

Answer 30

Raise insulin secretion -> correct hyperglycemia - Increase insulin sensitivity - Improve B-cell responsiveness

Question 31

Exenetide, Pramlintide main purpose

Answer 31

Suppress postprandial hyperglycemia

Question 32

-Glipizide-

Answer 32

Fastish Sulfonylurea | -Bind KIR

Question 33

-Glyburide-

Answer 33

Slower Sulfonylurea - Bind KIR - Doesn't cross placenta

Question 34

Glipizide, Glyburide | -Preferred drugs for what

Answer 34

Renal dysfunction | -(2nd gen are fecal excretion)

Question 35

Glipizide, Glyburide | -Bad drugs for what

Answer 35

Type I DM

Question 36

Drug for pregnancy

Answer 36

Glyburide

Question 37

Sulfonylurea Adverse effects

Answer 37

- Severe Hypoglycemia (overdose) | - Weight gain

Question 38

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

Answer 38

Insulin ONLY

Question 39

The Glinides

Answer 39

Repa and Nate

Question 40

Repaglinide, Nateglinide class

Answer 40

Meglitinides

Question 41

Repaglinide, Nateglinide MOA

Answer 41

Inhibit KIR, rapid insulin release

Question 42

Repaglinide, Nateglinide indication

Answer 42

Tx postprandial hyperglycemia | -Reduced risk of long-lasting hypoglycemia

Question 43

Biguanide drug

Answer 43

Metformin

Question 44

-Metformin- good for

Answer 44

Rarely produces lactic acidosis

Question 45

-Metformin- | MOA

Answer 45

Induces 5'AMPK - no effect on insulin - no hypoglycemia

Question 46

-Metformin- | indication

Answer 46

Obese diabetics, prediabetics | -(weight loss, beneficial effect on lipids)

Question 47

-Metformin- | also good for

Answer 47

Polycystic ovarian syndrome | -Hyperandrogenism insulin resistance

Question 48

Thiazolidinedione drugs

Answer 48

Glitazone - Pioglitazone - Rosiglitazone

Question 49

-Pioglitazone, Rosiglitazone- | MOA

Answer 49

PPARy ligand | -(peroxisome proliferator-activated receptor) nuclear hormone

Question 50

-Pioglitazone, Rosiglitazone- | target genes

Answer 50

GLUT4 and GLUT1 increase | -Increase insulin sensitivity

Question 51

-Rosiglitazone, Pioglitazone- | AE

Answer 51

Black Box for heart failure | -Rosiglitazone - angina, MI

Question 52

-Acarbose, Miglitol- | MOA

Answer 52

a glucosidase inhibitors | -Delay carb digestion, absorption

Question 53

-Acarbose, Miglitol- | administration

Answer 53

taken with first bite of meal

Question 54

-SitaGLIPTIN, SaxaGLIPTIN- | MOA

Answer 54

DPP-4 inhibitors | -slow stomach emptying

Question 55

-Diazoxide- | MOA

Answer 55

Hyperglycemic agent - opposite effect of sulfonylureas (KIR) - inhibits insulin release, not synthesis

Question 56

Sulfonylurea drugs

Answer 56

Glipizide | Glyburide

Question 57

-Diazoxide- | indication

Answer 57

Insulinomas

Question 58

-Glucagon- | MOA

Answer 58

G-protein -> liver glycogenolysis, gluconeogenesis

Question 59

-Glucagon- | indication

Answer 59

Severe hypoglycemia due to DM Tx

Question 60

-Orlistat- | MOA

Answer 60

Inhibit GI lipases and TG hydrolysis | -inhibit fat absorption

Question 61

-Pramlintine, Exenetide- | MOA

Answer 61

Slow gastric emptying