Pharm Test 4

Question 1

Beta cells produce

Answer 1

insulin, proinsulin, C peptide and amylin

Question 2

what is amylin?

Answer 2

something that suppresses production of glucagon which is the opposite of insulin

Question 3

what do alpha cells release?

Answer 3

glucagon

Question 4

what do delta cells release?

Answer 4

somatostatin

Question 5

what is an insulin secretagog?

Answer 5

glucose, something that makes the body secrete insulin

Question 6

what are the 2 major types of secretory tissues that are in the pancreas?

Answer 6

exocrine gland-digestive enzymes
endocrine gland- alpha, beta, delta cells

Question 7

where are the alpha beta and delta cells?

Answer 7

in the islets of langerhans

Question 8

insulin receptors are what kind of receptor?

Answer 8

tyrosine kinase

Question 9

what does insulin binding to insulin receptors do?

Answer 9

translocates glucose transporters to the cell wall

Question 10

we always have a ____ level of insulin

Answer 10

constitutive

Question 11

describe homeostasis processes when bg rises.

Answer 11

bg rises
insulin is released from beta cells
liver stores some as glycogen
bc insulin came out and was bound to insulin receptors now glucose transporters are moved to the cell wall
this pulls glucose into the cell

Question 12

glucagon causes breakdown of _______ in the liver to _______ bg

Answer 12

glycogen
raise

Question 13

type 1 diabetics are

Answer 13

insulin dependent- autoimmune thing where the body doesn’t produce insulin

Question 14

type 2 diabetics are ________ on insulin

Answer 14

non-dependent

Question 15

type 4 diabetes happens during

Answer 15

pregnancy. Pregnancy hormones block insulin receptors.

Question 16

type 3 diabetes is from

Answer 16

pancreatitis, drug therapy, illness, etc.

Question 17

cardinal symptoms of diabetes

Answer 17

polydipsia
polyphagia
polyuria

Question 18

Describe the sorbitol pathway, and why it leads to peripheral neuropathy and blindness.

Answer 18

Sorbitol and fructose increase intracellular osmotic pressure (attracts water leading to cell injury)
More glucose means more sorbitol, Sorbitol can not leave the cell, excess sorbitol in cell, more water rushes in, cells burst

Question 19

2 types of diabetes tests:

Answer 19

fasting BG
glucose tolerance test

Question 20

Describe the structure of insulin

Answer 20

long string of amino acids
Broken down into beta and alpha chain held together by disulfide linkages
They are in the active form when they are together
The proform has a C peptide. Only the body makes c peptide.

Question 21

what is leptin?

Answer 21

something that makes you feel full

Question 22

what are the types of glucose transporters?

Answer 22

glut 1,2,4

Question 23

4 main types of insulin preparations :

Answer 23

rapid acting
short acting
intermediate acting
long acting

Question 24

what are the rapid acting insulins?

Answer 24

Lispro, aspart, glulisine

Question 25

what are the short acting insulins?

Answer 25

Novolin, humulin

Question 26

what are the intermediate acting insulins?

Answer 26

Neutral protamine Hagedorn (NPH)

Question 27

what are the long acting insulins?

Answer 27

Glargine, detemir

Question 28

what does the tight control of bg look like?

Answer 28

Basal + bolus (calculated) Long acting once per day, rapid acting before meals

Question 29

what does the conventional control of bg look like?

Answer 29

70/30 premixes

Question 30

illness makes your ____ go up so you need more insulin

Answer 30

bg

Question 31

1 unit of Rapid acting insulin disposes ____ of carbohydrates

Answer 31

12-15g

Question 32

If lunch intake has 60 carbs how many units of rapid acting insulin should you give?

Answer 32

4 units. 60/15=4

Question 33

1 unit of rapid acting drops the bg by

Answer 33

50mg/dl

Question 34

if bg is 200 you should give how many units of rapid acting insulin?

Answer 34

2 units 200/50=100

Question 35

symptoms of hypoglycemia

Answer 35

Anxiety, blurred vision, palpitations, shakiness, slurred speech, sweating

Question 36

treatment for hypoglycemia

Answer 36

Glucose / simple sugars: 3-4 glucose tablets, ½ can of soda Glucagon injection 1 mg IM, IV, SQ - may repeat in 20 minutes if needed Inhibits insulin release, raises BG levels

Question 37

how does glucagon work?

Answer 37

inhibits insulin release from beta cells in the liver

Question 38

8 classes of oral antidiabetic drugs

Answer 38

biguanines insulin secretagogues thiazolidinediones alpha-glucosidase inhibitors bile acid sequestrant amylin analogs gliflozin incretin based therapies BIT A BAGI

Question 39

what is first line therapy oral antidiabetic?

Answer 39

biguanide

Question 40

how does biguanide work? drug example?

Answer 40

Slows down gluconeogenesis (glucose production in liver) metformin

Question 41

MOA of insulin secretagogue?

Answer 41

makes us produce more insulin via binding to K+ channels

Question 42

MOA of Thiazolidinediones (TZDs

Answer 42

Increase insulin signal transduction Increased effect of Glut 4 going to cell surface

Question 43

MOA of Alpha-glucosidase inhibitors

Answer 43

Blocks digestion of complex carbohydrates - smelly farts

Question 44

MOA of Bile acid sequestrant

Answer 44

Big gloop that goes through intestine and blocks glucose from being absorbed so take with food

Question 45

MOA of amylin analogs

Answer 45

suppresses glucagon release

Question 46

MOA of gliflozin

Answer 46

targets SGLT2 transporters. blocks glucose uptake in the PCT more glucose going out in urine, also works as an osmotic diuretic (good for BP reduction)

Question 47

side effects of gliflozins

Answer 47

Dehydration Necrosis of genital region High glucose in urine → bacteria in genital region fed a steady diet of glucose bc they are peeing out glucose, especially bad with bedridden patients

Question 48

pts with dm have a LDL goal of

Answer 48

<100

Question 49

Diagram a treatment algorithm for patients with Type II diabetes.

Answer 49

**Combination therapy** Biguanide Biguanide + Insulin OR Biguanide + Secretagogue Biguanide + 2-3 other classes Intensive Insulin Therapy