Pancreatic Hormones & Diabetic Drugs Flashcards Preview

Pharm > Pancreatic Hormones & Diabetic Drugs > Flashcards

Flashcards in Pancreatic Hormones & Diabetic Drugs Deck (57)
Loading flashcards...
1

Which diabetes has more of a genetic predisposition

Type II

2

Which diabetes has insulin deficiency

Type 1

3

Which diabetes has a loss of beta cells

Type 1

4

Which diabetes is more prone to ketoacidosis

Type 1

5

Which diabetes is prone to a non-ketototic hyperosmolar coma

Type II

6

K+/ATP and Insulin:

Open state of K+/ATP channel

hyperpolarize the cell by causing outflow of K+ and inhibit insulin release

7

K+/ATP and Insulin:

Closed state of K+/ATP channel

depolarize the cell and insulin released.

8

Insulin Receptor signaling:

insulin binding to alpha subunit regulates beta subunit activity -->

autophosphorylation of beta subunit -->

increase tyrosine kinase activity -->

phosphorylation of other substrates -->

activation of phosphoinositide 3-kinase

9

Effects of insulin on the liver

Stimulates:
- glycogen synthesis
- triglyceride synthesis

Inhibits:
- glycogenolysis
- ketogenesis
- gluconeogenesis

10

Effects of insulin on skeletal muscle

Stimulates:
- glucose uptake
- protein synthesis
- glycogen synthesis

Inhibits:
- Protein degradation
- Glycogenolysis

11

Effects of insulin on adipose tissue

Stimulates:
- Glucose uptake
- Triglyceride storage

Inhibits:
- lipolysis

12

Overall, insulin stimulates ____and inhibits ____

Promotes anabolic processes and

Inhibits catabolic processes

13

advantages to recombinant DNA insulin

• Less insulin resistance
• Less allergy
• Less lipodystrophy

14

Rapid/ short-acting insulin:
onset and duration

Onset: 5-15 min
Duration: 3-5 h

15

Rapid insulin

• Insulin lispro, aspart, glulisine given s.c
• Inhaled human insulin - Indicated only in adults,
• Contraindicated- children, asthma, bronchitis, smokers

16

short-acting insulin
• duration
• what? method given?
• use?

• Duration: 5-8h
• Regular insulin given s.c and i.v.
• Use in diabetic ketoacidosis and other emergency situations

17

intermediate-acting insulin:
• onset
• duration
• what?

• onset: 2-5h
• duration: 4-12h
• Lente insulin, NPH insulin (Neutral protamine Hagedorn or isophane) mixture of insulin with protamine (basic substance obtained from fish sperm)

18

Ultra-long acting insulin
• onset
• duration
• what?

• onset: slow
• duration: 20-24h
• Ultra lente, Insulin glargine, Insulin detemir
• Peakless, given once daily

19

Hypoglycemia
• S/Sx
• Tx

• Sympathetic signs (tachycardia, sweating, palpitations, tremors) parasympathetic signs (nausea, hunger)
• Treatment : Glucose or glucagon treatment

20

Allergy and resistance to insulin

• Local cutaneous reactions or systemic
• Human insulin are less antigenic than insulin from animal sources

21

lipodystrophy

• Atrophy of fatty tissue at the site of injection
• Never seen since the development of highly purified insulin

22

Treatment of Type II DM includes

• Diet
• Exercise
• Wt reduction
• Step wise approach to drug treatment
• Patient education
➢ Oral drugs for reduction of blood glucose
• Used only in the Rx of Type II DM
• Oral medication is initiated when 2-3 months of diet and exercise alone are unable to achieve or maintain their optimal plasma glucose levels

23

Insulin secretogogues

• Sulfonyureas
• Meglitinides

24

Oral Hypoglycemics

1. Insulin secretogogues
• Sulfonyureas
• Meglitinides
2. Biguanides
3. Thiazolidinediones
4. Alpha glucosidase inhibitors

25

First Generation Sulfonylurea

• Chlorpropramide
• Tolbutamide
• Tolazamide

26

2nd Generation Sulfonuylurea

• Glipizide
• Glyburide
• Glimepiride

27

Mechanism of action of Sulfonylurea

• Block ATP sensitive K+ channels in pancreatic beta cells --> Inhibits the efflux of K+ resulting in depolarization
• Opening of voltage gated Ca influx --> release of preformed insulin -->
• Increase the sensitivity to insulin by increasing number of insulin Receptors

28

Chloropropamide (Diabinese)

• Long acting for 32 hours
• Can cause prolonged hypoglycemia in elderly patients (contraindicated age)
• Slowly metabolised in liver, so Contraindicated in patients with hepatic disease

29

Tolbutamide (Orinase)

• Rapidly metabolised in liver
• Short half life - safest SU in elderly

30

2nd generation SU drugs:

• glipizide (glucotrol)
• glyburide (micronase, glynase prestab)
• glimepiride

➢ Second generation drugs commonly prescribed agents because of fewer side effects and drug interactions