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Endo II Exam 2 > Diabetes Pharmacotherapy > Flashcards

Diabetes Pharmacotherapy Flashcards

(74 cards)

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1
Q

rapid acting insulin

A

lispro
aspart
glulisine

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2
Q

short acting insulin

A

regular - human

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3
Q

intermediate acting insulin

A

NPH

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4
Q

log acting insulin

A

glargine

detemir

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5
Q

fixed mix insulin

A

NPH/regular

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6
Q

metformin

A

biguanine

-antihyperglycemic

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7
Q

glimepiride

A

sulfonylurea

-stimulate insulin secretion

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8
Q

glipizide

A

sulfonylurea

-stimulate insulin secretion

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9
Q

glyburide

A

sulfonylurea

-stimulate insulin secretion

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10
Q

repaglinide

A

non-sulfonylurea secretagogue

-stimulate insulin secretion

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11
Q

nateglinide

A

non-sulfonylurea secretagogue

-stimulate insulin secretion

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12
Q

pioglitazone

A

insulin sensitizer

-thiazolidinediones - TZD

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13
Q

acarbose

A

alpha-glucosidase inhibitor

prevent complex carb hydrolysis and delay carb absorption

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14
Q

miglitol

A

alpha-glucosidase inhibitor

prevent complex carb hydrolysis and delay carb absorption

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15
Q

exenatide

A

GLP-1 agonist

potentiate glucose-dependent insulin secretion

suppress glucagon secretion

slow gastric emptying

promote satiety

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16
Q

C peptide

A

removed from proinsulin when insulin released

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17
Q

insulin chemistry

A

solution as monomer, dimer, hexamer

Zn coordinated

crystallize differently - determine how fast dissolve after subQ injection

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18
Q

stimulus for insulin release

A

glucose

also, AAs, FAs, ketone bodies

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19
Q

alpha2

A

inhibit insulin release

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20
Q

beta2

A

stimulate insulin release

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21
Q

vagus

A

stimulate insulin release

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22
Q

GLUT2

A

glucose transport into beta cell

ATP generation - results in influx of extracellular Ca

leading to fusion of insulin granules with membrane
-insulin release

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23
Q

insulin release

A

two phases

DMII - missing first

DMI - missing both

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24
Q

insulin after meal

A

greater frequency and higher amplitude pulses

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25
insulin in circulation
free monomer | -half life - 5-8 minutes
26
insulin receptor
tyrosine kinase
27
GLUT4
insulin sensitive receptors go to membrane when have increased insulin stimulation -muscle and adipose tissue
28
long term insulin resistance
GLUT1 and GLUT4
29
diminished insulin secretion in DM II
GLUT4
30
phosphoinositol 3-kinase
activated insulin receptor brings GLUT4 receptors to membrane via this
31
DM I
lack beta cell activity - absent insulin associated with HLA insulin-dependent
32
DM II
defective insulin secretion tissue resistance increased hepatic glucose with obesity strong fam hx
33
therapeutic insulin subQ
1 doesn't match normal up and down of insulin levels 2 goes to peripheral circulation, instead of portal circulation
34
detemir
long acting insulin - binds albumin
35
glargine
long acting insulin - acidic pH
36
lispro, aspart, glulisine
rapid acting insulin - 2AA substitution - faster than regular insulin
37
intermediate insulin
crystalline suspension
38
NPH
added protamine, Zn, phosphate buffer intermediate acting insulin - crystalline suspension
39
rapid acting insulin
action - 15 minutes taken immediately before meal lower risk of hypoglycemia**
40
IV insulin
only regular, aspart, glulisine, lispro rapid acting and regular** IV or subQ pump
41
neutral protamine hagedorn
NPH insulin - intermediate acting complex with protamine and zinc
42
changes in subQ blood flow
important indicator in variability of response to insulin
43
exubera
inhalation insulin
44
CSII
continuous subQ insulin infusion timed throughout day -regular or rapid acting
45
measure of long term hyperglycemic control
HbA1C < 6.5%
46
IIT
intensive insulin therapy basal - long acting QD bolus - rapid acting before meal
47
split mix insulin therapy
mix dose of NPH/regular insulin
48
adverse effect insulin
hypoglycemia more rigorous attempt to achieve euglycemia - greater risk hypoglycemia
49
counter-regulatory hormones
epi, glucagon, cortisol, GH dominant - glucagon type I DM - long duration - glucagon secretion becomes deficient and epi becomes dominant
50
tx of hypoglycemia
ingestion glucose severe - glucagon injection or IV glucose
51
lipoatrophy and lipohypertrophy
subQ fat at site of insulin injection patient advised to rotate injection site
52
DKA tx
IV insulin continuous infusion also - replacement of fluid and electrolytes
53
perioperative and childbirth
when diabetic patient gets IV insulin - more control
54
drug-induced hypoglycemic state
ethanol beta antagonist salicylates ethanol - inhibitor of gluconeogenesis
55
inhibit insulin secretion
phenytoin clonidine CCBs
56
inhibit insulin secretion
diuretics
57
hyperglycemic effect
epi glucocorticoid contraceptives
58
initial therapy for DMII patient who fails diet and exercise therapy
metformin
59
DM I tx
insulin | -don't respond to oral hypoglycemic agents
60
metformin effect
antihyperglycemic effect does not cause hypoglycemia** - inhibits gluconeogenesis - increased insulin action - increased glucose uptake - reduces intestinal glucose absorption
61
obese insulin resistant pt with DM II tx
metformin** also has lipid lowering effect
62
lipid lowering effect
metformin
63
sulfonylurea MOA
stimulate insulin release from beta cells of pancreas -bind and block ATP sensitive K channel - causes Ca influx - insulin release**
64
extrapancreatic effects
sulfonylureas - increased insulin receptors - increased glucose transporters - enhanced tissue response to insulin
65
second generation sulfonylureas
100x more potent
66
pt older than 30, not obese, residual beta cell fxn, fasting glucose <300
sulfonylurea tx
67
adverse sulfonylurea
hypoglycemia - including coma CI - sulfa allergy, DMI, pregnant/nursing mother, hepatic/renal insufficiency
68
meglitinide MOA
bind ATP sensitive K channels - different site than sulfonylureas opens Ca channels - rapid increase in insulin release rapid acting - meal skipped - so is drug dose**
69
alpha glucosidase inhibitors
competitive inhibition of sugar digestion -limits postprandial rise in glucose for new DM II pt with mild hyperglycemia
70
adverse of alpha glucosidase inhibitors
flatulence, diarrhea, GI upset
71
TZDs
insulin sensitizers -removed from market bind nuclear transcription factors involving insulin receptor signaling cascade resensitize target tissue to insulin increase GLUT 1 and 4 transport proteins
72
rosiglitazone
risk of MI TZD
73
GLP-1 analogs
secreted by intestinal L cells agonist at GLP-1 receptor
74
exenatide
GLP-1 reduction of HbA1c levels need for BID subQ injections

Endo II Exam 2 (16 decks)

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