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55 Cards in this Set
- Front
- Back
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What is the treatment strategy for type I DM?
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-Low sugar diet
-Insulin replacement |
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What is the treatment strategy for type II dm?
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-Modify diet
-Exercise to lose weight -Oral hypoglycemics |
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5 types of insulin; which are short, med, or long acting?
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LinLU
Lispro - short Insulin - short NPH - med Lente - long Ultralente - long |
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What is the receptor at which Insulin acts? Transduction mech?
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The insulin receptor - Tyrosine kinase
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What are the effects of insulin on liver, muscle, and fat?
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Liver: store glucose as glycogen
Fat: increase glucose uptake, store as TG Muscle: increase glu uptake, store glycogen/protein, increase K uptake |
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Which type of DM is insulin replacement absolutely necessary for?
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Type I
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What are 2 other situations in which Insulin replacements may be given?
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-Life threatening hyperkalemia (to increase muscle uptake)
-Stress-induced hyperglycemia |
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What are 2 toxic side effects insulin replacement can have?
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-Hypoglycemia
-Hypersensitivity |
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What is given to trigger insulin RELEASE from beta-cells of the pancreas?
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SULFONYLUREAS
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How are the Sulfonylureas classified?
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Into 2 generations - 1st generation causes disulfiram effects; 2nd gen causes hypoglycemia
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What are the 2 first generation Sulfonylureas?
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Tolbutamide and Chlorpropamide
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What are the 3 second generation Sulfonylureas?
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Glyburide
Glimepiride Glipizide |
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And what is the side effect of 1st gen sulfonylureas?
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Disulfiram like rash
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What is the side effect of the 2nd gen sulfonylureas?
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Hypoglycemia (overdo the insulin release)
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How do the Sulfonylurea durgs trigger insulin release?
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Act like ATP - close a K channel to depolarize the B-cell membrane, triggers Ca-channel opening, Ca influx, vesicle release!
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For which type of DM are the sulfonylureas prescribed?
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Type II only - only type II still HAS the beta cells; they're destroyed in Type I!
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What diabetes drug has a mechanism that's not exactly KNOWN?
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Biguanides
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What is the Biguanide?
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Metformin
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What are 3 possible effects of Metformin?
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-Decrease GLUCONEOGENESIS IN LIVER
-Increase glycolysis -Decrease serum glucose! |
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What is Metformin's clinical use?
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Decrease blood sugar - hypoglycemic
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How is Metformin administered?
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Orally
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How is insulin administered?
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Intramuscularly
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What is the most GRAVE side effect of METFORMIN?
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Lactic acidosis
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What drugs increase the target cell RESPONSE to insulin?
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The GLITAZONES!
-Rosiglitazone -Pioglitazone |
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Rosi has a cousin?
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YES! her name is Pio!
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What is the clinical use of the glitazones?
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Monotherapy for Type II DM or in combo with other agents
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What are 3 adverse effects that the glitazones can cause?
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-Weight gain
-Edema -Hepatotoxicity |
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What drugs decrease the absorption of glucose and prevent it from even reaching the bloodstream?
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a-Glucosidase inhibitors
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What are 2 a-glucosidase inhibitors?
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-Acarbose
-Miglitol |
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What are the main side effects of Acarbose and Miglitol?
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Gi disturbance - gas
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How do the a-glucosidases work?
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They inhibit intestinal brush border a-glucosidases so delay sugar hydrolysis and glucose absorption.
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What effect does the delay in sugar hydrolysis and absorption have?
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Less postprandial hyperglycemia
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What is the mechanism of Orlistat?
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Alters fat metabolism by inhibiting pancreatic lipases
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What is Orlistat used for clinically?
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Long-term management of obesity
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4 toxic side effects of Orlistat:
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-Steatorrhea
-GI discomfort -Reduce abspn of Vit's DEAK -HEadache |
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What is Sibutramine?
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A sympathomimetic
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What is the mechanism by which Sibutramine is a sympathomimetic?
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It inhibits the reuptake of NE and Serotonin
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What is Sibutramine used for?
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Long and short-term management of obesity
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What are 2 side effects of Sibutramine?
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-HTN
-Tachycardia (sympathomimetic) |
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What are the 2 drugs that inhibit the enzyme Peroxidase in the thyroid?
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-Propylthiouracil
-Methimazole |
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What is the clinical use of PTU and Methimazole?
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Hyperthyroidism (Graves)
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Which Peroxidase inhibitor also blocks peripheral conversion of T4->T3?
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Propylthiouracil
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What are 3 side effects of PTU and Methimazole?
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-Skin rash
-Agranulocytosis -Aplastic anemia |
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Clinical uses of Growth Hormone:
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-GH deficiency
-Turner's syndrome (short) |
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4 clinical uses of Octreotide:
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-Acromegaly
-Carcinoid -Gastrinoma -Glucagonoma |
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4 clinical uses of Oxytocin:
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-Stimulate labor
-Uterine contractions -Milk let down -Uterine bleeding control |
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What is an ADH replacement?
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Desmopressin
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Clinical use of Desmopressin:
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CENTRAL Diab Insipidus - NOT nephrogenic
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Thyroxine replacement:
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Levothyroxine
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2 clinical uses of Levothyroxine:
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-Hypothyroidism
-Myxedema |
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3 toxic side effects of Levothyroxine:
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-Tachycardia
-Heat intolerance -Tremors |
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What are 5 pharmacologic Glucocorticoids?
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-Beclomethasone
-Dexamethasone -Hydrocortisone -Prednisone -Triamcinolone |
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Mechanism of Glucocorticoids:
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-Increase Lipocortin-A, inhibits PLA2, decreases COX expression, decreases PG's and LT's
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4 clinical uses of Glucocorticoids:
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-Suppress immune system
-Inflammation -Asthma -Addison's disease (replacement) |
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Toxicity of Glucocorticoids:
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Iatrogenic Cushing's syndrome
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