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42 Cards in this Set

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13 drugs to know for this section
Insulin
Lispro
NPH
Insulin zinc extended
Glargine
Tolbutamide
Glyburide
Glipizide
Metformin
Acarbose
Pigolitazone
Rosiglitazone
Repaglinide
Insulin synthesis
Proinsulin in golgi granules--folds and forms disulfide bonds--proteolytic cleavage removes C-peptide--insulin stored in granules w/Zn and C-peptide
Stimulates release of insulin
Glucose
Amino acids
Glucagon
Ach
GI hormones:secretin, pancreozynin, GIP
Beta receptors (increase cyclase)
Inhibits release of insulin
Alpha 2 adrenergic receptor (decreases cyclase)

Somatostatin receptor (decrease cyclase and decrease Ca influx)
Most important stimulator of insulin release
Glucose
The metabolism of glucose increases... Which does what?
ATP
Inhibits K channels--Depolarization of beta cells--Ca influx--insulin release
Insulin enhances glucose uptake by all body tissues except,
CNS, peripheral nerves, blood vessels, renal medullary, and hepatocytes
Insulin stimulates anabolism in which three tissues?
Liver
Muscle
Adipose
Describe the insulin receptor
Two identical alpha subunits and two identical membrane-spanning beta units
DM characterized by
Hyperglycemia
Thickening of BMs
Late complications:-the opathies
Symptoms of DM
Polyuria
Polydipsia
Wt. Loss (Type 1)
Fasting hyperglycemia
Glycosuria
Which hormones are unopposed in DM
Glucagon
Cortisol
Catecholamines
GH
Type 1
before 30
10%
lean, ketoacidosis prone
HLA-association
Require insulin
Type II
After 30
90%
Obese (80%), ketoacidosis resistant
Non-HLA
Insulin usually not required
Stable glucose levels
Is insulin active when it is taken orally?
No
What kind of insulin preps are there?
Purified pork
Recombinant human
Glargine Onset Peak Duration
Ultra long lasting
O 1.5 hr
P none
D 20 hr
Insulin lispro (Humalog) differs from insulin how?
Lysine and proline @ positions 28 and 29 on beta chain in reverse order than normal
Lispro OPD
O 0-.25 hr
P 1/4-1/2 hr
D 3-4 hr
Regular OPD
O .5-1 hr
P 1-2 hr
D 3-4 hr
Insulin zinc prompt OPD
O .5-1 hr
P 1-2 hr
D 12-16 hr
Isophane (NPH) OPD
O 1-2 hr
P 8-12 hr
D 20-28
Insulin zinc OPD
O 1-2 hr
P 8-12 hr
D 18-24 hr
Protamine zinc (PZI) OPD
O 3-4 hr
P 8-12 hr
D 36
Insulin zinc extended OPD
O 3-4 hr
P 8-14 hr
D 36 hr
MA of sulfonylureas
Direct stimulation of insulin release (binds K channels)

Increased peripheral uptake of glucose

Decreased gluconeogenesis at the level of the liver
Commonly used sulfonylureas and 1/2 life
Acetohexamide 6 hr
Chlorpropamide 36 hr
Tolazamide 6 hr
Tolbutamide 6 hr
2nd generation sulfonylureas that is 200X more potent than tolbutamide
The 4 G's
Glyburide
Glipizide
Gliclazide
Glimepiride
Metformin
(-) gluconeogenesis in liver
Almost never causes hypoglcemia but can cause LACTIC ACIDOSIS
Acarbose
Alpha glucosidase inhibitor, (-) breakdown of sucrose to glucose
What should you take if you have hypoglycemia from acarbose?
Glucose tablets, not regular sugar that might have sucrose in it.
Pioglitazone and rosiglitazone MA
Decrease insulin resistance

Activate nuclear receptor, PPARγ which activates insulin responsive genes and decreases gluconeogensis in liver
Repaglinide
MA same as sulfonylureas
how is nateglinide different from repalinide?
Faster action w/shorter duration
Chronic DM stats
1. 6-10 million Americans
2. 3rd leading cause of death
3. Leading cause of blindness
4. Decrease life span by 1/3
Captopril and DM
ACEi

Decreases kidney failure by 50% in DM type 1

Increase risk of hypoglycemia
Losartan and irbesartan and DM
Angiotensin II receptor antagonists

Decreased incidence of diabetic nephropathy
In type 1 DM, when do Beta cell antibodies appear?
Several years before onset of symptoms
Which virus has been associated with Type 1 DM
Coxsackie
Final evidence that DM is an AI disorder
Transplantation of pancreatic tissue from one identical twin to the one that has DM will result in the new tissue being attacked in the DM pt.
If DM is diagnosed early, what can be used to halt its progression? What is the down side?
Immunosuppressant: Cyclosporin A

Pt. has to be on it for the rest of their life
A rare but potential fatal side effect associated w/metformin admin is...?
Lactic acidosis