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49 Cards in this Set
- Front
- Back
Which molecule is the most important regulator of insulin release?
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Glucose
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Which receptors on pancreatic beta cells are responsible for taking up glucose?
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GLUT-2 receptors
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Which enzyme is found only in the beta cells of the pancrease and hepatocytes and is responsible for breaking down glucose?
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Glucokinase
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What is the process of beta cell insulin release?
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Glucose enters a cell through GLUT-2 receptors and is broken down by glucokinase. ATP is produced and increased ATP levels cause a blockade of K channels, depolarizing the cell and releasing insulin.
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Insulin acts on what type of cellular receptors throughout the body?
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Tyrosine Kinase
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What happens when insulin stimulates the IP3 signal transduction pathway in target cells?
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It leads to glucose/protein metabolism or lipid synthesis.
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What happens when insulin stimulates the MAP kinase pathway in target cells?
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It leads to cellular growth and differentiation.
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How is insulin removed from the body?
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It is degraded in the liver. Over 50% released form pancreas is destroyed in first pass effect.
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In what tissue does insulin not directly increase the uptake of glucose?
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Brain
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What is the etiology of Type 1 diabetes?
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Autoimmune attack, selective for beta cells in the pancreas.
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What factors are involved with the development of Type 1 diabetes?
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Genetic 50% and Environmental 50%.
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What is the treatment for gestational diabetes?
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Insulin
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MODY
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Mature Onset Diabetes of the Young
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What are the main treatment goals in both Type 1 and Type 2 Diabetes?
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Tight blood glucose control.
Control of blood pressure and serum lipids |
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Tight blood glucose control can prevent or reverse all of the major complications of diabetes except whcih effects?
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Cardiovascular effects
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How do the slow absorption insulins work?
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They are bound to protamine or self aggregate to allow for slow absorption.
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Rapid acting insulins include:
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Lispro, Insulin Aspart and Glulisine.
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Which insulin is short acting?
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Regular insulin.
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What are the long acting insulins?
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Glargaline, Determir
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Lipodystrophy
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Atrophy of subcutaneous fat around injection sites of insulin.
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What happens in hypoglycemia?
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Hypothalamus detects fall in blood glucose and it increases epinepthrine. This leads to glycogenolysis, increased HR, palpitations,sweating, hunger, weakness.
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What occurs in diabetic ketoacidosis and hyperosmolar coma?
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1. Dehydration-caused by osmotic diuresis
2. Acidosis- from increased lipolysis and production of acidic ketones 3. Electrolyte imbalance due to acidosis and dehydration 4. Type II diabetics are more likely to suffer from hyperosmolar coma which is dehydration without ketoacidosis. |
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What is the mechanism of action of the sulfonylureas?
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They close beta cell K channels and lead to increased depolarization and insulin release.
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Tolbutamide
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Sulfonylurea
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Tolazamide
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Sulfonylurea
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Chlorpropamide
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Sulfonylurea
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Glyburide
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2nd gen sulfonylurea
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Glimepiride
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2nd gen sulfonylurea
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Glipizide
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2nd gen sulfonylurea
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What are the adverse reactions of the sulfonylureas?
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They can increase risk for liver failure.
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Replaginide
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Similar action to sulfonylureas.
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Nateglinide
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Similar action to sulfonylureas
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What is the mechanism of action of the biguanides?
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Increases tissue glucose uptake reduces hepatic gluconeogenesis. May be caused by increase in AMP kinase.
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Metformin
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Biguanide
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Does metformin produce hypoglycemia?
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No
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What is a major benefit of metformin over other drugs?
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It has been shown to delay or prevent the onset of type 2 diabetes if given early.
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What are the adverse reactions associated with metformin?
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GI distress
Can cause lactic acidosis in in alcoholics |
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What is the mechanism of action of the thiazolidinediones?
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They activate the transcription factor PPARy which upregulates genes that increase insuling sensitivity.
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Rosiglitazone
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Thiazolidinedione
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Pioglitazone
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Thiazolidinedione
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What are the adverse effects of the thiazolidinediones
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Weight gain, fluid retention, CHF, hepatotoxicity.
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In what conditions are thiazolidinediones contraindicated?
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Pregnancy and heart failure.
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What is the mechanism of action of the a-glucosidase inhibitors?
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Inhibits a-glucosidase in the gut which slows intestinal absorption of glucose and decreasing post-prandial glucose peaks.
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Acarbose
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A-glucosidase inhibitor
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Miglitol
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A-glucosidase inhibitor
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Pramlintide
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Injectable analogue of amylin.
Reduces postprandial glucose peak. |
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Incretins
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Class of hormones that increase insulin secretion, increase beta cell growth, reduce glucagon, slow gastric emptying, reduce appetite.
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Exenatide
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GLP-1 analog.
Injected subQ. Incretin |
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Sitagliptin
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Blocks GLP-1 degredation.
Thought to have similar effects to exenatide. |