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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > PHARM - Drugs Used to Treat Diabetes - Week 8 > Flashcards

PHARM - Drugs Used to Treat Diabetes - Week 8 Flashcards

1
Q

What cell is responsible for the exocrine function of the pancreas?

A

Acinar cells

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2
Q

What two cells are responsible for the endocrine function of the pancreas? What is the umbrella term for them and what do they secrete?

A

Islets of Langerhans

  • Beta cells secrete insulin
  • Alpha cells secrete glucagon
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3
Q

Describe in 4 steps the physiological response to high blood glucose levels.

A

Elevated blood glucose levels
Insulin is released by beta cells in the pancreas
Fat, muscle, and liver cells take in glucose from the blood
Normal blood glucose levels reached

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4
Q

How are glucose levels reduced in the cell (2)?

A

Conversion to glycogen and synthesis slowed

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5
Q

Describe in 4 steps the physiological response to low blood glucose levels.

A

Decreased blood glucose levels
Glucagon is released by alpha cells in the pancreas
Liver cells release glucose into the blood
Normal blood glucose levels reached

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6
Q

What two hormones are involved in increasing blood glucose levels?

A

Adrenaline and hydrocortisone

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7
Q

What occurs as a result of the insulin signalling cascade?

A

Recruitment of GLUT4 transporter proteins to the cell membrane

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8
Q

Define type 1 diabetes in terms of insulin availability.

A

Absolute lack of insulin

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9
Q

When does type 1 diabetes usually occur (2)?

A

Juvenile onset typically <20 years

Viral initiated autoimmune destruction of islet cells

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10
Q

Consider viral-initiated type 1 diabetes. What are individuals with this predisposed to and why?

A

Ketoacidosis due to the breakdown of protein and fats

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11
Q

Name 4 symptoms of type 1 diabetes.

A

Muscle cramps
Faintness
Cardiac arrythmia
Infection

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12
Q

Define type 2 diabetes in terms of insulin availability.

A

Relative lack of insulin

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13
Q

Name 2 possible mechanisms for type 2 diabetes and a cause if applicable.

A

Impaired secretion of insulin

Insulin resistance caused by impaired receptor function

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14
Q

Name 3 possible causes of type 2 diabetes in middle-aged individuals.

A

Overweight/obese
Physically inactive
Family history

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15
Q

Describe the 1st and 2nd phase of responses to high blood glucose levels for insulin in normal, type 1, and type 2 individuals.

A

1st phase: release of stored insulin
2nd phase: continued release of stored and newly synthesised insulin
Normal - sharp rise in blood insulin levels, followed by a steady decline, followed by a a steady increase, then steady decrease.
Type 1 - flat line
Type 2 - steady increase only after a significant amount of time, followed by a steady decrease.
The peak for blood insulin levels in type 2 diabetes is significantly lower than that of of the initial increase in normal individuals.
The increase in type 2 matches the second increase in glucose in normal individuals.

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16
Q

Define diabetes mellitus.

A

The chronic disturbance of carbohydrate and lipid metabolism resulting from absolute or relative lack of insulin.

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17
Q

Name 6 secondary complications associated with diabetes.

A 
Hyperglycaemia
Polyuria
Atherosclerosis
Neuropathy
Nephropathy
Retinopathy
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18
Q

Name the four aims of diabetes therapy.

A

Glucose homeostasis (4-8mmol/L)
Restore metabolism
Relieve symptoms
Reduce long-term complications

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19
Q

Name 11 symptoms of diabetes.

A 
Polyphagia
Polydipsia
Polyuria
Blurred vision
Weight loss
Weakness
Dry itchy skin
Impaired wound healing
Dry mouth
Recurrent infections
Impotence
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20
Q

What is mandatory in the treatment of diabetes? Describe three components to this.

A

Dietary and lifestyle modifications

  • carbohydrate intake
  • exercise
  • stop smoking
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21
Q

Name two treatment options for type 1 diabetes.

A

Insulin injection

Islet cell transplantation

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22
Q

Name a treatment option for type 2 diabetes.

A

Hypoglycaemic agents

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23
Q

How is insulin administered?

A

Subcutaneously

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24
Q

Name three sources for insulin.

A

Porcine, bovine, and human

Human using recombinant DNA

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25
Q

What is the standard for dosage on insulin for the treatment of type 1 diabetes (4)?

A

No standard

-depends on weight, diet, and exercise

26
Q

What is the aim of appropriate dosage for treating type 1 diabetes?

A

Avoiding hyperglycaemia

27
Q

How is blood glucose monitored (what molecule is measured)?

A

Levels of glycated haemoglobin

28
Q

Name three adverse effects of treating type 1 diabetes and what this condition is called.

A

Hypoglycaemia

  • faintness
  • sweating
  • tremors
29
Q

Name four possible drug interactions when treating type 1 diabetes.

A

Beta blockers
Corticosteroids
Diuretics
Alcohol

30
Q

Consider type 2 diabetes caused by a relative lack of insulin. What kind of drug action is desirable to treat it? Give an example.

A

Drugs that stimulate the pancreas to release insulin

Sulphonylureas

31
Q

Consider type 2 diabetes caused by insulin resistance. What kind of drug action is desirable to treat it? Give two examples.

A

Drugs that sensitise the body to insulin and/or control hepatic glucose production
Biguanides
Thiazolidinediones

32
Q

What kind of drug action is desirable to treat type 2 diabetes by targeting glucose absorption? Give an example.

A

Drugs that slow the absorption of carbohydrates

Alpha-glucosidase inhibitors

33
Q

What kind of drug action is desirable to treat type 2 diabetes by targeting glucose reabsorption? give an example.

A

Drugs that increase excretion of glucose

Sodium glucose cotransporter 2 inhibitors

34
Q

What kind of drug action is desirable to treat type 2 diabetes by targeting incretins? give an example.

A

Drugs that regulate insulin and glucagon

Incretin mimetics and enhancers

35
Q

What drug class is the first-line treatment for diabetes type 2? Name an example.

A

Biguanides - metformin

36
Q

Name four mechanisms of action for metformin.

A

Increased insulin-mediated glucose uptake
Reduced hepatic glucose production
Decreased carbohydrate absorption
Reduced LDL cholesterol and triglyceride levels

37
Q

How is metformin administered?

A

Orally

38
Q

How often is metformin administered typically?

A

Once a day

39
Q

Name four advarse effects of metformin.

A

Diarrhoea
Nausea
Abdominal discomfort
No weight gain with possible modest weight loss

40
Q

What can occur if metformin is improperly prescribed.

A

Lactic acidosis

41
Q

In patients with what 2 diseases is metformin contraindicated?

A

Renal and hepatic diseases

42
Q

What line of treatment are sulphonyureas?

A

First or second.

43
Q

Describe the mechanism of action for sulphonyureas (5).

A

Acts on B cells to stimulate insulin secretion

Binds Katp channel reducing K+ permeability and causing Ca2+ entry and insulin release.

44
Q

How are sulphonyireas administered? How often?

A

Orally once daily

45
Q

Do sulphonyureas cross the placenta and/or enter breast milk?

A

Yes to both

46
Q

How are sulphonyureas removed from the body?

A

Excreted via the kidney

47
Q

Name two adverse effects of sulphonyureas.

A

Hypoglycaemia

Weight gain

48
Q

Where in the kidney are sodium glucose cotransporter 2 proteins found? What percentage of glucose do they reabsorb?

A

Along the tubules following bowmans capsule. Reabsorb up to 90%, with the remaining taken care of by cotransporter 1.

49
Q

How are SGLT2 inhibitors administered, how often, and how are they removed?

A

Orally once daily

Excreted via kidney

50
Q

If something is administered once daily, what does that suggest about its half life?

A

Long half life

51
Q

Name 6 adverse effects of using SGLT2 inhibitors.

A 
Genital infections
Polyuria
Dysuria
Modest weight loss
Urinary tract infections
Thirst
52
Q

Why should SGLT2 inhibitors be used with precaution in the elderly (3)?

A

It can cause volume depletion, hypotension, and fainting

53
Q

What effect do SGLT2 inhibitors have on loop diuretics and thiazides? What should be done as a result of this?

A

It can increase their effects. Precaution should be taken when co-administering these drugs.

54
Q

What effect do incretins have on the pancreas (3) and what receptor do they target?

A

Increases insulin secretion
Decreases glucagon secretion
Increases insulin biosynthesis

55
Q

What effect do incretins have on the liver?

A

Decreased glucose production

56
Q

What effect do incretins have on adipose and muscle tissue?

A

Increases glucose uptake/storage

57
Q

What effect do incretins have on the stomach?

A

Decreases gastric emptying

58
Q

What effect do incretins have on the brain (2)?

A

Increases neuroprotection

Decreases apetite

59
Q

How are glucagon-like peptide 1 receptor agonists administered?

A

Subcutaeneous injection

60
Q

Name four mechanisms of action for GLP-1 receptor agonists.

A

Potentiates glucose mediated insulin secretion
Suppresses glucagon secretion
Slows gastric emptying
Loss of appetite

61
Q

What is the central action of GLP-1 receptor agonists?

A

Loss of appetite

62
Q

Name 7 adverse effects of GLP-1 receptor agonists.

A 
Nausea
Vomiting
Diarrhoea
Weight loss
Antibody formation
Immune reactions
Pancreatitis

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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