Br Pharmacology: Pancreatic Hormones, Antidiabetic Agents And Glucagon

Front 1

What type of receptor is insulin receptor?

Back 1

tyrosine kinase

Front 2

When insulin is high what glucose receptor is also high in the liver?

Back 2

GLUT2

Front 3

What enzymes are increased in the liver by insulin action?

Back 3

pyruvate kinase, phosphofructokinase, glucokinase

Front 4

Glucose transport into skeletal muscle occurs via what receptor?

Back 4

GLUT4

Front 5

Does insulin activate LPL or hormone sensitive lipase in adipose tissue? What receptor does glucose use to enter adipose cells?

Back 5

1) LPL
2) GLUT4

Front 6

What is alpha-glucosidase and where is it found? What inhibit it?

Back 6

1) Found in GI tract that converts complex starches and oligosaccharides to monosaccharides
2) inhibited by acarbose and miglitol

Front 7

There are 3 rapid-acting insulins what are they?

Back 7

insulin lispro, aspart and glulisine

Front 8

When are rapid acting insulins given?

Back 8

injected immediately before a meal to control postprandial glucose levels

Front 9

Which insulins are used in continuous subcutaneous infusion devices?

Back 9

rapid-acting

Front 10

Someone presents to the ED with uncomplicated diabetic ketoacidosis. What should be given?

Back 10

rapid acting insulin

Front 11

Regular insulin is short acting and is used in emergencies or administered subcutaneously in maintenance regimens. How long before a meal is it given?

Back 11

1 hour

Front 12

NPH is what type of insulin?

Back 12

intermediate acting

Front 13

Long acting insulins are? How long do they last?

Back 13

1) glargine and detemir
2) 20 or more hours

Front 14

Which insulins are peakless? what are they used for?

Back 14

1) glagine and detemir
2) Control basal glucose levels without producing hypoglycemia

Front 15

Besides giving glucose to someone that is hypoglycemic what else can be given?

Back 15

IV glucagon

Front 16

Who is most susceptible to effects of hypoglycemia?

Back 16

children under 7, people with advanced renal disease, and elderly

Front 17

rapid acting insulins peak after how long and wear off within how many hours?

Back 17

peak in 1 hour and are gone in 5

Front 18

Short acting insulins peak after how long and wear off within how many hours?

Back 18

peak at about 3.5 to 4 hours and gone by 12 hours

Front 19

intermediate acting insulins peak after how long and wear off within how many hours?

Back 19

NPH peaks at 4 hours and is gone by 16 hours. Note it takes about 1-2 hours for effects to even begin

Front 20

Which insulin acts the longest but also has the longest time to begin working?

Back 20

glargine does not wear off in 24 hours but takes 6.5 hours to really begin working

Front 21

Increasing the dose of all insulin types increases duration except which?

Back 21

rapid acting insulins

Front 22

What is the MOA of insulin secretagogues?

Back 22

Close K+ channel in beta cells leading to depolarization and release of insulin

Front 23

What are examples of second generation sulfonylureas? What are the older drugs?

Back 23

1) glyburide, glipizide, glimepiride
2) tolbutamide and chlorpropamide

Front 24

What is an example of a meglitinide and what does it do? What is another drug with a similar effect?

Back 24

1) repaglinide has a rapid onset and short duration and is used for postprandial glucose control
2) nateglinide which has similar effects

Front 25

A type II diabetic should take what drugs right before a meal?

Back 25

nateglinide and/or repaglinide

Front 26

What is a common side effect insulin secretagugues? Which drugs is it most common with? What are other side effects?

Back 26

1) hypoglycemia, common with glyburide and glipizide
2) rash WEIGHT GAIN

Front 27

What are the effects of metformin? What kind of drug is it?

Back 27

it is a biguanide that decreases post prandial and fasting glucose, inhibit gluconeogenesis, increase glucose uptake and glycolysis, slow absorption of glucose from GI, decrease glucagon levels

Front 28

Because metformin reduces endogenous glucose how do its effects on insulin and weight differ from the effects of secretagogues and thiazolidinediones?

Back 28

decreases insulin production and enhances insulin sensitivity, and does not increase weight

Front 29

What is the first choice in treating Type II diabetes? What else can it be used for?

Back 29

1) metformin
2) restoration of fertility in women with PCOD

Front 30

What are toxicities of metformin?

Back 30

1) nausea and diarrhea
2) lactic acidosis in patients with renal or liver disease, alcoholism

Front 31

What is the MOA of thiazolidinediones?

Back 31

increase insulin sensitivity by activating PPAR-gamma receptor, which is a nuclear receptor that increases enzymes of glucose and lipid metabolism. They also inhibit gluconeogenesis

Front 32

What are some of the effects of taking thiazolidinediones?

Back 32

increase uptake of glucose in adipose and muscle cells and reduce fasting and postprandial hyperglycemia

Front 33

What other conditions can thiazinolidinediones be used in?

Back 33

restore fertility in PCOD

Front 34

What drugs are in the thiazolidinedione category?

Back 34

rosiglitazone and pioglitazone

Front 35

Common adverse reactions of thiazolidinediones are?

Back 35

mild anemia and edema from fluid retention which can increase risk of heart failure. Woman have increased risk of bone fracture

Front 36

acarbose and miglitol are analogs of what?

Back 36

carbohydrates

Front 37

What effect do acarbose and miglitol have on fasting blood sugar? When are they taken?

Back 37

1) none
2) just before a meal

Front 38

Which drugs have been shown to prevent type 2 diabetes in prediabetic people

Back 38

metformin, thiazolidinediones and alpha-glucosidase inhibitors

Front 39

Common adverse effects of alpha-glucosidase inhibitors are?

Back 39

flatulence, diarrhea, abdominal pain

Front 40

Two people present with hypoglycemia. One overdosed on insulin the other has been taking too much alpha-glucosidase. What can be used in the person with insulin but not in the alpha-glucosidase person to raise blood glucose?

Back 40

sucrose can be given to the person taking insulin but only glucose can be given to the person taking alpha-glucosidase

Front 41

What is pramlintide?

Back 41

amylin analog

Front 42

amylin is produced where in the body?

Back 42

beta cells

Front 43

what effect does pramlintide have? What is its MOA?

Back 43

1) decrease glucagon, slow gastric emptying, reduce appetite in CNS
2) activates calcitonin and RANK recptors

Front 44

Does pramlintide have a short or long duration?

Back 44

short

Front 45

Adverse effects of pramlintide include?

Back 45

hypoglycemia and GI disturbances

Front 46

Exenatide is analog of what?

Back 46

GLP-1

Front 47

What is GLP-1? where is it produced? What are its effects?

Back 47

1) an incretin
2) endocrine cells in GI epithelium
3) increase insulin release, decrease gastric emptying, inhibit glucagon, cause SATIETY

Front 48

Through what mechanism does exenatide have its effects?

Back 48

activates GLP-1 receptor which is a G protein that increase cAMP and intracellular Ca

Front 49

When is exenatide used? Is it short or long acting

Back 49

1) in conjunction with metformin or a sulfonylurea
2)it is long acting

Front 50

Sitagliptin inhibits what?

Back 50

dipeptidyl peptidase 4 (DPP4)

Front 51

What function does DPP4 have?

Back 51

degrades GLP-1

Front 52

Sitagliptin would have the same effects as what drug?

Back 52

exenatide because overall GLP-1 effects are produced

Front 53

What are common side effects of sitagliptin?

Back 53

URI, headache, nasopharyngitis

Front 54

What drugs augment insulins action?

Back 54

metformin, thiazolidinedione and alpha-glucosidase

Front 55

What type of receptor does glucagon activate?

Back 55

G protein-coupled receptor in heart, smooth muscle, liver

Front 56

What is glucagons effect on the heart? liver? smooth muscle?

Back 56

1) increases heart rate and contraction force
2) increases hepatic glycogenolysis and gluconeogenesis
3) relaxes smooth muscle

Front 57

Glucagon can be used to treat what?

Back 57

1) hypoglycemia in diabetics
2) depressed heart from beta-blocker excess

Front 58

Someone has taken too much propanolol. What can be given to correct this? Why?

Back 58

1) glucagon because it increases heart rate through a receptor that does not involve beta receptors

Front 59

If a glucagon is to be given to someone with hypoglycemia what must that person have?

Back 59

hepatic stores of glycogen, which is not the case in unmanaged type I diabetics