Pharm 6 Diabetes Flashcards Preview

Test 9 > Pharm 6 Diabetes > Flashcards

Flashcards in Pharm 6 Diabetes Deck (61):
1

2 methods of insulin secretion

-Pulsatile pacemaker B cells open Ca channels
-Glucose through GLUT2 -> ATP -> block KIR channel -> Ca opens

2

Insulin molecule

A + B chain, C-peptide is cleaved

3

Insulin metabolism

50% degraded in liver, 50% in other target tissues

4

Insulin receptor MOA (GLUT4)

Tetramer
-Insulin binds to a-subunits -> b-subunits autophosphorylate -> tyrosine kinase

5

Insulin receptor MOA (mitogen)

MAP-kinase phosphorylation

6

Insulin in liver

-Glycogen/triglyceride synthesis
-Inhibit glycogenolysis/gluconeogenesis

7

Insulin in fat

-Glucose uptake, triglyceride storage
-Inhibit lipolysis

8

Insulin in general

Promote anabolism, inhibit catabolism

9

Insulin deficiency acidosis mechanism

Increase lipolysis -> ketoacids -> acidosis

10

Glucose intolerance with onset during pregnancy

GDM - Gestational Diabetes Mellitus

11

Instant type I diabetes cause

Total pancreatectomy

12

Drug therapy provoking chronic hyperglycemia

Steroid therapy

13

Rate limiting step for insulin absorption

Subcutaneous dissociation from hexamers into dimers and then monomers

14

-Lispro-

Lysine-Proline switched, can't form aggregates
-Ultra fast
-Take after starting meal

15

-Aspart-

Proline replaced with aspartic acid, can't form aggregates
-Ultra fast

16

-Insulin-

Can be given IV
-Fast

17

-NPH insulin-

Regular plus protamine zinc insulin (positively charged)
-Intermediate

18

-Glargine-

Ultra slow, peakless
-Single bedtime dose

19

-Determir-

Binds to albumin
-Ultra slow

20

Insulin pump benefit

Controls "dawn phenomenon"

21

Injection to accelerate insulin absorption

-Intramuscular
-Heat (exercise)
-Abdomen or buttock (blood flow)

22

Compromised renal function effect on insulin

Reduced clearance, prolonged effectiveness

23

-Pramlintide-

Amylin analog
-Slows postprandial glucose levels
-Slow stomach, inhibit glucagon

24

-Pramlintide-
Contraindications
Adverse Effects

-Gastroparesis
-Delayed onset of action of oral drugs

25

-Exenatide-
MOA
indication

Incretin mimetic
-Stimulate Insulin, inhibit Glucagon
-Suppress postprandial hyperglycemia
-From lizard

26

GLUT4 recruiting without insulin

5'AMP-K
-From exercise

27

Sulfonylurea MOA

Directly inhibit KIR -> Insulin secretion
-(normally inhibited by GLUT2 glucose)

28

2 Sulfonylurea drugs

Glipizide
Glyburide

29

Sulfonylurea binding site

SUR1 on inwardly-rectifying potassium channel

30

Sulfonylurea effect

Raise insulin secretion -> correct hyperglycemia
-Increase insulin sensitivity
-Improve B-cell responsiveness

31

Exenetide, Pramlintide main purpose

Suppress postprandial hyperglycemia

32

-Glipizide-

Fastish Sulfonylurea
-Bind KIR

33

-Glyburide-

Slower Sulfonylurea
-Bind KIR
-Doesn't cross placenta

34

Glipizide, Glyburide
-Preferred drugs for what

Renal dysfunction
-(2nd gen are fecal excretion)

35

Glipizide, Glyburide
-Bad drugs for what

Type I DM

36

Drug for pregnancy

Glyburide

37

Sulfonylurea Adverse effects

-Severe Hypoglycemia (overdose)
-Weight gain

38

Drug to use for surgery, severe infections, severe stress or trauma, severe hepatic or renal failure

Insulin ONLY

39

The Glinides

Repa and Nate

40

Repaglinide, Nateglinide class

Meglitinides

41

Repaglinide, Nateglinide MOA

Inhibit KIR, rapid insulin release

42

Repaglinide, Nateglinide indication

Tx postprandial hyperglycemia
-Reduced risk of long-lasting hypoglycemia

43

Biguanide drug

Metformin

44

-Metformin- good for

Rarely produces lactic acidosis

45

-Metformin-
MOA

Induces 5'AMPK
-no effect on insulin
-no hypoglycemia

46

-Metformin-
indication

Obese diabetics, prediabetics
-(weight loss, beneficial effect on lipids)

47

-Metformin-
also good for

Polycystic ovarian syndrome
-Hyperandrogenism insulin resistance

48

Thiazolidinedione drugs

Glitazone
-Pioglitazone
-Rosiglitazone

49

-Pioglitazone, Rosiglitazone-
MOA

PPARy ligand
-(peroxisome proliferator-activated receptor) nuclear hormone

50

-Pioglitazone, Rosiglitazone-
target genes

GLUT4 and GLUT1 increase
-Increase insulin sensitivity

51

-Rosiglitazone, Pioglitazone-
AE

Black Box for heart failure
-Rosiglitazone - angina, MI

52

-Acarbose, Miglitol-
MOA

a glucosidase inhibitors
-Delay carb digestion, absorption

53

-Acarbose, Miglitol-
administration

taken with first bite of meal

54

-SitaGLIPTIN, SaxaGLIPTIN-
MOA

DPP-4 inhibitors
-slow stomach emptying

55

-Diazoxide-
MOA

Hyperglycemic agent
-opposite effect of sulfonylureas (KIR)
-inhibits insulin release, not synthesis

56

Sulfonylurea drugs

Glipizide
Glyburide

57

-Diazoxide-
indication

Insulinomas

58

-Glucagon-
MOA

G-protein -> liver glycogenolysis, gluconeogenesis

59

-Glucagon-
indication

Severe hypoglycemia due to DM Tx

60

-Orlistat-
MOA

Inhibit GI lipases and TG hydrolysis
-inhibit fat absorption

61

-Pramlintine, Exenetide-
MOA

Slow gastric emptying