E1. Drugs acting on glucose metabolism Flashcards Preview

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Flashcards in E1. Drugs acting on glucose metabolism Deck (43):
1

Look at slides 3 – 10 review of glucose metabolism.

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2

What cells are involved in the making of insulin?
A. Alpha cells
B. Beta cells
C. F cells
D. Delta cells

B. Beta cells

3

What cells are involved in the making of glucagon?
A. Alpha cells
B. Beta cells
C. F cells
D. Delta cells

A. Alpha cells

4

What cells are responsible for somatostatin?
A. Alpha cells
B. Beta cells
C. F cells
D. Delta cells

D. Delta cells

5

What cells are responsible for pancreatic polypeptide?
A. Alpha cells
B. Beta cells
C. F cells
D. Delta cells

C. F cells

6

What can cause the stimulation of insulin secretion?

– Rise in blood glucose concentration
– G.I. hormones:
– – gastric, CCK, secretin, gastric inhibitory polypeptide, glucagon
– amino acids and fatty acids in the GIT
– vagal stimulation (M receptors)
– – catcholamines (beta-2 receptors)

7

Whatcauses the inhibition of insulin secretion?

– decrease in blood glucose concentration
– somatostatin
– catecholamines (a2 or I3 receptors)

8

What happens if you have too much insulin?
Too little insulin?

Too much: hypoglycemia
too little: hyperglycemia

9

What are the differentials for hypoglycemia? (5 main, 4 of which have subs)

1. artifact
2. Unable to make glucose
– liver failure/cirrhosis
– Portosystemic shunt
– severe malnutrition (neonates/toy breeds)
– hyperadrenocorticism (pituitary/GH deficiency)
– glycogen storage diseases
3. Excessive consumption
– sepsis
– extreme exertion
4. Exogenous hypoglycemic agents
– insulin overdose
– overdose of other hypoglycemic agents (e.g.. glipizide)
5. Endogenous hypoglycemic agents
– xylitol toxicity (dogs)
– insulin secreting islet cells neoplasia (insulinoma)
– extrapancreatic neoplasia
– islet cell hyperplasia

10

What are the two main therapeutic considerations for hypoglycemia? (Gen.)

Not involving insulin, and involving insulin.
*Look at slide 13 for subcategories

11

What are the three main pharmacologic therapy for hypoglycemia?

– Replacement
– diet
–Anti-hypoglycemic agents
*look at slide 14 subcategories

12

Is glucagon commonly used to treat hypoglycemia? What's the initial dilution you should start off with?

Not commonly used. Initial dose should be 50 ng/kg followed by 10 – 15 ng/kg/minute.
*adjust based on blood glucose measurement

13

What is the proper dose if using dextrose for an acute case or maintenance?

Acute: 1 mL/kg of 50% dextrose diluted (1:4)
maintenance:
-2.5-5% dextrose IV
-Adjust based on blood glucose levels

*don't want to use greater than 5% dextrose because greater than that will cause phlebitis.

14

What are some considerations you should take into account when using dextrose to treat hypoglycemia? (2)

– Hyperosmolality/irritation
– rising glucose stimulates insulin secretion

15

You use dietary management to treat acute and chronic hypoglycemia?

Acute: Karo syrup/corn syrup (mostly used outside of clinic, as good as dextrose in an emergency situation)

chronic:
– frequent, small meals
– complex carbs (symbol carbs may stimulate insulin secretion)
– easily digestible
– moderate fat and protein

16

How can use pharmacologic therapy to treat hypoglycemia?

What is the goal of this therapy?

– *glucocorticoids*
– Diazoxide
– Streptozotocin
– somatostatin

Goal is to eliminate/minimize clinical signs associated with hypoglycemia (this may not be maintaining a "normal" blood glucose!)

17

What is the DOC/ reached for first drug to treat hypoglycemia?

Glucocorticoids (prednisone, prednisolone)

18

What do glucocorticoids do to the gluconeogenesis, glucose uptake (in tissue), and glucagon secretion?

Increase gluconeogenesis, decreased glucose uptake into tissue, stimulate glucagon secretion

19

What is the bioavailability of glucocorticoids is taken orally?

Good oral bioavailability

20

Where does prednisone and prednisolone need to go to be activated? (Organ)

The liver/hepatic metabolism is required

21

What dose should you start off with when using prednisone or prednisolone?S

.5 mg/kg/day, increase as needed

22

What are the side effects of using prednisone or prednisolone?

Generally mild at low doses (PU/PD, panting) and get progressively more severe as this is increased (immunosuppression, etc.).

23

What are the drugs that can be used to treat hypoglycemia?

Diazoxide, somatostatin, octreotide (somatostatin analog), streptozotocin

24

How do you give Diazoxide?
When should you give this?
What are its side effects?

– Oral
– when glucocorticoids and diet longer work
– side effects:
paper celebration, anorexia/vomiting/diarrhea, less commonly (tachycardia, hematologic changes, diabetes, fluid retention)
look at slide 19 and 20 for more information. Slide 20 gives the mode of action.

25

What does somatostatin do?

Inhibits release of insulin, glucagon, growth hormone, CCK, secretin, gastrin, VIP

26

What is octreotide sometimes used to treat? (Dogs, ferrets, cats)

27

Look at slide 22 for information on streptozotocin.

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28

What are the differential for hyperglycemia? (7)

Physiologic hyperglycemia(Stress, postprandial, Diestrus), diabetes mellitus, hypersdrenocorticism, Pheochromocytoma, Pancreatitis/Exocrine Pancreatic Neoplasia, Some Drugs/Toxins, Head Trauma

29

What are the two types of diabetes mellitus?

Type I: insulin-dependent (IDDM) (insulin deficiency)
Type II: non-insulin-dependent (NIDDM)(insulin resistance
*type II seen in cats

*Look at slide 25 for a bit more info. Two

30

Look at the slides 26-28.

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31

What is the goal of therapy referring to hyperglycemia?

– Reduce hyperglycemia
– reverse catabolic effects
– reverse ketosis
– control clinical signs

*look at slide 29 for more info

32

What are the three general treatments for diabetes mellitus? (All three have subcategories)

– General management

33

How does acarbose (Precose) work?

It is not a hypoglycemic agents. It inhibits alpha amylase and brush border oligo/disaccharides.

*look at slide 31

34

What are the three types of oral hypoglycemics?

Sulfonylureas, Biguanides,

35

Name the drugs that are Sulfonylureas? (only first 2 really matter)

36

What is the main thing that Glipizide does?

Increased release of insulin

*look at slide 34

37

What is the drug that is considered a Biguanides?
What are the two biggest things you need to know about that drug?

Metformin

recognizes as an anti-hyperglycemic that doesn't affect insulin secretion

*look at slide 35

38

Look at slide 36-39.

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39

What are the two types of insulin that can be given to animals? What is the concentration? T

40

How should you properly store and handle insulin?

41

What are the types of insulin? (Duration/acting period)

Short, intermediate and long

look at slide 42

42

How can short acting insulin be given?

When is this most commonly used

IV, IM, SC

most commonly used for DKA management

look at slide 43

43

Look at slide 44-51.

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