Pharm: Insulin, sulfonylureas, meglitinides, GLP-1 agonists, DPP-4 inhibitors Flashcards
List the rapid-acting, short-duration insulin analogs (great for postprandial needs).
glulisine, aspart, and lispro
“Girls and Lads” sign on the tall tower - like the tall peak in insulin
Why are glulisine, aspart and lispro agents fast-acting?
They don’t polyermize like insulin because of amino-acid modifications.
The two intermediate-acting insulin analgos are __________. (These form dimers.)
regular insulin and NPH (neutral protamine hagedorn) insulin
Think of the “Rest Now” sign above the more gradual peak on the witch’s house.
Insulin induces __________ receptor translocation.
GLUT4 (think of the four door)
The only insulin drug that can be given IV is ________. Subcutaneous insulin is harder to control.
regular insulin (like the IVy under the “Rest” sign
The most potent stimulator of insulin release is _________.
glucose (like LangerHansel’s candy that is super large)
The two long-acting insulins are ______________.
detemir and glargine
“Don’t Go” sign under the flat part of the roof
Hypoglycemia presents with signs similar to ____________.
autonomic hyperactivity (tachycardia, palpitations, sweating and nausea)
“Glucagon… for when you glucose _____________.” AKA When do you have high levels of glucagon?
is gone (fasting state)
How does sulfonylurea work?
It binds and closes the potassium channels in the beta cells, stimulating the depolarization that causes release of insulin.
(Think of the sulfonylurea swan in the beta cell pond behind the CLOSED K+ banana garden.)
The first-generation sulfonylurea drugs end in the _________ suffix.
- amide
ex: tolbutamide and chlorpropamide
(Think of how the sulfonylurea swan is in A MaID outfit)
The second-generation sulfonylurea drugs are _______, _______, and _______.
glyburide, glipizide, and glimepiride (think of the TWO little swans RIDing on mama swan’s back and the one ZIPing along side her)
_______ has the shortest half-life of the second-generation sulfonylurea drugs.
glipizide- therefore less hypoglycemia (glipi-sig-sagging around)
What drug class works the same way as the sulfonylureas?
The meglitinides (like the father goose GLIDing above the swan): rapaglinide and nateglinide
The meglitinides do not contain ________ and thus ideal for patients with allergies.
sulfa (because the father goose- GLIDing above- does not lay stinky sulfur eggs)
The main side effect of sulfonylureas and meglitinides are _________.
hypoglycemia particularly in the long-acting forms (think of all the fallen overripe candies)
Why do meglitinides and sulfonylureas cause weight gain?
Because insulin- induced to release- causes anabolism/growth (think of the fat witch under the tree eating the overripe candy)
Do not _________ while taking first-generation sulfonylureas.
drink alcohol- because it can lead to a disulfiram-like reaction (think of the “Do Not Drink” sign by the swan lake)
The GLP-1 analogs are ______ and _______.
exenatide and liraglutide (the witch with her ExenaTIDE detergent)
GLP is released from ___________.
intestinal L cells
In the muscles, insulin stimulates _________.
glycogen and protein synthesis (think of the glycogen-glazed ham)
What does GLP-1 do?
- Induces satiety
- Stimulates insulin release
- Reducing glucagon release
- Delaying gastric emptying
(The galling packets of glucagon; stopped up stomach)
What does DPP-4 stand for?
dipeptidyl peptidase 4
The DPP-4 inhibitos end in ________.
-gliptin: sitaliptin, saxagliptin, and linagliptin (think of the DriPPing cloths cLIPped in clothes pins)
What does glucagon do?
Stimulates gluconeogensis and glycogenolysis (processes that increase blood sugar)
What side effects can the DPP-4 inhibitors have?
Nasopharyngitis, URIs (the clip on the witch’s nose), and acute pancreatitis (witch squeezing the pancreas sponge)
True or flase: the GLP-1 agonists and DPP4- inhibitors can cause hypoglycemia.
False. Their glucose-release effects stops when glucose normalizes.
________ open in response to closing of potassium channels.
Voltage-sensitive calcium channels (think of the calci-yum ice-cream flowers bending over the fence when Gretel grabs the candy)
Insulin does what in liver cells?
Increases glycogen storage (think of the liver-shaped jar being filled with glycogen candies)
In adipocytes, insulin ____________.
Stimulates the conversion of carbohydrates into fat
Insulin binds to a ___________ type of receptor.
tyrosine kinase (just like the tyrosine tire swing)
Remember that insulin administration causes a drop in __________ in addition to glucose.
potassium (just like the banana bitten off by the old hag)
Increased intracellular ATP leads to ________ of potassium channels.
closure (think of the closed gate of the K+ banana graden)
Beta cells produce insulin in response to beta-____ receptor simulation (among many other things).
2 (think of the LangerHansle with the beta-2-tuba)
Glucose increases ___________ (molcule) in beta cells.
ATP (from glycolysis)
