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510 - Pharmacology > S2L2 - Diabetes > Flashcards

S2L2 - Diabetes Flashcards

1
Q

What does insulin do?

A

Regulates glucose storage

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2
Q

What does glucagon do?

A

Modulates glycogen stores for release

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3
Q

What does somatostatin do?

A

Inhibits secretory cells

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4
Q

What does gastrin do?

A

Stimulates gastric acid secretion

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5
Q

What is type III and IV diabetes?

A

Type III is induced by other causes like pancreatitis or drug therapy
Type IV is gestational

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6
Q

How is insulin formed?

A

From pro-insulin within beta cell golgi

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7
Q

What is formed in equal amounts with insulin?

A

C-peptide

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8
Q

What degrades insulin?

A

60% liver and 40% kidney but reversed in insulin treated patients

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9
Q

What stimulates insulin release?

A

Vagus nerve stimulation and blood glucose levels

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10
Q

What are the target tissues of insulin?

A

Liver, fat and muscle

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11
Q

What is the insulin effect on the liver?

A

Inhibits glycogenolysis, conversion of AAs to glucose and FAs and AAs to keto acids, promotes glucose storage as glycogen and increases TG synthesis

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12
Q

What is the insulin effect on muscle?

A

Increases AA and glucose transport and glycogen and protein synthesis

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13
Q

What is the insulin effect on adipose tissue?

A

Increases TG storage and glucose transport into cells

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14
Q

What are the routes of insulin administration and the formulations

A

Inhaled not well tolerated, SQ most often, IV in emergency

Rapid, short, intermediate and long

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15
Q

How is DKA managed?

A

saline hydration, regular insulin infusion every 2 hours, potassium serum level maintenance which can translate to hyponatremia

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16
Q

What is HHS?

A

Hyperosmolar hyperglycemic syndrome - elevated blood glucose level complication in T2D with similar symptoms to DKA, but management more focused on hydration

17
Q

What are the symptoms and management of hypoglycemia? Why does it happen?

A

Tachycardia (fast HR), diaphoresis (sweating), tremor, nausea, confusion - treat with glucose or glucagon (oral or injectable) - complication of therapy

18
Q

What are sulfonylureas and how do they work?

A

Insulin secretory agents that stimulate the pancreas - they close K channels depolarizing the cell and causing calcium influx to stimulate insulin release

19
Q

Why are sulfonylureas not used anymore?

A

Can give hypoglycemia and increased drug activity because of liver and kidney dysfunction

20
Q

What are the sulfonylurea drugs?

A

Glyburide, glipizide and glimepiride

21
Q

What are the newer insulin secretory drugs?

A

Meglitinide class - repaglinide
D-Phenylalanine - nateglinide
Used in patients with sulfur allergy - similar MOA and benefits of sulfonylurea

22
Q

What is metformin?

A

A biguanide - inhibits the conversion of lactic acid to glucose via gluconeogenesis in the liver by activating AMPK - stimulates glycolysis in tissues and reduces plasma glucagon levels

23
Q

What can happen in chronic metformin use? and how is it treated?

A

lactic acidosis - MALA - drug builds up with no way to metabolize or clear - treated by sodium bicarbonate administration (to balance acid) or given dialysis (to clear drug)

24
Q

What are thiazolidinediones?

A

Pioglitazone and rosiglitazone
Regulate PPAR-gama to regulate muscle and fat expression to increase insulin sensitivity by helping glucose metabolism and adipose storage

25
Q

What else are thiazolidinediones used for and what are the risks?

A

Cholesterol profile

Low hypoglycemia risk - but increase cardiac event risk

26
Q

What are alpha-glucosidase inhibitors?

A

Acarbose and miglitol

Inhibit intestinal alpha-glucosidase - delays absorption of starch and disaccharides

27
Q

What are amylin analogs?

A

Pramlintide
Suppress glucagon release and cause delayed gastric emptying and anorectic effects
Used in patients who need additional therapy

28
Q

What is incretin therapy?

A

Exenatide - analog of GLP-1 to decrease glucagon release and increase insulin release
Sitagliptin - inhibits DDP-4 which will increase GLP-1 and GIP levels (also increase insulin release)
Given in combination to T2D patients with high blood sugar

510 - Pharmacology (7 decks)

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