Pharmacology II Flashcards
How is Diabetes Mellitus characterized?
- Hyperglycemia with derangedd secretion of insulin
- Thickening of basement membranes of capillaries
- Late complications involving tissues that DO NOT require insulin for glucose uptake (retina, glomerulus, and peripheral nerves resulting in blindness, renal failure, and neuropathy)
What is the difference between Type I and Type II DM?
Type I: lack of insulin release by B-cells
Type II: Insensitivity to insulin by receptive tissue (also sometimes low insulin release)
What is the treatment for Type I DM? What are the delayed preparations?
Insulin
Forms:
Insulin Lispro (rapid onset, but shorter duration)
Isophane (NPH)
Insulin glargine (maintains glucose at around 130mg/dl for ~20hr)
Insulin Zinc extended
What are the short acting insulin preparations?
Insulin Aspart
Insulin glulisine
What is the treatmet for Type II diabetes?
- Diet and Exercise
- Oral hypoglycemics (& euglycemics)
- Insulin may be used
What are pharmacological treatments available to treat Type II DM? (think general groups)
Sulfonylureas
Metformin
Acarbose
Thiazolidinediones
Exenatide
SGLT2 Inhibitors
What are the different sulfonylureas?
Tolbutamide
Glyburide
Glipizide
Gliclazide
Glimepiride
What is the MOA of sulfonylureas in treating T2 DM?
Sulfonylureas bind to the same K+ channel on membrane of pancreatic beta-cells that is regulated by glucose metabolism
–> Leads to depolarization of cells and insulin release
What are side effectsof sulfonylureas?
Prolonged and severe hypoglycemia
(May be FATAL!)
Symptoms:
Sweating
Hunger
parasthesis
Tremor
Anxiety
Treat with fast acting glucose:
OJ
Coke
IV glucose
What is reaglinide?
Not a sulfonylurea, but act just like one
–> binds to K+ channels to cause depolarization and insulin release
What is metformin? MOA?
A Biguanide used to reduce hyperglycemia
–> Reduces hepatic glucose output by inhibiting gluconeogenesis
What are adverse effects of metformin? And what is the key positive effect?
Never causes hypoglycemia
Adverse Effects:
Lactic acidosis
(only seen in patients with renal failure or CHF)
Diarrhea
What is Acarbose? MOA?
An alpha-glucosidase inhibitor
–> Acts by inhibiting carbohydrate breakdown in the intestine
–> Reduces glucose uptake from intestine - reduces post-prandial spike in blood glucose
What are side effects of Acarbose?
Alone, will not cause hypoglycemia - but if taken with sulfonylurea & hypoglycemia occurs, must take glucose, not sucrose (patient should keep glucose tablets with them)
Abdominal bloating
diarrhea
flatulence
What are the thiazolidinediones? MOA?
Pioglitazone
rosiglitazone
ciglitazone
Selective PPAR-gamma agonists (peroxisome proliferator-activated recetpor-gamma)
–> Increases insulin sensitivity
Possibly by increasing GLUT4 in muscle and adipose
–> Decreases gluconeogenesis in liver
(aka ‘glitazones’)
