Antidiabetic Drugs Flashcards by Joshua Layton

What cells in the pancreas secrete glucagon? Insulin?

Alpha cells

Beta cells

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If GLP1 and GIP bind to beta cells, how is insulin released?

Glucose comes into GLUT2 channels in beta cells….increases ATP production….which closes ATP sensitive K+ channels…which depolarizers the cell and opens volatage gated Ca2+ cells….thus causing insulin and Amylin to be released

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What 2 things cause insulin to be released?

Incretins

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What are incretins?

GLP-1

GIP

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What are the 2 actions of incretins?

increase insulin release

- stop liver from producing glucose

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What cells does GIP get secreted from in the GI system? GLP-1?

K cells

L cells

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What breaks down incretins to raise BGL? Where is it released from?

DPP-4

Enterocytes

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What is the BGL for a pt to be considered hypoglycemic?

<50mg/do

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What are the CNS manifestations of a pt who is hypoglycemic?

Confusion
Irritable
Tremor
Diaphoresis

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What are progressive/later Sx of a pt who is hypoglycemic?

Hypothermia
Seizures
Coma

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What are the 3 Tx for a pt who is hypoglycemic?

Oral form concentrated glucose
IV dextrose
Glucagon

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What is a contraindication for oral glucose for a pt who is hypoglycemic?

Unconscious pt who can’t swallow

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What does glucagon to the BGL?

Increases BG

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What are the 2 things that the liver does when glucagon is given?

Glycogenolysis

Gluconeogensis

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What is glycogenolysis?

Liver breaks down glucagon to make glucose to be released into the blood

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What is the 2 forms of gluconeogenesis?

AA break down into glucose

Glycerol from triglycerides breakdown into glucose

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What are the 3 routes glucagon can be given?

IM
SC
IV

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What Sx can glucose cause in a body? What is done to protect against this Sx?

N/V

Place pt on side prior to injecting

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What percent of DM pt are type 1? Type 2?

Type 1=10%

Type 2=20%

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What is the MOA of DM type 1? Type 2? What lack of transportation is causing this?

Type 1= Decreased insulin secretion

Type 2= insulin resistance

No GLUT 4 transportation

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What is normal fasting BGL for a healthy pt?

80-100 mg/dl

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What levels are needed to be collected in order to Dx someone w/ DM?

Multiple readings of Fasting BGL >126mg/dl
Or
>200mg/dl 2 hrs postprandial

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What does postprandial mean?

After a meal

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What cells does insulin bind to? What does the binding cause?

Insulin binds to adipocytes or skeletal cells

Opens GLUT4 transporters to let glucose into cell

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Which GLUT cells don’t need insulin to keep them open? Where are they found?

GLUT 3 Found in the brain

Where are GLUT 1 found?

RBC

What are the Sx of pt not on medication w/ DM?

``` Polyuria Polydipsia Polyphagia Ketoacidosis Tissue damage ```

What is polydipsia? What is polyphagia?

Increased thirst Increased hunger

How come DM causes polyuria? What does glucose pull into DCT?

Glucose overwhelms reabsorption in PCT >300mg/dl Pulls water into DCT and acts as osmotic

What tissue damage can be caused by DM if untreated?

Atherosclerosis Diabetic retinopathy Diabetic nephropathy Neuropathy

What is nephropathy?

Damage to glomerulus leading to proteinuria

What is neuropathy?

Damage to neurons in end of extremities. Can’t feel toes

What is diabetic gastroparesis? How is it caused? What are the 4 Sx of it?

Decrease in gastric emptying Damage to vagus nerve Nausea Fullness Acid Reflux Lack of appetite

What type of DM is Diabetic Ketoacidosis (DKA) often found in?

Type 1

What type of DM is hyperosmolar hyperglycemia syndrome (HHS) often found in?

Type 2

What is the age of a pt commonly in DKA? HHS?

``` DKA= <40yo HHS= >40yo ```

What is the serum glucose level of a pt w/ DKA? HHS?

``` DKA= <600mg/dl HHS= >600mg/dl ```

How many ketones are often in body of pt w/ DKA? HHS?

``` DKA= >4 HHS= <2 ```

What is the pH of a pt w/ DKA? HHS?

``` DKA= low pH HHS= normal pH ```

What is the Tx for pt w/ DKA? HHS?

DKA= insulin therapy HHS=fluids and monitor K+ levels

What is HbA1c measure?

Amount of glucose bound to hemoglobin in RBC

How long does HbA1c measurements last for to determine glucose control?

Last 3 months

What is HbA1c for non DM pt? What is the goal HbA1c for DM pt?

Non DM= 5% DM= <6.5%

How often should a type 1 DM pt use a glucometer? Type 2 DM?

Type 1= 5x/day | Type 2= at least 1/day

What is a CGM what does it do?

Continuous Glucose monitor

What are the 3 types of Tx for DM?

Watch diet Exercise Drugs

How does exercise help w/ DM?

Causes GLUT 4 translocation w/o insulin

What are the 2 categories of routes for DM drug therapy?

Parenteral | Oral

What 3 types of drugs for DM are parenteral?

Insulin’s Amylin analogs Incretin mimetics

What are the 6 drugs for DM that are oral?

``` Secretagogues Alpha-glucosidase inhibitor Biguanides Insulin sensitizer DPP-4 inhibitors SGLT2 inhibitors ```

What are the two categories of secretagogues?

Sulfonylureas | Meglitinides

What is another name for insulin sensitizing drugs?

Thiazolidinediones

What 2 routes is insulin given?

SC | ORAL

What is insulin indicated for(4)?

Reversing ketoacidosis Gestational DM Type 2 DM Hyperkalemia

What pump does insulin stimulate on cells?

Na/K pumps

What type of chain is insulin? What makes up the A chain? B chain?

Polypeptide chain A chain= 21 AA chain B chain= 20 AA chain

Why can’t insulin normally be given orally?

Because protein chain gets destroyed and gets absorbed into tripeptide chains (nothing longer)

What bond hold A and B chains together in insulin?

Disulfide bonds

What types of insulin are OTC?

``` Regular(Humulin R) Isophane NPH(Humulin N, Novokun N) ```

How long does insulin last outside of the fridge?

1 month

What are the number of units for insulin usually found as?

100 units/ml

What can an insulin overdose cause?

Hypoglycemia

How does stress effect BLG?

Stress releases cortisol which increases BGL

What do IV infusion sets do to insulin? How does this effect the dose?

Infusion sets absorb insulin May have to increase insulin dose

What factor requires a pt to reduce insulin dose? Why?

Heavy exercise It used up the glucose in the blood and body

What factors can increase the need for insulin?

Stress Illness Surgeries

Why do beta blockers cause a decrease in the need for insulin?

Because a decrease in sympathetic system will also decrease BGL

Why do thiazides increase the need for insulin?

Thiazides increase the process of gluconeogenesis

What are the ADR of insulin?

Lipodystrophy | Hypoglycemia

How can a pt avoid lipodystrophy? What is lipodystrophy?

Rotate injection sites Dimpling effect on skin and fat

How does an insulin pump work?

Gives a small dose always...then gives large bolus of insulin at meal times

What should always be given prior to giving insulin?

Take a BGL

What insulin is given IV?

Regular insulin

What drugs cause an increase in BGL which require and increase in need for insulin?

Corticosteroids Thyroid drugs Thiazides

What are the MOA of Amylin(3)?

Slows gastric emptying Suppress glucagon secretion from alpha cells Decreases appetite

What is Amylin secreted w/?

Insulin

What conditions have decreased amounts of Amylin release?

Type 1 and type 2 DM

What are the indications for Amylin?

Uncontrolled DM Type 1 and 2

What route is Amylin given?

What are the 2 ADR of Amylin?

N/V | Weight loss

What is the MOA of incretins?

GIP and GLP-1 act on beta cells to release insulin

What is another name for incretin mimetics? Route? Indication?

Lizard spit SC Type 2 DM

Why is the 4 MOA of GLP-1 agonists?

Increase insulin release from beta cells Decrease glucagon secretion from alpha cells Delay stomach emptying Decrease appetite

What is the MOA of Biguanides(3)?

Decrease liver glucose production Decrease intestinal glucose absorption Enhance glucose utilization by other tissues

What effect do biguanides have on GI? What is it? What can it lead to?

Lactic acidosis Increased glucose leads to lactate conversion from enterocytes Can cause respiratory and cardiac distress

What is the MOA of secretagogues? Indication?

Binds to SUR on beta cells to close ATP sensitive K+ channels which causes insulin release

What is the MOA of thiazolidinediones? What is another name for them? ADR? Contraindications

Enhance peripheral response to insulin Insulin sensitizers Causes fluid retention Increases liver enzymes HF liver failure

What is the MOA of alpha-glucosidase inhibitor? When should it be given? ADR?

Inhibits disaccharidase which decreases the amount of glucose going into blood after a meal given w/ each meal Farts Diarrhea

What is the MOA of DDP-4?

Breaks down incretins

What is DDP-4 inhibitors indicated for? What is it used in combo w/?

Type 2 DM Combo w/ metformin or thiazolidinediones

What is the MOA of an SGLT2 inhibitor?

blocks Sodium Glucose transporters in PCT to be reabsorbed...this causing glucose to act as osmotic to water

What are ADR of SGLT inhibitors(4)?

Genital fungal infections UTIs Polyuria Hypotension

What type of insulin is inhaled Afrezza?

Regular insulin

Antidiabetic Drugs Flashcards

(93 cards)