Topic 18 Flashcards Preview

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Flashcards in Topic 18 Deck (72):
1

2 functions of the pancreas are?

exocrine
endocrine

2

The Endocrine Pancreas produces what?

insulin (signalling a “fed” state)
glucagon (signalling a “hungry” state)
gastrin, somatostatin, and many others

3

Beta cells secrete what? which causes?

insulin which causes blood glucose to decrease

4

Alpha cells secrete what? which causes?

glucagon which causes blood glucose to increase

5

Delta cells secrete what? which regulates?

somatostatin which regulates a LOT of things

6

The Exocrine Pancreas releases what?

bicarb
digestive zymogens to break down fats and proteins

7

Diabetes insipidus=

Critter doesn’t produce or kidneys don’t respond toVasopressin (Antidiuretic Hormone/ADH)
- which creates dilute/unconcentrated urine

8

Diabetes mellitus (DM) [all 4 types] are characterized as what?

an absolute or relative deficiency of insulin
#1) Type 1
#2) Type 2
#3) Type 3 “Other” DM
#4) Gestational DM

9

normal glucose levels

75-115

10

Type 1 DM=

Insulin-Dependent DM (IDDM)

11

Type 2 DM=

Non-Insulin-Dependent DM (NIDDM)

12

Broadly, Type 1 DM is an ____ insulin deficiency and Type 2 DM is a _____ deficiency of insulin

absolute
relative

13

which type is more prevalent over 35 years old

type 2

14

which type is more common

type 2 (90-95%)

15

which type has a greater genetic predisposition

type 2

16

which type so critters produce variable amounts of insulin and exhibit insulin resistance

type 2
--These critters typically require increasing doses of insulin and combination therapy with other antihyperglycemics

17

with which type- due to side effects of drugs, toxins, viral infections, genetic predispositions, etc. Variable in course & treatment

Type 3 DM: Other

18

Type 4 DM: Gestational: Women may develop extreme insulin resistance during their ____ trimesters of pregnancy

third
--same time they might be prone to blowing out mitral valves, as a result of hormonal changes
--Controlled with insulin

19

uncontrolled Type 4 DM can lead to what?

extremely large babies, dystocia, and neonatal hypoglycemia

20

describe insulin's chemical structure

A small polypeptide consisting of two chains (A & B) connected by a disulfide bond

21

insulin's half life

3-5 minute half-life

22

Since insulin is removed from circulation so rapidly (3-5 minute half-life), plasma insulin levels are not an accurate measure of insulin production. What measurement is better?

C-protein measurement is a better guide

23

what is the C-Protein

A 31 amino acid peptide used to differentiate Type 1 DM from Type 2 DM

24

C-Protein half life and what it means

Half-life of C-Protein is ~30 minutes
–Therefore ~5X as much in the blood stream as insulin

25

Where is insulin produced and in response to what?

produced by β-cells in the pancreas in response to glucose (the archetypical “fed state”)

26

Insulin’s main effect target tissues are? What effect does insulin exhibit on these?

liver, fat, and muscle
exhibits anabolic effects on these target tissues

27

Insulin is increasingly being used by perfusionists for what type of therapy?

hyperkalemia therapy
--often in conjunction with glucose to “drive” potassium intracellularly

28

insulin drug names that are Rapid onset/short-acting (4)

Regular insulin (Humulin R, Novolin R)
Insulin aspart (Novolog)
Insulin glulisine (Apidra)
Insulin lispro (Humalog)

29

Regular insulin

(Humulin R, Novolin R)

30

Insulin aspart

(Novolog)

31

Insulin glulisine

(Apidra)

32

Insulin lispro

(Humalog)

33

insulin drug name that is Intermediate onset/intermediate acting

Neutral Protamine Hagedorn (NPH) insulin
(Humulin N, Novolin N)

34

Neutral Protamine Hagedorn (NPH) insulin

(Humulin N, Novolin N)

35

insulin drug names that are Long acting insulins (2)

Insulin glargine (Lantus)
Insulin detemir (Levemir)
Do NOT mix with other types of insulin!

36

Insulin glargine

(Lantus)

37

Insulin detemir

(Levemir)

38

The ADA recommends diabetics’ blood glucose (BG) maintain a mean of?

154 mg/ml.

39

Long-term BG measurement is via

Glycated (glycosylated) Hb (HbA1c)

40

Injectable Antihyperglycemic drug name

Pramlintide (Symlin)

41

Pramlintide

(Symlin)

42

Incretin Mimetic drug names

Exenatide (Byetta): SHORT ACTING
Liraglutide (Victoza): LONG ACTING

43

Exenatide

(Byetta)

44

Liraglutide

(Victoza)

45

Incretins are hormones released by the GI tract post-prandially that stimulate the pancreas to do what?

release insulin, slow gastric emptying, decrease glucagon release, and encourage β-cell growth

46

name the Oral Insulin “Adjuncts” (5)

*Insulin Secretagogues
*Insulin Sensitizers
*α-Glucosidase Inhibitors
*Dipeptidyl Peptidase-IV Inhibitors
*Sodium Glucose Co-Transporter Inhibitors (SGLT Inhibitors)

47

Insulin Secretagogues: Sulfonylureas (3) drug names

Glyburide (Diabeta, Micronase)
Glimepiride (Amaryl)
Glipizide (Glucotrol)

48

Insulin Secretagogues: Glinides (2) drug names

Nateglinide (Starlix)
Repaglinide (Prandin)

49

Insulin Sensitizers: Biguanides (1) drug names

Metformin (Glucophage)

50

Insulin Sensitizers: Thiazolidinediones (2) drug names

Pioglitazone (Actos)
Rosiglitazone (Avandia)

51

Glyburide

(Diabeta, Micronase)

52

Glipizide

(Glucotrol)

53

Glimepiride

(Amaryl)

54

Nateglinide

(Starlix)

55

Repaglinide

(Prandin)

56

Metformin

(Glucophage)

57

Pioglitazone

(Actos)

58

Rosiglitazone

(Avandia)

59

what do Biguanides prevent and why is it important?

Prevents hepatic gluconeogenesis (huh?)
***This is very important because hepatic glucose production is the main source of excessive glucose in Type-2 DM!

60

what do Thiazolidinediones do?

Increase intracellular receptors in skeletal muscle, liver, and adipose tissue to become more sensitive to endogenous insulin

61

α-Glucosidase Inhibitors drug name (2)

Acarbose (Precose)
Miglitol (Glyset)

62

what do α-Glucosidase Inhibitors do

Work by reversibly inhibiting an enzyme in the small intestines that helps digest polysaccharides into simple sugars

63

Acarbose

(Precose)

64

Miglitol

(Glyset)

65

Dipeptidyl Peptidase-IV Inhibitors drug names(2)

Saxagliptin (Onglyza)
Sitagliptin (Januvia)

66

what do Dipeptidyl Peptidase-IV Inhibitors do?

Work at the cellular level to increase post-prandial insulin release while inhibiting glucagon (insulin’s physiologic antagonist) release

67

Saxagliptin

(Onglyza)

68

Sitagliptin

(Januvia)

69

Sodium Glucose Co-Transporter Inhibitors (SGLT Inhibitors) drug name (1)

Canagliflozin (Inkovana)

70

what do Sodium Glucose Co-Transporter Inhibitors (SGLT Inhibitors) do?

SGLT2 is a low affinity, high capacity transport mechanism in the proximal tubule
•It’s designed to “capture” glucose lost in renal filtration
•Glucose is therefore freely “lost” into the urine

71

Canagliflozin

(Inkovana)

72

what Sodium Glucose Co-Transporter Inhibitors (SGLT Inhibitors) was almost approved for use in the US?

Dapagliflozin (Farxiga)
*A 6-fold increase in bladder cancer