LEC 5 - Drugs Effecting Glucose Metabolism Flashcards Preview

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Flashcards in LEC 5 - Drugs Effecting Glucose Metabolism Deck (76):
1

What cell type in the pancreas is responsible for glucose regulation?

Pancreatic islet 

2

What cell type in the pancreas is responsible for the release of digestive enzymes?

Pancreatic acini 

3

How does the liver play a role in glucose regulation?

Stores glucose as glycogen when glucose is high 

Delivers glucose to plasma when levels drop

4

What are the two pathways in the liver that allow for glucose to enter blood when levels are low?

Glycogenolysis 

-- and -- 

Gluconeogenesis 

5

What are the glucose releasing hormones?

Glucagon 

Catecholamines 

Cortisol 

Growth hormones

6

What cell types releases insulin?

Beta cells

7

What cell types release glucagon?

Alpha cells

8

How do the beta cells know when to release insulin?

Glucose through GLUT 

Stimulates Na channels and Ca channels 

Cell depolarizes 

Insulin released 

 

9

How do the alpha cells know to release glucagon?

No glucose through GLUT channel 

Allow for Na and Ca channesl to be placed 

Glucose is inhibitory in this cell type 

10

What are the signs of diabetes mellitus?

PU/PD

Weight loss even iwth polyphagia

11

What do dogs get with chronic DM?

Cataracts 

12

What do cats get with chronic DM?

Neuropathy

13

What is seen in clinical chemistry with DM?

Blood glucose higher than normal 

Glucouria 

Increased fructosamine levels

14

Why do you see glucouria with DM?

Blood glucose higher than the capacity that the kidney can shuttle back into the ody

15

What type of DM is most common in dogs?

Type 1

16

What is the progonosis of a dog with type 1 DM?

Surive 2 to 3 years 

Cataracts within 5 to 6 months 

17

What causes type 1 DM?

Loss of functioning beta cells 

(90% have to be lost for symptoms to be seen) 

 

18

What are the etiologies of type 1 DM?

Autoimmune 

Genetics

Acute, severe pancreatitis 

19

What is the cause of Type 2 DM?

Acquired resistance of tissues to insuling 

Problems binding to receptor 

Problems with function of the receptor 

Problems with downstream signaling 

 

20

Common causes of Type 2 DM?

Obesity 

Concurrent dz

Chronic inflammation

Renal/Hepatic/Cardiac insuffiency 

21

What can cause severe peristant insulin resistance?

Diestrus induced increase in GH 

Cushing's disease 

Diabetogenic drugs 

Acromegaly

22

What are the drugs that can cause insulin resistance?

Progestin 

Glucocorticoids

23

How can dogs get type 2 DM?

Have several of the predisposing causes 

Can occur in Type 1 

24

What is the irreverisble part of insulin resistance?

Deposition of toxinc amyloid in islets 

Reduced insulin secretion 

25

What is the reversible part of insulin resistance?

High blood glucose 

leads to gluco/lipotoxicity 

26

What is remission in cats associated with?

Insulin choice 

low carb diet 

strict monitoring 

27

What does remission in a cat require?

Presence of functioning beta cells 

28

What type of DM do horses tend to get?

Type 2 

29

What are the treatment goals of DM?

Eliminate clinical signs 

Prevent complications 

Good quality of life 

NOT TO MAINTAIN GLUCOSE IN NORMAL RANGE 

30

What are the classes of insulin?

Short acting 

Intermeidate acting 

Long acting 

31

What are the characteristics of long acting insulin?

laast 12 to 24 hours 

 

32

What are the characteristics of intermediate acting insulins?

8 to 18 hours 

Used for maintence 

Admin SC 

Give with meal 

33

What are the characterisitics of short acting insulin?

1 to 4 hours 

given iV 

Used in emergencies 

34

What is insulin metabolized by?

liver and kidney 

35

What are adverse reactions to insulin?

Hypoglycemia 

Hyperglycemia 

Local/systemic immune reactions 

36

What is porcine zinc suspension type?

Intermediate

37

What are the characteristics of porcine insulin zinc suspension?

Two peaks of activity - has long and short action 

zinc crystals slow absorption 

 

38

Why is porcine insulin handled by dogs better?

Same AA sequence 

39

What type of insulin is neutral protamine hagedorn insulin?

Intermediate

40

What are the characteristics of neutral protamine hagedorn insulin?

Protamine slows absorption 

Single peak of activity 

Human recombinant 

41

What type of insulin is protamin zinc insulin?

Long acting

42

What is the composition of protamine zinc insulin?

90% beef - 10% pork 

immune reaction seen in dogs 

which leads to insulin resistance 

43

What type of insulin is glargine insulin?

Long acting

44

What is the problem with glargine insulin 

High concentration so easy to overdose 

Cn precipitate when given 

45

What is great about glargine insulin?

Can cause remission in cats 

46

What type of insulin is determir insulin?

Long action

47

What is so good about detemir insulin?

Allows for remission in cats 

With no precipitation 

Increased plasma protein binding = decreased elimination 

48

What is the polypol pathway responsible for/

Cataracts 

Neuropathy

49

What is the polypol pathway?

Glucose > Sorbitol 

Sorbitol causes glycationof protein NH2 groups 

 

50

What can sorbitol glycation be detected by?

Fructosamine 

A1C

51

What does fructosamine detect?

Glycated albulmin 

 

52

What does A1C detect?

Glycated hemoglobin

53

Which sorbitol test is done for animals?

Fructosamine

54

When should insulin resistance be considered?

Glucose control is erratic 

Insulinn doses constantly changing 

Glucose levels < 300 

Can't get them below that 

55

What can be fatal when adjusting insulin doses?

Hypoglycemia

56

What causes DKA/

Uncontrolled hyperglycemia 

Chronic ketone body formation by liver 

Ketone body = strong acid 

Severe metabolic acidosis 

57

What are the signs of DKA?

Lethargy / depression / coma 

Dehydration 

Muscle wasting 

Heptaomegaly 

Plantigrade stance in cats

58

What is the order of treatment for DKA?

Correct dehydration 

Admin short acting insulin 

Correct electrolyte imbalances 

Correct acidosis 

59

What electrolyte imbalance is most common with DKA?

Hypokalemia 

60

How does insulin help with hypokalemia?

Increase activity of Na-K ATPase in cell membrane leading to cellular uptake of potatssium 

61

When is glupizide given?

Possible alternative to someone who doesnt want to give injections 

Cat on well maintained low dose of insulin 

62

Where does glipizide act?

K channel in beta cell

63

How is glipizide handled in the body?

PO 

 

64

What are the adverse reactions seen with glipizide 

 

Promotes formation of toxic amylin fibers = death of beta cells

Reduce changes of remission 

Hepatotoxic 

Hypoglycemia 

65

How does metaformin work?

Reduces glucose output by the liver 

increase glucose uptake 

inhibit gluconeogenenesis by opposing glucagon signals

66

When is metaformin used?

Type 2 DM 

Cats 

 

67

What are the adverse reactions to metaformin?

Vomiting, lethargy, weight loss

Overdose = lactic acidosis 

do not use with cats in renal dz

68

What is the use of kinostat?

Prevents cataracts in dogs

69

How does kinostat work?

Inhibits aldose reductase 

Stops glucose to sorbitol in eye 

70

What is the treatment for hypoglycemia?

Karo sryup on gums ASAP 

IV fluids with dextrose in hospital once there

71

What is octreotide used for?

Insulinomas in ferrets and dogs

72

How does octreotide work?

Inhbits insulin gene expression 

73

What is diazoxide used for?

Insulinomas in dogs and ferrets

74

How does diazoxide work?

Increased potassium permeability in beta cells 

75

why is diazoxide a bad choice for most owners?

1/2 life = 5 hours 

have to give 4 times a day

76