Endocrine Lecture 1

Front 1

what are the first generation sulfonylureas?

Back 1

acetohexamide, chlorpropamide, tolazamide, tolbutamide

I aced the chlorine totally B!

Front 2

what are the second generation sulfonylureas?

Back 2

glipizide, glyburide, glimepiride

triple G

Front 3

what drugs are the meglitinides?

Back 3

nateglinide, repaglinide

mega natty rap

Front 4

what drugs are the biguanides?

Back 4

metformin

Front 5

what drugs are in the thiazolidinedione class?

Back 5

pioglitaztine and rosiglitazone

rosser is a pig

Front 6

what bile acid sequestrant is used in diabetes?

Back 6

colesevelam

Front 7

what dopamine agonist is used in diabetes?

Back 7

bromocriptine

Front 8

what are the drugs in the SGLT-2 (sodium glucose cotransporter 2) inhibitor class?

Back 8

canagliflizoin, dapaglifozin, empaglifozin

dad has a can of empathy

Front 9

what are the drugs that are the DPP-4 inhitior (dipeptidyl peptidase 4 inhibitor) class?

Back 9

alogliptin, sitagliptin, saxagliptin, linagliptin

sit sax all in line

Front 10

what are the rapid acting insulins?

what is the rapid inhaled insulin?

Back 10

lispro, aspart, glulisine

LAG

afrezza

Front 11

what are the short acting insulins?

Back 11

humulin and novolin R

Front 12

what are the intermediate acting insulins?

Back 12

humullin and novolin N

Front 13

what is the ultra long acting insulin?

Back 13

degludec

Front 14

what are the concentrated insulins?

Back 14

humulin r 0 300 and glargine u 300

Front 15

what is the only amylinomimetic for diabetes?

Back 15

pramlintide, this inhibits glucagon which decrease blood glucose

Front 16

what are the GLP1(glucagon like peptide 1) agonists and mimetics?

Back 16

exenatide, liraglutide, albiglutide, dulaglutide

Ex liar alex big dulces

Front 17

what does amylin do?

Back 17

inhibits glucagon secretion

Front 18

what is gestational diabetes?

Back 18

diabetes during the 24-28 week of gestation not known to have diabetes

Front 19

when does the honeymoon phase happen? what type of diabetes?

explain the physiology that causes type 1 dm?

why does this cause hyperglycemia?

Back 19

type 1, following diagnosis when the pancreas is still able to produce enough insulin to manage glucose levels

immune mediated beta cell destruction

absolute deficiency in insulin and amylin

Front 20

explain the physiology of type 2 diabetes.

what causes hyperglycemia?

Back 20

impaired insulin secretion, insulin resistance because of upregulated basal insulin secretion, the pancreas in unable to maintain insulin production and basal insulin demand exceeds supply capacity of the pancrease, 60-90% of beta cell die

insulin resistance with insuffcient supply of insulin to meet demand of body

Front 21

what 2 factors are involved in the causation of type 2 diabetes? what does this cause

what is this also known as?

Back 21

genes and environment

insulin resistance and beta cell failure

relative insulin deficiency

Front 22

what organs/body parts are involved with diabetes?

Back 22

fat, kidney, muscle, liver, brain, pancreas, intestines

Front 23

does alcohol cause hyper or hypoglycemia?

Back 23

hypo

Front 24

what drugs cause hyperglycemia?

Back 24

diuretics, glucocorticoids, olanzapine, phenytoin, sympathomimetics(NE and E)

Front 25

is there any recommended screening/diagnosing guidlines for type 1?

type 2?

Back 25

None for type 1

test everyone over the age of 45, if normal repeat in 3 years

Front 26

when would you consider screening for type 2 prior to the age of 45?

Back 26

if overweight or obese with one of the following

physical inactivity, 1st degree relative, women who delieverd a 9 lb baby, polycyctic ovary syndrome, >140/90, HDL less 35 and TG gre 250, A1c greater than 5.7%, hx of CVD

Front 27

normal fasting glucose?

normal oral glucose tolerance test?

normal A1c?

Back 27

less tha 100

less than 140

less than 5.7

Front 28

what is considered an impaired fasting glucose number?

impaired oral glucose tolerance test?

Back 28

100-125

140-199

Front 29

what is fasting glucose in a diabetic?

oral glucose tolerance test?

a1c?

Back 29

greater or equal 126

greater or equal 200

greater or equal 6.5

Front 30

what is fasting glucose for those at increased risk for diabetes?

oral glucose tolerance test?

a1c?

Back 30

100-125

140-199

5.7-6.4

Front 31

symptoms of hyperglycemia?

symptoms of hypoglycemia?

Back 31

blurry vision, difficulty concentrating, frequent urination, headache, fatigue, glucose in piss

nevrousness, sweating, confusion, lightheaded, hunger, insomnia, blurry vision, weakness

Front 32

what is needed for diabetes diagnosis?

Back 32

high fbg, ogtt, a1c and symptoms of hyperglycemia

Front 33

what does a1c measure?

Back 33

glucose over 2-3 months, includes both postpradial blood glucose and fasting blood glucose

Front 34

what did the a1c derived average glucose study show?

how much does an a1c of 5 correlate with in average glucose?

6

Back 34

a1c correlates with average glucose

97

120 add 30 for the rest

Front 35

define insuline resistance syndrome, who gets this?

Back 35

impaired response to the physiological effects of insulin

type 2

Front 36

what are the goals for diabetes?

Back 36

maintain glucose, prevent hyper/hypo, delay macro/micro complications, eliminate other risk factors, maintain qol

Front 37

when should you use the ADA guidelines?

ACCE/ACE guidelines?

which one is more strict?

Back 37

elderly and frail

young

AACE/ACE

Front 38

what is the FBG for ADA? a1c? BP?

AACE/ACE? a1c? BP?

Back 38

80-130, less than 7, less than 140/90

less than 110, less than or equal to 6.5, less than 130/90

Front 39

what are features that can be modified in treating a diabetic?

Back 39

patient attitude, treatment efforts, resources, support

Front 40

what drugs should you consider for a patient that is in increased risk for diabetes?

how much excercise a week?

Back 40

metformin, pioglitazone, orlistat if severly obese

150 mins per week, no more than 2 consecutive days w/o excercise

Front 41

why would you give an ACE to a diabetic?

Back 41

prevents progression to macroalbuminuria ffor type 1

Front 42

should a type 1 diabetic check BG?

how often should they check a1c?

GFR and urinary albumin?

Eyes?

what vaccines?

Back 42

3 or more times a day

3-6 months

5 or more years

after diagnosis and annually

influenza, pneumococcal, hepatitis B (HIP)

Front 43

what is different about the excercise regimen for type 2?

what is unique about CAD prevention in diabetics?

Back 43

includes resistance training

BP less than 140/90, statin, ACE, use aspirn if 10 year risk is greater than 10%

Front 44

what is unique about the monitoring for type 2?

how much weight should diabetics lose?

Back 44

includes annual feet exam

5-10%

Front 45

what is the therapy for type 1?

gestational?

Back 45

insulin that mimics body phsilogical secretions

insulin, oral sulfonyurea or metformin

Front 46

describe the treatment algorithm for ADA

Back 46

diet excercise, metformin, if a1c in not achieved after 3 months do dual therapy, add anything, if a1c is not achieved in 3 months do triple therapy, then try injectables (metformin, insulin, mealtime insulin or glp)

Front 47

describe the treatment algorith for AACE

Back 47

depends on entry a1c, if less than 7.5 monotherapy, if greater than 7.5 dula therapy, if greater than 9 and no symptoms do dual or triple therapy, if greater than 9 w symptoms add insulin and other agents

Front 48

what does a fasting value indicate?

post meal?

Back 48

microvascular problems

macrovascular problems

Front 49

what 4 people received a nobel prize for insulin?

Back 49

fredrick banting, jj macloed, charles best, jb collin

Front 50

what hormone is synthesized by the beta cells?

what happens to this?

what happens to proinsulin?

Back 50

a preprohormone called preproinsulin

leaves ER and part of N termins is cleaved to create proinsulin

in golgi, PC and PC2 cleave the connecting peptide leaving the a and b chain attached by disulfide bonds

Front 51

what type of recptor is the insulin receptor?

describe the structure?

is the recptor found only in a dimeric form?

Back 51

tyrosine kinase like receptor that autophosphorylates

heterodimeric, external alpha subunit and beta transmembrane subunit (tyrosine kinase activity)

no tetrameric form, has greater affinity

Front 52

explain the sig transduction after insulin binds?

Back 52

binding, autophosphorylation of beta, aggregation of alpha and beta, beta phosphoraltes IRS1 (insulin receptor substrate 1), gene expression, insertion of GLUT transpoorters into cell membrane, increase uptake of blood glucose

Front 53

describe the different forms of insulin molecules and how it affects absorption

Back 53

hexameric state is not absorbed, this eventually turns into the dimeric state which is slowly abosrbed, then this breaks down to the monmeric state which is rapidly absorbed

Front 54

what are the effects of zinc and protamine?

Back 54

increase onset of action and half life

Front 55

how is lispro different from natural insulin?

is there any difference in binding?

Back 55

proline at 28 and lysine at 29 are reversed, this allows lispro to dissociate from hexmeric form to monomeric after injection

bind insulin receptor the same, greater affinity for IGF1 receptor

Front 56

how is insulin aspart different from natural insulin?

Back 56

Proline at position 28 of b chain is replaced with aspartic acid, which allows dissociate from hexmeric to monomeric form after injection

Front 57

how is insulin glulisine different from natural insulin?

Back 57

b chain aspargine at 3 is replaced with lysine

b chain lysine at 29 is replaced with glutamic acid

Front 58

how are the short acting insulins different from natural insulin?

intermediate acting insulins?

Back 58

has zinc and crystals

has zince and protamine

Front 59

how is insluin glargine different from natural insulin?

Back 59

2 arg residues added to c termine of B and 21 asparagine is replaced with glycine, makes peptide less soluble

Front 60

how is insulin degludec different from natural insulin? what are the effects?

Back 60

B 30 threonine is deleted and is conjugated to hexadecanedioic acid on b 29 lysine, causes hexamers to form which favors slow release of insulin

Front 61

what are the main differences between glut 4 and glut 2?

Back 61

glut 2 does not depend on insulin for diffusion and is found in the liver and kidney

glut 4 is found in adipose and muscle and only works if insulin is present

Front 62

Afrezza

what is the time until onset?

time until peak?

duration?

Back 62

5-10 minutes

10-14 minutes

2-3 hours

Front 63

skip

Back 63

skip

Front 64

rapid acting insulin lispro/aspart/glusine

onset of action?

peak?

duration?

Back 64

5-15 min

1-2 hour

3-5 hour

Front 65

Regular insulin (humulin R and Novolin R/short acting insulin)

onset?

peak?

duration?

Back 65

30-60 min

2-4 hours

6-10 hours

Front 66

intermediate insulin (NPH)

onset?

peak?

duration?

Back 66

1-2 hours

4-8 hours

10-20 hours

Front 67

long acting insulin glargine

onset?

peak?

duration?

Back 67

2-4 hours

none

24 hours

Front 68

long acting insulin detemir

onset?

peak

duration?

Back 68

2-4 horus

none

12-24 hours

Front 69

asdf

Back 69

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