Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

KG - Pharmacology 2 > KG - Pharm 2 Exam 3, Diabetes > Flashcards

KG - Pharm 2 Exam 3, Diabetes Flashcards

(124 cards)

Start Studying
1
Q

rapid acting insulins?

A

insulin lispro
insulin aspart
insulin glulisine

*second part of name has something to do with an amino acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

short acting insulins?

A

regular insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

intermediate insulins?

A

isophane insulin
NPH

*INtermediate (I = isophane, N = nph)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

long acting insulins?

A

insulin glargine

insulin detemir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

problem w/ Type 1 DM?

A
  • CIRCULATING INSULIN ABSENT

- pancreatic beta cells don’t respond to glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

problem w/ type 2 DM?

A

insensitivity to circulating insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how do type 2 DM pts develop insensitivity to insulin?

A

chronic over feeding –>
sustained Beta cell stimulation –>
hyperinsulinism –>
receptor insensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

classical symptoms DM

A

3Ps

  • polydipsia
  • polyphagia
  • polyuria
  • weakness
  • fatigue
  • thirst
  • nocturnal enuresis
  • peripheral neuropathy
  • vulvo-vaginitis/pruritis in females
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

chronic diabetic syndrome - ocular signs

A
  • cataracts
  • lens changes
  • retinopathy
  • blindness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

chronic diabetic syndrome - CV signs

A
  • gangrene
  • ATHEROSCLEROSIS
  • HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

chronic diabetic syndrome - neurobiological signs

A
  • PERIPHERAL NEUROPATHY
  • postural hypotension
  • diarrhea/constipation
  • problems voiding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

chronic diabetic syndrome - skin/mucous membrane signs

A
  • infection
  • xanthoma
  • shin spots
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

physiological changes in insulin deficiency?

A
  • hyperglycemia
  • hyperlipidemia
  • hyperketonemia
  • myoglobinuria
  • glucosuria
  • microangiopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

diagnosis DM?

A
  • FASTING glucose > 126 on at least 2 separate occasions
  • following ingestion of 75 G GLUCOSE, plasma glucose > 200 at 2 hours and one other time during 2 hr test
  • HbA1c > 6%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

HbA1c levels

A
  • NORMAL < 6%
  • POORLY CONTROLLED DM > 10%
  • DESIRABLE LEVEL FOR TIGHTLY CONTROLLED DM < 7%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

insulin release activated by ____?

A
  • GLUCOSE
  • BETA 2 ADRENERGIC (epi/norepi) AGONISTS
  • other sugars
  • AAs
  • fatty acids
  • ketone bodies
  • vagal activation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

insulin inhibited by ____?

A
  • ALPHA 2 AGONISTS

- conditions that activate SNS (hypoxia, hypothermia, surgery, burns)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

insulin PROMOTES ___?

A

ENTRY GLUCOSE INTO:

  • SKELETAL MUSCLE
  • HEART MUSCLE
  • FAT
  • LEUKOCYTES
  • NOTE REQ FOR GLUCOSE TRANSFER INTO BRAIN, LIVER, RBCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when insulin injected… what happens?

A
  • plasma glucose down
  • plasma pyruvate/lactate up
  • phosphate down
  • potassium down (bc potassium channels are closed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Actions of insulin, general?

A

INHIBITS CATABOLIC PROCESSES (breakdown glycogen, fat, protein… promotes anabolic state)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

actions of insulin - liver?

A
  • DECREASE GLUCONEOGENESIS

- INCREASE GLYCOGEN SYNTHESIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

actions of insulin - muscle?

A
  • STIMULATE GLUCOSE UPTAKE

- promote protein/glycogen synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

actions of insulin - adipose?

A
  • STIMULATES GLUCOSE UPTAKE

- increase lipogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how to treat type 1 DM?

A

INSULIN!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
how to treat type 2 DM?
ANTIDIABETIC AGENTS
26
toxicity/adverse rxn insulin?
HYPOGLYCEMIA - tachycardia - confusion - vertigo - sweating ``` allergy lipodystrophy lipohypertrophy insulin resistance drug interactions ```
27
tx for hypoglycemia
- 50% glucose solution IV | - glucagon injection
28
insulin allergic rxns?
- local allergic rxns 10x more common than systemic runs - inflammation can persist for several days - local inflammation/infection - -> unhygienic injection technique - -> impurities - systemic runs can manifest spectrum of responses
29
factors that increase insulin requirement
- fever, thyrotoxicosis, pregnancy, stress, surgery, trauma, infection, increased metabolism - increased antibodies - excess GH (acromegaly) - excess adrenocortical hormone (Cushing's) - altered sensitivity of muscle/fat to insulin
30
which insulins can be used IV?
rapid acting, short acting
31
method for insulin replacement?
INJECTION - create insulin profile & eat to fill it | PUMP - adjust boluses accd to what you eat
32
glucagon - MOA
increase blood glucose by mobilizing hepatic glycogen WHEN AVAILABLE - regs glucose, AAs
33
glucagon - therapeutic effects
- juveniles don't respond as well - not as effective in pts w/ reduced glycogen stores - potent inotropic/chronotropic effects on heart (used in beta blocker overdose) - used in radiology to relax intestine
34
diazoxide - info
- non-diuretic thiazide - vasodilator - hyperglycemic
35
diazoxide - MOA
hyperglycemia by: - directly inhibit insulin secretion - decrease peripheral glucose use - stimulate hepatic glucose production
36
diazoxide - therapeutic effects
pts w/ INSULINOMA
37
glucagon - pharmacokinetics
- parenteral admin (SC, IM, IV) | - gradual onset of action
38
diazoxide - pharmacokinetics
- oral admin | - fairly long duration action (half life = 24-36 hrs)
39
"other anti diabetic agents" - MOA
- increase endogenous insulin release - decrease glucose levels - increase sensitivity to insulin
40
sulfonylureas - MOA
- STIMULATE INSULIN RELEASE FROM PANCREATIC BETA CELLS - BLOCK K+ CHANNELS - INDIRECTLY potentiate action of insulin on target tissues
41
sulfonylureas - adverse effects
- HYPOGLYCEMIA (more w/ long lasting ones, 2nd gen better) - GI side effects - WEIGHT GAIN
42
sulfonylureas - contraindications/precautions
- renal dz/hepatic dysfunction | - SULFA ALLERGIES
43
first gen sulfonylureas?
- Tolbutamide - Chlorpropamide - Tolazamide
44
Tolbutamide - distinguishing characteristics
- infrequent hypoglycemia (least overall) - safest in elderly - rapid absorption
45
Chlorpropamide - distinguishing characteristics
- worst hypoglycemia (first gen sulfonylureas)
46
second gen sulfonylureas?
- Glyburide - Glipizide - Glimepiride
47
glyburide - distinguishing characteristics
- 24 hour effect | - HYPOGLYCEMIA (worst of sec gen sulfonylureas)
48
glipizide - distinguishing characteristics
- half life 2-4 hrs | - least hypoglycemia (of second gen sulfonylureas)
49
list meglitinides
- repaglinide | - nateglinide
50
how are meglitinides different from sulfonylureas?
not sulfonamides so can be used w/ sulfa allergy
51
meglitinides - therapeutic effects
EUGLYCEMIA - lower POSTPRANDIAL glucose - rapid, short action - LESS HYPOGLYCEMIA than sulfonylureas - lower HbA1c - little effect on weight
52
meglitinides - MOA
- receptors on K+ channels beta cells, increase insulin release
53
meglitinides - pharmacokinetics
- oral admin, PREPRANDIAL (1-10 min) - rapid action - liver metab - CYP3A4
54
meglitinides - adverse effects
SLIGHT hypoglycemia
55
meglitinides - contraindications/precautions
- don't use w/ sulfas - caution w/ liver probs - less hypoglycemia than 2nd gen sulfonylureas
56
DOC newly diagnosed type 2 DM?
METFORMIN
57
metformin - MOA
DOES NOT RELEAST INSULIN - increase glucose uptake (increase insulin action in muscle, fat) - decrease glucose absorption from GI - decrease glucagon - decrease gluconeogenesis
58
metformin - therapeutic effects
- decrease glucose - EUGLYCEMIA (NOT in normal pts) - decrease POSTPRANDIAL hyperglycemia - 15-20% decrease plasma triglycerides - DOES NOT INCREASE BODY WEIGHT - DECREASE MACROVASCULAR EVENTS - SAFE FOR KIDS > 10 y.o.
59
Metformin + lifestyle changes = _____
NO INCREASE BODY WEIGHT | DECREASE MACROVASCULAR EVENTS
60
Metformin - pharmacokinetics
- oral admin | - can get once/day dose, extending release
61
metformin - adverse effect
- LACTIC ACIDOSIS (rare, but lethal) | - DIARRHEA, anorexia, n/v
62
metformin - contraindications/precautions
- LACTIC ACIDOSIS CONDITIONS - -> renal dz - -> hepatic dz - -> alcoholism - -> dz predisposing to tissue hypoxia (CHF, COPD)
63
metformin - class?
biguanides
64
list thiazolidinediones | (AKA - "TZDs" & "glitazones"
- Pioglitazone | - Rosiglitazone
65
thiazolidinediones - MOA
"INSULIN SENSITIZERS" - target insulin resistance - ligands of PPAR alpha receptor, can cause POST-RECEPTOR INSULIN-MIMETIC ACTION - -> increase glucose transporter synthesis in adipose - -> onset/offset action can take weeks-months - do not stimulate insulin secretion
66
thiazolidinediones - therapeutic effects
- LOWERS INSULIN RESISTANCE - decrease triglycerides in long term use - slight increase HDL - potential to REDUCE DEVELOPMENT OF TYPE 2 DM (PROPHYLACTIC USE) - improved glycemic control
67
thiazolidinediones - pharmacokinetics
- oral admin - long half life (103-158 hrs) - liver metab
68
thiazolidinediones - adverse effects
- WEIGHT GAIN - EDEMA (incr risk heart failure w/ CHF) - back pain, fatigue, HA - slight hypoglycemia
69
Rosiglitazone - distinguishing characteristics
- BLACK LABEL WARNING - often taken off market | - 2x increased incidence MI, angina
70
thiazolidinediones - contraindications/precautions
- HEPATIC DZ | - CHF
71
list alpha-glucosidase inhibitors
- Acarbose | - Miglitol
72
alpha-glucosidase inhibitors - MOA
reduce glucose absorption - inhibit alpha-glucosidase in small intestine --> delayed carb digestion & absorption
73
alpha-glucosidase inhibitors - these are used for which NON-FDA approved use?
Type 1 DM
74
alpha-glucosidase inhibitors - therapeutic effects
- decr postprandial glucose - min effects fasting glucose - modestly lower HbA1c levels - NO SIGNIFICANT EFFECTS ON WEIGHT
75
alpha-glucosidase inhibitors - pharmacokinetics
- oral admin - half life = 2 hrs - metab by intestinal digestive enzymes & microorganisms
76
alpha-glucosidase inhibitors - adverse effects
- GI EFFECTS - ab pain, diarrhea, GAS | - elevated hepatic enzymes, jaundice
77
alpha-glucosidase inhibitors - contraindications/precautions
- GI disease, obstruction, ileus, IBD, hiatal hernia - hepatic dz - renal impairment
78
incretins - physiology?
- GLP1 & GIP increase release insulin - GLP1 inhibits glucagon release - decreased hepatic gluconeogenesis *incretins are released in response to glucose
79
incretins - list
- exanatide | - liraglutide
80
incretins - info
- synthetic version exendin 4 | - RESISTANT TO ENZYMATIC DEGRADATION BY DPPV-IV
81
incretins (Exenatide) - pharmacokinetics
- morning and evening SC INJECTIONS - 60 MIN BEFORE TWO MAIN MEALS - -> half life 2 hrs - -> kidney elimination - -> new formula = ONCE/WK INJECTION
82
incretins (Liraglutide) - pharmacokinetics
- SINGLE DAILY SC INJECTION | - -> half life 12-13 hrs
83
incretins - therapeutic effects
- lowers postprandial AND fasting serum glucose - promotes better glycemic control - modestly lowers HbA1c - POTENTIAL INCREASED BETA CELL # and FUNCTION - WEIGHT LOSS - slows gastric emptying, pt eats less
84
incretins - adverse effects
- GI disturbance - hypoglycemia in combo therapy - hypersensitivity rxns - ACUTE PANCREATITIS POTENTIALLY
85
incretins - contraindications/precautions
- slow GI problems, GI disease - oral meds that cannot be exposed to stomach acid too long - renal impairment
86
which incretin mimetic can cause thyroid cancer?
- Liraglutide
87
DPP-IV inhibitors - list
- sitagliptin - saxagliptin - linagliptin - alogliptin
88
DPP-IV inhibitors - MOA
- DPP-IV inhibitors | - POTENTIATES EFFECTS ON INCRETIN HORMONES by inhibiting breakdown by DPP-IV
89
DPP-IV inhibitors - therapeutic effects
- lower postprandial and fasting serum glucose - cause modest decr HbA1c - NO EFFECT ON WEIGHT
90
DPP-IV inhibitors - pharmacokinetics
- ORAL ADMIN, once/day - eliminated by kidney - half life 12 hrs
91
DPP-IV inhibitors - adverse effects
- hypersensitivity rxns
92
which DPP-IV inhibitor may be associated w/ ACUTE PANCREATITIS & PANCREATIC CANCER?
sitagliptin
93
DPP-IV inhibitors - contraindications/precautions
- slow GI probs | - renal impairment
94
amylin-like peptide - list
pramlintide
95
when to use pramlintide?
- ONLY ADJUNCT TO INSULIN THERAPY | - TYPE 1 & TYPE 2
96
pramlintide - MOA
SYNTHETIC ANALOG AMYLIN (hormone co-secreted w/ insulin) - works w/ insulin to REGULATE POSTPRANDIAL GLUCOSE BY - -> decr gastric emptying - -> suppress glucagon secretion - -> decr appetite/caloric intake
97
pramlintide - therapeutic effects
- modestly decr HbA1c | - WEIGHT LOSS
98
pramlintide - pharmacokinetics
- SC INJECTION, 3x daily (w/ meal bolus insulin) - elim by kidney - half life 48 min
99
pramlintide - adverse effects
- GI - hypoglycemia w/ insulin - injection site lipodystrophy
100
pramlintide - contraindications/precautions
slow GI probs
101
list dopamine agonist
bromocriptine
102
bromocriptine - MOA
- dopamine agonist - augments low hypothalamic dopamine levels --> inhibits excessive sympathetic tone w/in CNS --> decr postmeal plasma glucose levels due to ENHANCED SUPPRESSION of HEPATIC GLUCOSE PRODUCTION
103
bromocriptine - indications/therapeutic effects
- improves glycemic control - DECR FASTING & POSTPRANDIAL FFA & TRIGLYCERIDE LEVELS - modestly decr HbA1c - weight neutral - REDUCE CARDIOVASCULAR END POINT PROBLEMS (potentially)
104
bromocriptine - pharmacokinetics
- oral, w/in 2 hrs of awakening - quick release - eliminate by biliary system
105
bromocriptine - adverse effects
- mild/transient = nausea, weakness, constipation, dizziness | - non-cycloset = psychotic disorders, hallucinations, fibrotic complaints
106
bromocriptine - contraindications/precautions
- pregnant/nursing
107
list bile acid binding resins
colesevelam
108
colesevelam - MOA
unknown
109
colesevelam - indications/therapeutic effects
- DECREASE FASTING PLASMA GLUCOSE & HbA1c | - beneficial effects hyperlipidemia - HELPS CHOLESTEROL
110
colesevelam - adverse effects
- safe drug | - CONSTIPATION, BLOATING
111
list SGLT2 inhibitors
- canagliflozin - dapagliflozin ``` a = without gli = glucose flozin = flow ```
112
SGLT2 inhibitors - MOA
inhibits sodium-glucose co-transporter 2 (SGLT2) in kidney
113
SGLT2 inhibitors - indications/therapeutic effects
- modest decrease HbA1c
114
SGLT2 inhibitors - pharmacokinetics
oral
115
SGLT2 inhibitors - adverse effects
- common = female genital infections/UTIs - OSMOTIC DIURESIS -- postural dizziness, orthostatic HTN, syncope, dehydration - renal probs = incr Cr, decr GFR - hyperkalemia - increased LDL-C
116
SGLT2 inhibitors - contraindications
- SEVERE RENAL IMPAIRMENT/DIALYSIS (can reduce GFR) | - prone to UTIs/GU infections
117
which drug classes can cause bad hypoglycemia?
- sulfonylureas | - meglitinides (not AS bad...)
118
which antidiabetic drug classes can cause hyperinsulinemia?
- sulfonylureas | - meglitinides
119
which antidiabetic drug classes can cause lactic acidosis?
metformin (but rare)
120
which antidiabetic drug classes must be injected?
- incretin mimetics | - pramlintide
121
which antidiabetic drug classes don't have many GI side effects?
- thiazolidinediones - gliptins - meglitinides (slight only)
122
which is the newest class of anti diabetic drugs?
SGLT2 inhibitors
123
w/ which drug were CVD deaths increased? (1970 study)
tolbutamide
124
what should be done to maintain tight control of HbA1c in type 2 DM?
- metformin - reduce macro vascular events in obese pts - BP control - tight control HbA1c reduces microvascular events

KG - Pharmacology 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions