Flashcards in Diabetes Pharmacology Type I and Type II Deck (63):
Earliest signs of diabetes?
Three microvascular injuries that occur with diabetes?
Cataracts and retinopathy
How to prevent cataracts and retinopathy?
Keep A1c below 9%
How to prevent nephropathy?
Keep A1c below 8%
How to prevent neuropathy?
Keep A1c below 7%
What are the four goals of therapy?
1.) Prevent hyperosmolar coma/ketoacidosis
2.) Reduce microvascular injury
3.) Reduce hypertension
4.) Prevention of atherosclerotic disease
Two general types of drugs that increase plasma insulin?
Three general types of insulins?
Rapid acting and short acting
What are the rapid acting insulin?
Lispro insulin (Humalog)
Insulin aspart (Novolog)
What are the short acting insulin?
What are the moderate acting insulins?
What are the long acting insulins?
What are two types of secretagogues?
What are the sulfonylureas?
What are the short acting secretagogues?
What are intermediate-mixed insulins preparations?
Isophane + regular insulin or Lispro
What may be used in a patient that has a high insulin dosage requirement?
What are two general categories of direct acting agents for increased glucose uptake?
What are the Biguanides?
What are the thiazolidinediones?
What are the two general categories of GLP-1 mechanism for increased tissue glucose uptake?
Dipeptidyl peptidase inhibitors
What are the GLP-1 analogs?
What are the Dipeptidyl peptidase inhibitors?
What does metformin cause?
Increased insulin sensitivity
How does metformin mediate its affects?
Not well understood but increase AMP:ATP ratio activating AMP kinase
What are contraindications of metformin?
Hepatic and renal insufficiency
What can metformin cause?
How do thiazolidinediones work?
Ligands for cytosolic and nuclear PPAR receptors
What are the two PPAR receptors?
What affect to thiazolidinediones have?
Increased fatty acid uptake
Increased fatty acid oxidation
Increased insulin sensitivity and glucose uptake
What are the two thiazolidinediones?
What receptors does pioglitazone work on?
What receptors does rosiglitazone work on?
Which thiazolidinedione has better lipid metabolism effects?
What do incretins/GLP-1 do?
Increase GLUT-2 expression in beta-cells of the pancreas
When is GLP-1 released and where?
From small intestine and colon in response to carbohydrate, protein and fat intake
What enzyme breaks down GLP-1 and GIP?
What do dipeptidylpeptidase inhibitors do?
Inhibit DPP4 increasing the life span of GLP-1 and GIP
What releases GLP-1?
Distal small intestines and colon
What releases GIP?
What are the effects of GLP-1 (7-36) amide (active form)?
What is are the effects of GLP-1 (9-36) amide (inactive form)?
Increased independent glucose clearance
What are the effects of GIP (1-42) active form?
What are the effects of GIP (3-42) inactive form?
What are the GLP-1 analogs?
Which GLP-1 analog has reduced DPP4 sensitivity?
What are examples of DPP4 inhibitors?
What are amylin analogs?
What are alpha-glucosidase inhibitors?
What are inhibitors of sodium-glucose transport?
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
What is the only drug approved to lower blood sugar in Type I diabetics since insulin?
Mechanism of action of Pramlintide?
Inhibit release of glucagon
What do alpha-glucosidase inhibitors do?
Inhibit intestinal alpha-glucosidase slowing post-prandial increase in plasma glucose
What does alpha-glucosidase enzyme do?
What is more commonly used among "skinny" Type II diabetics?
Where do SGLT-2 transporters work and what do they do?
Co-transport sodium and glucose in the proximal convoluted tubule
What are the SGLT-2 inhibitors?
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
What are side effects of glucose in the urine?
Urinary tract infections (fungal)
Urine loss of 200-500 Kcals/day
What drug is acid-soluble and precipitates at body pH?
What drug heavily binds to albumin?