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Flashcards in Insulin & Oral Antidiabetics Deck (40):
1

Is insulin a pancreatic catabolic hormone that promotes nutrient use?

No- anabolic and promotes storage

2

What three things increase pancreas beta cells release of insulin?

1. Vagal innervation
2. GI hormones
3. Glucose, A.A.

3

What are insulins effects on liver?

increase glycogen and trig. synthesis,

inhibits glyogenolysis, glycogenesis and ketogenesis

4

What are insulins effects on muscle?

increase glucose and amino acid uptake. Increase glycogen and protein synthesis.

5

What is insulins effect on adipose tissue?

increase triglyceride storage and inhibits lipolysis

6

What if anabolic reactions can't take place?

anabolic/catabolic balance is disturbed and catabolic prevail

7

The metabolic changes that occur in DM are similar to those that occur during what?

fasting [if you have nothing to eat, you use and eventually deplete your stored nutrients.]

8

What is the etiology of diabetes mellitus?

decrease insulin production or increase in insulin resistance

9

Review epidemiology of diabetes

8% incidence, 20 million people in 2011, $245 billion

10

What percentage are insulin dependent diabetes cases? what are they due to? detection? what age?

1. 5-10%
2. autoimmune destruction of beta cells
3. very low undetectable insulin
4. diagnose before 30

11

What percentage is not insulin dependent? due to what? insulin levels? insulin response? onset age?

1. 90%
2. decreased responsiveness
3. subnormal
4. blunted
5 usually over 40 and overweight

12

What is gestational diabetes due to?

steroid induced insulin resistance- 7% of pregnancies --mostly 3rd trimester

13

What drugs induce DM?

glucocorticoids or growth hormones

14

What are the 4 therapeutic approaches to Type 1 DM?

1. insulin
2. insulin and pramlintide
3. diet
4. exercise

15

What are the 4 therapeutic approaches to Type 2 DM?

1. diet
2. Exercise
3. anti-diabetic drugs individually or in combo
4. insulin

16

What are the 3 things we do for gestational diabetes?

1. diet and exercise
2. insulin. only FDA approved
3. Some oral anti-diabetic drugs (sulfonylureas and biguanides)

17

What are the major complications of diabetes?

end-stage renal disease, heart disease, stroke, hypertension, blindness, peripheral neuropathy

18

What do sulfonylureas meglitides and nateglinide attack>

ATP sensitive K channels in the beta cells

19

What do biguanides do?

reduce hepative gluconeogenesis by inhibiting mitochondrial glycerophosphate dehydrogenase, antagonize the actions of glucagon

20

What do thiazolidinediones act on?

PPARy in muscle, adipose, and liver

21

Incretins or inhibitors of incretin degradation effect what cells?

alpha and beta cells in pancreas

22

amylin analogs affect what cells?

alpha cells and CNS

23

What receptor do we try to affect in the kidney?

inhibitors of sodium glucose co-transporter

24

What does insulin form in concentrated solutions?

dimers and hexamers, but they are absorbed slowly when injected

25

What are the main differences from types of administered insulin?

rate of absorption, onset, and duration of action

26

how can we change rate of absorption?

mutation of amino acid residues, addition of components such as protamine, buffers in insulin

27

What are lispro, aspart, glulisine?

rapid acting insulin

28

What is regular crystalline insulin?

short acting

29

What is NPH??

intermediate acting (slower than regular) insulin

30

What are glargine and detemir?

long acting insulins

31

Continuouse insulin infusions usually use what type of insulin?

regular or rapid acting [ lispro, aspart, glulisine]

32

The effectiveness of insulin therapy can be enhanced with what?

amylins

33

The insulin secretagogues effect what receptor?

decrease K efflux in beta cells(lowered with increased ATP)

34

Do meglitinides or sulfonylureases have higher affinity for K channels?

meglitinides

35

What inhibits mitochondrial glycerophosphate dehydrogenase?

biguanides- actions take place in the liver leading to reduction of gluconeogenesis and thus hepatic glucose output

36

Does biguanides cause hypoglycemia and weight gain?

No, neither

37

What are the agonists for PPARy?

Thiazolidinediones- increase insulin sensitivity in target tissures

38

What do incretins do in pancreatic beta cells? alpha cells?

up insulin

down glucagon
[together decrease postprandial glucose]

39

What does amylin do?

inhibit glucagon secretion and has CNS-mediated anorectic effect

40

What is the only combination approved for type 1 diabetes?

insulin and pramlintide