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GERR > Pharmacology - Treatment of Diabetes 1 > Flashcards

Pharmacology - Treatment of Diabetes 1 Flashcards

1
Q

a metabolic disorder of multiple aetiology characterised by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism as a result of defects in insulin secretion, action or both

A

diabetes mellitus

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2
Q

3 complications of diabetes

A

microvascular - retinopathy
macrovascular - atherosclerosis
neuropathy

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3
Q

which type of diabetes is known as insulin dependent

a.type 1
b.type 2
c.diabetes insipidus
d.diabetes mellitus

A

a.type 1

pancreatic B cells are destroyed , no insulin is made

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4
Q

which type of diabetes is known as non insulin dependent diabetes

a.type 1
b.type 2
c.diabetes insipidus
d.diabetes mellitus

A

type 2

insulin stops working at its target tissue (muscle)

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5
Q

patient with diabetes onset in childhood, malnourished appearance the genetic predisposition for this type of diabetes is moderate which type most likely

a.type 1
b.type 2
c.diabetes insipidus
d.diabetes mellitus

A

a.type 1

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6
Q

diabetic patient middle aged, obese , genetic predisposition for this type of diabetes is very strong which type most likely

a.type 1
b.type 2
c.diabetes insipidus

A

b.type 2

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7
Q

the majority of insulin resistant people ………….. develop diabetes

a.do
b.dont

A

b.dont

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8
Q

what are insulin levels measured using

a.A peptide ELISA
b. B peptide ELISA
c. C peptide ELISA

A

c. C peptide ELISA

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8
Q

what are insulin levels measured using

a.A peptide ELISA
b. B peptide ELISA
c. C peptide ELISA

A

c. C peptide ELISA

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9
Q

during insulin production which chain is cleaved between the proinsulin and insulin stage

a. A
b.B
c.C

A

c.C

preproinsulin -> proinsulin -> insulin

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10
Q

why is c chain ELISA used

A

measure the mature insulin as the c chain is only cleaved when insulin is formed not preproinsulin / proinsulin

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11
Q

what is the main trigger for insulin secretion

a. blood glucose
b. glucagon like peptide
c.vagal stimulation

A

a. blood glucose

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12
Q

how many phases do beta cells release insulin in

a.1
b.2
c.3
d.4

A

b.2

rapid 1st phase triggered by increased glucose levels

slow sustained second phase of newly formed vesicles triggered independently of glucose (mop up any remaining glucose)

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13
Q

insulin is released in a pulsatile fashion into what structure (lots removed by first pass in liver)

a. IVC
b.abdominal aorta
c.portal vein
d.SVC

A

c.portal vein

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14
Q

what is the half life of insulin in the circulation

a.1-2 hrs
b. 5-6 hrs
c.5-6 mins
d.2-3 mins

A

c.5-6 mins

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15
Q

what transporters allow for glucose to enter the pancreatic b cell

a.Glut 1
b.Glut 2
c.Glut 3
d.Glut 4

A

b.Glut 2

16
Q

what enzyme metabolises glucose to make ATP

a.protein kinase
b.glucophosphatase
c.glucokinase
d.glycogen synthase

A

c.glucokinase

17
Q

what channel is blocked when ATP is produced from glucose in the B cell

a.ATP sensitive sodium channel
b.ATP sensitive potassium channel
c. ATP sensitive calcium channel

A

b.ATP sensitive potassium channel

sofulureas mimic ATP for treatment of diabetes

depolarisation ,
opens voltage gated calcium channels
calcium in
vesicles fuse with plasma membrane
granule release of insulin into blood stream

18
Q

when insulin binds to receptors on the cell surface membrane it uses a signal transduction pathway to uptake glucose into muscle, fat and liver cells via which transporter

a.glut 1
b.glut 2
c.glut 4
d.glut 3

A

c.glut 4

glucose utilised as glycogen, protein synthesis , lipids

19
Q

what protein is released from insulin receptors when insulin binds

a. ATP
b.AMP
c.IRS

A

c.IRS

insulin receptor substrate proteins

20
Q

what are the 3 main targets of insulin

A

liver
muscle
fat

remove glucose from circulation and store it

insuline crosses BBB but glucose uptake in brain not glucose dependent glut 1 and 2 transporters

21
Q

insulin is needed by all patients with..

a.type 1 diabetes
b.type 2 diabetes
c.diabetes mellitus

A

a.type 1 diabetes

in type 2 diabetes for intercurrent events eg surgery/infection
used in emergency to treat Ketoacidosis
in pregnancy

USED IN EMERGENCY TREATMENT OF HYPERKALAEMIA as a side effect is lowered potassium

22
Q

how is insulin administerd

a.orally
b.subcutaneously
d.buccal

A

b.subcutaneously

inject either side of the bellybutton

can get inhaled insulin

23
Q

what do people with diabetes measure their blood glucose with

A

glucometer
done regularly

/18 to get European level from American units

x18 to get American level from European

24
Q

what is the principle of insulin preparations

a.alter rate of absorption by increase particle size

b.alter rate of absorption by increase particle conc

A

a.alter rate of absorption by increase particle size

25
Q

insulin lispro and insulin aspart are examples of which type of insulin

a.fast onset, short acting

b.slow onset, long acting

A

a.fast onset, short acting

onset 3o mins
peak 2-4 hrs

injected 1/2 per day

26
Q

insulin zinc suspension, protamine insulin are examples of what type of insulin

a.fast onset, short acting

b.slow onset, long acting

c.intermediate

A

c.intermediate

27
Q

insluin zinc suspension crystal form, insulin glargine (mantis) is an example of what type of insulin formation

a.fast onset, short acting

b.slow onset, long acting

c.intermediate

A

b.slow onset, long acting

once per day
reduced risk of nighttime hypoglycaemia

best therapy is mix of short and medium lasting injected before meals

28
Q

factors affecting rate of absorption of insulin

A

abdomen> arm> buttocks> thigh
exercise (increased bf at side)
amount go insulin
depth of injection
whether or not the insulin is degraded

29
Q

hypoglycaemia (sweating, shaky, cranky, dizzy) is treated with what if the patient is conscious

a.sweet drinks

b. food

c.iv glucagon

d.insulin

A

a.sweet drinks

30
Q

hypoglycaemia (sweating, shaky, cranky, dizzy) is treated with what if the patient is unconscious

a.sweet drinks

b. food

c.iv glucagon

d.iv insulin

A

c.iv glucagon

31
Q

a build up of fat at the site of insulin injection is known as..

a.lypodystrophy

b.lipohypertrophy

c.lipoatrophy

A

a.lypodystrophy

32
Q

increased fat cells at the insulin injection is known as..

a.lypodystrophy

b.lipohypertrophy

c.lipoatrophy

A

b.lipohypertrophy

33
Q

true or false insulin effects serum potassium levels

a.true
b.false

A

a.true

decreases potassium levels

stimulates potassium uptake into cells via sodium k atpase

iv insulin can lead to hypokalaemia

used in emergency to treat hyperkalemia, or diabetic Ketoacidosis

34
Q

which type of syringe should be used to administer insulin

a.insulin syringe in graduated units

b.insulin syringe in ml

A

a.insulin syringe in graduated units

calculations importants as given in units of insulin

35
Q

what happens when diabetic people don’t take insulin,

A

glucose not processed

liver produces more glucose

glucose accumulates in the blood stream

body finds alternative source of energy from fat breakdown

fat breakdown produces ketone which build up in the blood

ketones and glucose in urine

a lot of water is lost too, can lead to dehydration and worsened Ketoacidosis

36
Q

vomiting, excessive thirst, increased urination, rapid breathing, fruity smelling breath , stomach pain, drowsiness and increased HR are all symptoms of what

a.hyperglycaemia

b. diabetes mellitus

c.diabetes insipidus

d.diabetic ketoacidosis

e.hypoglycaemia

A
37
Q

treatment of DKA

A

EMERGENCY

IV insulin
IV fluids

38
Q

when do you stop IV insulin in cases of diabetic acidosis

a.when blood glucose returns to normal

b.when blood pH increases and venous ketones reduce

A

b.when blood pH increases and venous ketones reduce

GERR (53 decks)

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