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PHCP MIDTERMS > Adrenal Gland, DM > Flashcards

Adrenal Gland, DM Flashcards

1
Q

Alpha cells secrete

A

Glucagon & Proglucagon

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2
Q

Beta cells secrete

A

Insulin, C-peptide, Proinsulin, Amylin

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3
Q

Delta cells secrete

A

Somatostatin

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4
Q

Epsilon cells secrete

A

Ghrelin

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5
Q

hyperglycemic factor that mobilizes the glycogen

A

Glucagon

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6
Q

small protein that is used to regulate blood sugar

A

Insulin

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7
Q

long single chain protein which hydrolyzed into insulin and c peptide

A

Proinsulin

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8
Q

Islet Amyloid Polypeptide (IAPP)

A

Amylin

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9
Q

IAPP product and moderates the appetite and gastric emptying even glucagon and insulin secretion

A

Amylin

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10
Q

universal hormone inhibitor; can inhibit other hormones

A

Somatostatin

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11
Q

peptide that increases the pituitary growth hormone release

A

Ghrelin

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12
Q

for ACUTE STRESS

A

Medulla

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13
Q

Produces Norepinephrine and Epinephrine

A

Medulla

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14
Q

Activated by Sympathetic Autonomic Nervous System/ Sympathetic Nervous System

A

Medulla

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15
Q

Tumor at the adrenal medulla

A

Pheochromocytoma

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16
Q

increased cardiac output due to sodium and water retention

A

Hyperaldosteronemia (secondaryHTN)

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17
Q

for CHRONIC STRESS

A

Cortex

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18
Q

Divided into three: Glomerulosa, Fasciculata, Reticularis

A

Cortex

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19
Q

Mineralocorticoids, Aldosterone

A

Glomerulosa

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20
Q

Glucocorticoids, Cortisol

A

Fasciculata

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21
Q

Androgen, Testosterone, Estradiol

A

Reticularis

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22
Q

Catecholamines

A

Medulla

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23
Q

Hypothalamus secretes

A

Corticotropin releasing hormone (CRH)

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24
Q

Anterior pituitary secretes

A

Adrenocorticotropic Hormone (ACTH)

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25
Q

↑Aldosterone

A

Hypokalemia

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26
Q

inhibition of Aldosterone

A

Hyperkalemia

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27
Q

↑Cortisol

A

Cushing Syndrome

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28
Q

↓Cortisol

A

Addison’s disease

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29
Q

Via the action of NADPH, Cholesterol will be converted to

A

Pregnenolone

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30
Q

Enzyme that converts Pregnenolone to 17-hydroxy-pregnenolone

A

17-alpha-hydroxylase

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31
Q

Enzyme that converts 17-hydroxy-pregnenolone to Dehydroepi-androsterone

A

17, 20-lyase

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32
Q

Enzyme that converts Dehydroepi-androsterone to Androstene-3,17-dione

A

3 beta-dehydrogenase

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33
Q

Enzyme that converts Testosterone to Estradiol

A

Aromatase

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34
Q

Enzyme that converts 11beta-deoxycortisol to cortisol

A

11beta-hydroxylase

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35
Q

Enzyme that converts pregnenolone to progesterone

A

3 beta-dehydrogenase

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36
Q

Enzyme that converts Corticosterone to aldosterone

A

18-hydroxylase

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37
Q

Increased myoglobin could lead to

A

Rhabdomyolysis

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38
Q

plays an important role in the regulation of carbohydrate, protein, and fat metabolism

A

Cortisol

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39
Q

During fasting/starvation, glucocorticoids can activate

A

gluconeogenesis

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40
Q

production of energy from non-carbohydrate sources such as proteins and fats

A

gluconeogenesis

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41
Q

In females, ↑testosterone leads to

A

Virilization

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42
Q

development of 2° characteristics of male in females

A

Virilization

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43
Q

Supraphysiologic dose or high level of cortisol is caused by:

A
  • Drugs (corticosteroids)
  • Adrenal gland tumor (Pheochromocytoma)
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44
Q

can happen because the corticosteroids would inhibit the vitamin D absorption, which would now inhibit the calcium absorption

A

Osteoporosis

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45
Q

Effect of supraphysiologic doses of glucocorticoids in children:

A

Reduced growth and bone development

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46
Q

decreased muscle mass, peripheral fats, weakness, and thinning of the skin

A

Cushing Syndrome

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47
Q

↑Thyroid hormone

A

Grave’s disease

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48
Q

↓Thyroid hormone

A

Hashimoto’s thyroiditis

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49
Q

Initial effect of supraphysiologic amount of corticosteroids

A

Insomnia, Euphoria

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50
Q

Subsequent effect of chronic use of corticosteroids

A

Depression

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51
Q

Large doses of corticosteroids increase intracranial pressure, leading to

A

Pseudotumor cerebri

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52
Q

also known as idiopathic intracranial hypertension, is a problem caused by elevated cerebrospinal fluid pressure in the brain

A

Pseudotumor cerebri

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53
Q

hypothyroidism in children

A

Cretinism

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54
Q

Effects on infant of supraphysiologic amounts of corticosteroids

A

fetal lung formation & production of pulmonary surfactants

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55
Q

involves the destruction of all regions of the adrenal cortex

A

Primary adrenal insufficiency (Addison disease)

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56
Q

TB outside lungs

A

Miliary Tuberculosis/ Extrapulmonary Tuberculosis

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57
Q

decrease cortisol synthesis & increased androgen production is caused by

A

Defect in 21beta-hydroxylase

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58
Q

Defect in 21beta-hydroxylase

A

Congenital adrenal hyperplasia

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59
Q

Decrease aldosterone production is caused by

A

Defect in 11beta-hydroxylase

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60
Q

Defect in 17 alpha-hydroxylase will result to

A

Hypogonadism

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61
Q

During hypogonadism, there is an increase in what enzyme?

A

11 deoxy corticosterone

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62
Q

Primary insufficiency of plasma ACTH levels

A

400 to 2000 pg/mL

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63
Q

Secondary insufficiency of plasma ACTH levels

A

normal to low (5–50 pg/mL)

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64
Q

adrenal gland failure due to bleeding into the adrenal glands

A

Waterhouse-Friderichsen Syndrome

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65
Q

septicemia (a bloodstream infection) caused by Neisseria meningitidis

A

Meningococcemia

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66
Q

rare but serious condition that causes abnormal blood clotting throughout the body’s blood vessels

A

Disseminated intravascular coagulation (DIC)

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67
Q

Rapidly developing adrenocortical insufficiency associated with massive bilateral adrenal haemorrhage.

A

Waterhouse-Friderichsen Syndrome

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68
Q

Treatment for primary adrenal insufficiency

A

20-30 mg hydrocortisone daily

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69
Q

Treatment for acute adrenocortical insufficiency

A

IV Hydrocortisone sodium succinate or phosphate 100mg IV Q8H until stable

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70
Q

DOC for Waterhouse-Friderichsen Syndrome

A

Ceftriaxone

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71
Q

3rd generation cephalosporin that has a high affinity against gram-negative infections

A

Ceftriaxone

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72
Q

Sometimes used for reversal of adrenal insufficiency

A

Hydrocortisone

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73
Q

Diagnosis for Cushing Sydrome

A

● Dexamethasone suppression test
● MRI of the pituitary

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74
Q

Equivalent oral dose of hydrocortisone (cortisol)

A

20 mg

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75
Q

Equivalent oral dose of cortisone

A

25 mg

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76
Q

Equivalent oral dose of prednisone

A

5 mg

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77
Q

Equivalent oral dose of prednisolone

A

5 mg

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78
Q

Equivalent oral dose of methylprednisolone

A

4 mg

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79
Q

Equivalent oral dose of meprednisone

A

4 mg

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80
Q

Equivalent oral dose of triamcinolone

A

4 mg

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81
Q

Equivalent oral dose of paramethasone

A

2 mg

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82
Q

Equivalent oral dose of fluprednisolone

A

1.5 mg

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83
Q

Equivalent oral dose of betamethasone

A

0.6 mg

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84
Q

Equivalent oral dose of dexamethasone

A

0.75 mg

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85
Q

Equivalent oral dose of fludrocortisone

A

2 mg

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86
Q

Long-acting glucocorticoids

A

Betamethasone & Dexamethasone

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87
Q

Intermediate-acting glucocorticoids

A

Triamcinolone, Paramethasone & Fluprednisolone

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88
Q

Examples of mineralocorticoids

A

Fludrocortisone & Desoxycorticosterone acetate

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89
Q

results from excessive production of cortisol by adrenal glands and can be ACTH-dependent and ACTH-independent

A

Endogenous Cushing Syndrome

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90
Q

Chronic prolonged exposure to high level of cortisol

A

Endogenous Cushing Syndrome

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91
Q

Caused by low negative feedback to pituitary corticotropic cells from a high level of serum cortisol

A

Endogenous Cushing Syndrome

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92
Q

Increased adipose tissue in the face

A

moon facies

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93
Q

accumulation of adipose tissues in the nape

A

Buffalo hump

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94
Q

medical term for bruises

A

Ecchymosis

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95
Q

large stretch mars

A

Red striations

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96
Q

exaggerated, forward rounding of the upper back

A

kyphosis

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97
Q

Surgical removal of the adrenal tumor

A

Adrenalectomy

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98
Q

11- beta hydroxylase inhibitor

A

Osilodrostat

99
Q

Somatostatin analogs

A

Pasireotide

100
Q

Adrenal Steroid inhibitor

A

Metyrapone, ketoconazole, etomidate

101
Q

Glucocorticoid receptor antagonist

A

Mifepristone

102
Q

Adrenolytic agents

A

Mitotane

103
Q

ANALOGUES OF SOMATOSTATIN

A

Octreotide, Lanreotide

104
Q

main mineralocorticoid

A

Aldosterone

105
Q

main glucocorticoid

A

Cortisol (hydrocortisone)

106
Q

hyperpigmentation or bronzing of skin, especially when exposed to direct sunlight

A

Addison’s disease

107
Q

Approximate % of islet mass of A cell

A

20%

108
Q

Approximate % of islet mass of B cell

A

75%

109
Q

Approximate % of islet mass of D cell

A

3-5%

110
Q

Approximate % of islet mass of E cell

A

<1%

111
Q

Normal basal serum insulin value

A

5–15 μU/mL

112
Q

Basal serum insulin value during meals

A

60–90 μU/mL

113
Q

Insulin MW

A

5808

114
Q

Insulin is metabolized via

A

Liver & kidneys

115
Q

Insulin t1/2

A

3-5 minutes

116
Q

Reversal of catabolic features of insulin deficiency

A

Effects of Insulin on the LIVER

117
Q

Inhibits glycogenolysis

A

Effects of Insulin on the LIVER

118
Q

Inhibits conversion of fatty acids and amino acids to ketoacids

A

Effects of Insulin on the LIVER

119
Q

Inhibits conversion of amino acids to glucose (gluconeogenesis)

A

Effects of Insulin on the LIVER

120
Q

Anabolic action

A

Effects of Insulin on the LIVER

121
Q

Promotes glucose storage as glycogen (induces glucokinase and glycogen synthase, inhibits phosphorylase)

A

Effects of Insulin on the LIVER

122
Q

Increases triglyceride synthesis and VLDL formation

A

Effects of Insulin on the LIVER

123
Q

Increased protein synthesis

A

Effects of Insulin on MUSCLE

124
Q

Increases amino acid transport

A

Effects of Insulin on MUSCLE

125
Q

Increases ribosomal protein synthesis

A

Effects of Insulin on MUSCLE

126
Q

Increased glycogen synthesis

A

Effects of Insulin on MUSCLE

127
Q

Increases glucose transport

A

Effects of Insulin on MUSCLE

128
Q

Induces glycogen synthase and inhibits phosphorylase

A

Effects of Insulin on MUSCLE

129
Q

Increased triglyceride storage

A

Effects of Insulin on ADIPOSE TISSUE

130
Q

Lipoprotein lipase is induced and activated by insulin to hydrolyze triglycerides from lipoproteins

A

Effects of Insulin on ADIPOSE TISSUE

131
Q

Glucose transport into cells provides glycerol phosphate to permit esterification of fatty acids supplied by lipoprotein transport

A

Effects of Insulin on ADIPOSE TISSUE

132
Q

Intracellular lipase is inhibited by insulin

A

Effects of Insulin on ADIPOSE TISSUE

133
Q

51 Amino acids arranged into 2 chains

A

Insulin

134
Q

Single cell chain of 29 amino acids

A

Glucagon

135
Q

Glucagon MW

A

3485

136
Q

a 69-amino acid precursor intermediate with glucagon sequence interposed between peptide extensions

A

Glicetin

137
Q

Emergency treatment for severe hypoglycemia in px with type 1 diabetes

A

Glucagon

138
Q

Endocrine diagnosis for type 1 diabetes

A

Glucagon

139
Q

Tx beta blocker overdose

A

Glucagon

140
Q

ADR of Glucagon

A

Transient nausea and vomiting

141
Q

elevated blood glucose associated with absent or inadequate pancreatic insulin secretion

A

DIABETES

142
Q

severe or absolute insulin deficiency

A

TYPE 1 DM

143
Q

Excess release of fatty acids and subsequent formation of toxic levels of ketoacids

A

Ketoacidosis

144
Q

Type IA

A

immune-mediated

145
Q

Type IB

A

idiopathic

146
Q

Tx for Type 1 DM

A

Insulin

147
Q

necessary to sustain life of type 1 diabetic px

A

Insulin replacement therapy

148
Q

Most common form of Type 1 DM

A

Type 1a DM

149
Q

Tissue resistance to the action of insulin combined with relative deficiency in insulin secretion

A

Type 2 DM

150
Q

Relative lack of insulin

A

Type 2 DM

151
Q

Any abnormality in glucose levels noted for the first time during pregnancy.

A

Gestational DM

152
Q

FBS glucose level of diabetic person

A

> 126 mg/dL

153
Q

Rapidly acting insulin analogs

A

Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)

154
Q

Lispro (Humalog): Proline at position B28 is reversed with the lysine at

A

B29

155
Q

Aspart (Novolog): single substitution of proline by aspartic acid at position

A

B28

156
Q

Glulisine (Apidra): The amino acid asparagine at position B3 is replaced by ___________ and the lysine in position B29 by __________________

A

lysine; glutamic acid

157
Q

LONG-ACTING INSULIN

A

Insulin Glargine, Insulin Detemir, Insulin Degludec

158
Q

Intermediate acting insulin

A

NPH:Neutral Protamine Hagedorn /Isophane

159
Q

Peakless, long-acting insulin

A

Insulin Glargine

160
Q

U100 of detemir =

A

2400 nmol/mL

161
Q

2400 nmol/mL detemir =

A

600 nmol/mL NPH

162
Q

Stable premixed insulins

A

70%NPH and 30% regular

163
Q

Only insulin administered IV

A

Regular insulin

164
Q

useful in the treatment of diabetic ketoacidosis and during the perioperative management of insulin-requiring diabetics

A

Regular insulin

165
Q

deformity in the injection site

A

lipohypertrophy / lipodystrophy

166
Q

dry powder formulation of recombinant regular insulin

A

Inhaled insulin (Afrezza)

167
Q

an immediate type hypersensitivity, is a rare condition in which local or systemic urticaria results from histamine release from tissue mast cells sensitized by antiinsulin IgE antibodies

A

Insulin allergy

168
Q

Low levels of IgG anti insulin antibodies may neutralize the action of insulin

A

Immune insulin resistance

169
Q

Immune insulin resistance may be associated with other autoimmune diseases such

A

Systemic Lupus Erythematosus (SLE)

170
Q

uneven distribution of fats in the site of administration

A

Lipodystrophy / Lipohypertrophy

171
Q

Agents that bind to the sulfonylurea receptor and stimulate insulin secretion

A

SULFONYLUREAS

172
Q

These drugs modulate beta-cell insulin release by regulating potassium efflux through the potassium channels

A

MEGLITINIDES

173
Q

Insulin releasers/Secretagogues

A

SULFONYLUREAS and MEGLITINIDES

174
Q

Insulin sensitizers

A

BIGUANIDES & THIAZOLIDINEDIONES

175
Q

Active metabolite of Acetohexamide

A

hydroxyhexamide

176
Q

First generation Sulfonylureas

A

Chlorpropramide, Tolazamide, Acetohexamide

177
Q

Second generation Sulfonylureas

A

Glyburide, Glipizide, Glimepiride, Gliclazide

178
Q

Loading dose of Glyburide

A

2.5mg/d

179
Q

Maintenance dose of Glyburide

A

5-10 mg/d as single dose

180
Q

Shortest T1/2 among the Second generation Sulfonylureas

A

Glipizide

181
Q

Loading dose of Gliclazide

A

40-80mg/d

182
Q

Used to treat secondary adrenal insufficiency

A

Mirtazapine and progestins

183
Q

HbA1c of diabetic person

A

> 6.5%

184
Q

What do you call if 2 hr is between 140mg/ dL-199mg/dL?

A

Impaired glucose tolerance

185
Q

dry powder formulation of recombinant regular insulin

A

Inhaled insulin (Afrezza)

186
Q

Inhaled insulin excipient that provides a large surface area for adsorption of proteins like insulin.

A

fumaryl diketopiperazine

187
Q

faster in onset and shorter in duration than subcutaneous insulin

A

Inhaled insulin (Afrezza)

188
Q

May cause hyperemic flush if taken with alcohol. Avoid in elderly.

A

Chlorpropamide

189
Q

May cause hyponatremia due to the action in vasopressin secretion

A

Chlorpropamide

190
Q

Same with chlorpropamide but with shorter T1/2 (7 hrs)

A

Tolazamide

191
Q

modulate beta-cell insulin release by regulating potassium efflux through the potassium channels

A

MEGLITINIDE

192
Q

indicated for use in controlling postprandial glucose excursions

A

Repaglinide

193
Q

No sulfur in structure, safe for px with sulfur or sulfonylurea allergy

A

Repaglinide

194
Q

benzylsuccinic acid derivative

A

Mitiglinide

195
Q

Available in Japan but not US

A

Mitiglinide

196
Q

d-phenylalanine derivative

A

Nateglinide

197
Q

Meglitinide analogue that may be used in px with renal impairment and elderly

A

Nateglinide

198
Q

Euglycemic agent and does not inc. body wt.

A

Metformin

199
Q

May impair hepatic metabolism of lactic acid

A

Metformin

200
Q

Metformin is CI if GFR is

A

30mL/min

201
Q

They are ligands of peroxisome proliferator-activated receptor gamma

A

THIAZOLIDINEDIONES

202
Q

PPAR-y meaning

A

Peroxisome Proliferator Activated Receptor Gamma

203
Q

The first medication in the class of Thiazolidinediones that was withdrawn because of cases of fatal liver failure.

A

Troglitazone

204
Q

With PPAR alpha and PPAR gamma activities

A

Pioglitazone

205
Q

lowers triglycerides and increases HDL cholesterol without affecting total cholesterol and LDL cholesterol

A

Pioglitazone

206
Q

increases total cholesterol, HDL cholesterol, and LDL cholesterol but does not have a significant effect on triglycerides

A

Rosiglitazone

207
Q

competitively inhibit the intestinal α-glucosidase enzymes and reduce postmeal glucose excursions

A

Alpha-glucosidase inhibitors

208
Q

Taken with first bite of meal

A

Acarbose

209
Q

This class may cause hypoglycemia when taken with sulfonylurea

A

Alpha-glucosidase inhibitors

210
Q

GLP-1 is rapidly degraded by

A

dipeptidyl peptidase 4 (DPP-4)

211
Q

derivative of the exendin-4 peptide in Gila monster venom

A

Exenatide

212
Q

soluble fatty acid-acylated GLP-1 analogue

A

Liraglutide

213
Q

human GLP-1 dimer fused to human albumin

A

Albiglutide

214
Q

consists of two GLP-1 analog molecules covalently linked to an Fc fragment of human IgG4

A

Dulaglutide

215
Q

Dulaglutide dose

A

SQ 0.75 mg weekly

216
Q

DDP4 inhibitor that may increase the risk of heart failure

A

Saxagliptin

217
Q

lowers HbA1c by 0.4–0.6% when added to metformin, sulfonylurea, or pioglitazone

A

Linagliptin

218
Q

Linagliptin is secreted via

A

Biliary excretion

219
Q

lowers HbA1c by about 0.5–0.6% when added to metformin, sulfonylurea, or pioglitazone

A

Alogliptin

220
Q

lowers HbA1c levels by 0.5–1% when added to the therapeutic regimen of patients with type 2 diabetes

A

Vildagliptin

221
Q

reduce HbA1cby 0.6–1% when used alone or in combination with other oral agents or insulin

A

Canagliflozin

222
Q

The use of Canagliflozin will lead to weight loss of

A

2-5 kg

223
Q

The use of Empagliflozin will lead to weight loss of

A

2–3 kg

224
Q

reduces HbA1c by 0.5–0.8% when used alone or in combination with other oral agents or insulin

A

Dapagliflozin

225
Q

What is the dose of Dapagliflozin given in px with liver failure?

A

5 mg

226
Q

reduces HbA1c by 0.5–0.7% when used alone or in combination with other oral agents or insulin

A

Empagliflozin

227
Q

Canagliflozin and empagliflozin is C/I in GFR

A

< 45ml/min

228
Q

Dapagliflozin is C/I in GFR

A

< 60ml/min

229
Q

an islet amyloid polypeptide (IAPP, amylin) analogue

A

Pramlintide

230
Q

37-amino-acid peptide present in insulin secretory granules and secreted with insulin

A

IAPP

231
Q

bile acid sequestrant and cholesterol lowering drug

A

Colesevelam HCl

232
Q

approved as an antihyperglycemic therapy for persons with type 2 diabetes who are taking other medications or have not achieved adequate control with diet and exercise

A

Colesevelam HCl

233
Q

A nuclear receptor with multiple effects on cholesterol, glucose, and bile acid metabolism.

A

farnesoid X receptor (FXR)

234
Q

Use for px with hyperglycemia after carb-rich meals

A

Short acting secretagogue before meal

235
Q

Used for px with severe insulin resistance

A

Pioglitazone

236
Q

Used for px concerned with weight gain

A

GLP1 receptor agonist, DPP-4 inhibitor, SGLT2 inhibitor

237
Q

In case of loss of consciousness due to hypoglycemia, give

A

20-50 ml 50% glucose (D50%) IV bolus

238
Q

life-threatening medical emergency caused by inadequate or absent insulin replacement, which occurs in people with type 1 diabetes and infrequently in those with type 2 diabetes

A

Diabetic ketoacidosis (DKA)

239
Q

Increase fatty and ketones in the blood

A

Diabetic ketoacidosis (DKA)

240
Q

profound hyperglycemia and dehydration

A

Hyperosmolar hyperglycemic syndrome

241
Q

leading cause of vision loss in patients with diabetes

A

Diabetic retinopathy

242
Q

single most critical determinant of overall prognosis of diabetes

A

Diabetic nephropathy

243
Q

Used as aid to x-ray visualization of the bowel because of its ability to relax the intestine

A

Glucagon

244
Q

Enzyme that converts corticosterone to aldosterone

A

18-hydroxylase

PHCP MIDTERMS (2 decks)

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