Diabetes Pharmacology Type I and Type II Flashcards Preview

Endo/Repro Exam 2 > Diabetes Pharmacology Type I and Type II > Flashcards

Flashcards in Diabetes Pharmacology Type I and Type II Deck (63):
1

Earliest signs of diabetes?

Increased:
Postprandial chylomicrons
VLDL cholesterol
Gluconeogenesis, ketogenesis
Plasma triglycerides

2

Three microvascular injuries that occur with diabetes?

Cataracts and retinopathy
Nephropathy
Neuropathy

3

How to prevent cataracts and retinopathy?

Keep A1c below 9%

4

How to prevent nephropathy?

Keep A1c below 8%

5

How to prevent neuropathy?

Keep A1c below 7%

6

What are the four goals of therapy?

1.) Prevent hyperosmolar coma/ketoacidosis
2.) Reduce microvascular injury
3.) Reduce hypertension
4.) Prevention of atherosclerotic disease

7

Two general types of drugs that increase plasma insulin?

Insulin
Secretagogues

8

Three general types of insulins?

Rapid acting and short acting
Moderate acting
Long acting

9

What are the rapid acting insulin?

Lispro insulin (Humalog)
Insulin aspart (Novolog)

10

What are the short acting insulin?

Regular insulin

11

What are the moderate acting insulins?

Isophane/NPH

12

What are the long acting insulins?

Glargine
Detemir
Degludec

13

What are two types of secretagogues?

Sulfonylureas
Short-acting secretagogues

14

What are the sulfonylureas?

Glyburid
Glipizide
Glimepiride

15

What are the short acting secretagogues?

Repaglinide
Nateglinide

16

What are intermediate-mixed insulins preparations?

Isophane + regular insulin or Lispro

17

What may be used in a patient that has a high insulin dosage requirement?

Pramlintide

18

What are two general categories of direct acting agents for increased glucose uptake?

Biguanides
Thiazolidinediones

19

What are the Biguanides?

Metformin

20

What are the thiazolidinediones?

Pioglitazone
Rosiglitazone

21

What are the two general categories of GLP-1 mechanism for increased tissue glucose uptake?

GLP-1 Analogs
Dipeptidyl peptidase inhibitors

22

What are the GLP-1 analogs?

Liraglutide
Exenitide

23

What are the Dipeptidyl peptidase inhibitors?

Sitagliptin
Linagliptin
Saxigliptin

24

What does metformin cause?

Increased insulin sensitivity
Decreased gluconeogenesis

25

How does metformin mediate its affects?

Not well understood but increase AMP:ATP ratio activating AMP kinase

26

What are contraindications of metformin?

Hepatic and renal insufficiency
MI
Uncompensated CHF

27

What can metformin cause?

Lactic acidosis

28

How do thiazolidinediones work?

Ligands for cytosolic and nuclear PPAR receptors

29

What are the two PPAR receptors?

Gamma
Alpha

30

What affect to thiazolidinediones have?

Increased fatty acid uptake
Increased fatty acid oxidation
Increased insulin sensitivity and glucose uptake
Anti-inflammatory affects

31

What are the two thiazolidinediones?

Pioglitazone
Rosiglitazone

32

What receptors does pioglitazone work on?

PPAR-alpha
PPAR-gamma

33

What receptors does rosiglitazone work on?

PPAR-gamma

34

Which thiazolidinedione has better lipid metabolism effects?

Pioglitazone (PPAR-alpha)

35

What do incretins/GLP-1 do?

Increase GLUT-2 expression in beta-cells of the pancreas

36

When is GLP-1 released and where?

From small intestine and colon in response to carbohydrate, protein and fat intake

37

What enzyme breaks down GLP-1 and GIP?

DPP4

38

What do dipeptidylpeptidase inhibitors do?

Inhibit DPP4 increasing the life span of GLP-1 and GIP

39

What releases GLP-1?

Distal small intestines and colon

40

What releases GIP?

Duodenum
Jejunum

41

What are the effects of GLP-1 (7-36) amide (active form)?

Increased:
Insulin secretion
Satiety
Beta-cell survival
Decreased:
Glucagon secretion
Gastric emptying
Food intake

42

What is are the effects of GLP-1 (9-36) amide (inactive form)?

Increased independent glucose clearance
Cardioprotective
Vasoactive

43

What are the effects of GIP (1-42) active form?

Increased:
Insulin secretion
Lipogenesis
Beta-cell survival
Decreased:
Lipolysis

44

What are the effects of GIP (3-42) inactive form?

None

45

What are the GLP-1 analogs?

Exenatide
Liraglutide

46

Which GLP-1 analog has reduced DPP4 sensitivity?

Liraglutide

47

What are examples of DPP4 inhibitors?

Sitagliptin
Linagliptin

48

What are amylin analogs?

Pramlintide

49

What are alpha-glucosidase inhibitors?

Acarbose
Miglitol

50

What are inhibitors of sodium-glucose transport?

Dapagliflozin
Empagliflozin
Canagliflozin

51

What is amylin?

Small peptide hormone that is released into the bloodstream by the beta cells of the pancreas along with insulin after a meal

52

What is the only drug approved to lower blood sugar in Type I diabetics since insulin?

Pramlintide

53

Mechanism of action of Pramlintide?

Inhibit release of glucagon

54

What do alpha-glucosidase inhibitors do?

Inhibit intestinal alpha-glucosidase slowing post-prandial increase in plasma glucose

55

What does alpha-glucosidase enzyme do?

Digests carbohydrates

56

What is more commonly used among "skinny" Type II diabetics?

Alpha-glucosidase inhibitors

57

Where do SGLT-2 transporters work and what do they do?

Co-transport sodium and glucose in the proximal convoluted tubule

58

What are the SGLT-2 inhibitors?

Canagliflozin
Empagliflozin
Dapagliflozin

59

What do the SLGT-2 inhibitors cause?

Decrease in reabsorption of glucose and sodium from the PCT allowing it to be released in the urine

60

What are side effects of glucose in the urine?

Polyuria/dehydration
Urinary tract infections (fungal)
Urine loss of 200-500 Kcals/day
Ketoacidosis

61

What drug is acid-soluble and precipitates at body pH?

Glargine insulin

62

What drug heavily binds to albumin?

Detemir insulin

63

What is the standard insulin therapy for Type I diabetics?

Glargine insulin (once daily) + rapid acting insulin with meals
or insulin pump with rapid-acting insulin