Pharm Pancreatic Hormones, Antidiabetic Agents, And Glucagon

Front 1

Rapid acting insulins that do not self-aggregate

Back 1

Insulin lispro, insulin aspart, and insulin glulisine

Note: Used to control postprandial glucose and used to treat emergency treatment of diabetic ketoacidosis.

Front 2

Peakless basal acting insulin

Back 2

Insulin glargine

Front 3

Alpha cells in the pancreas

Back 3

Produce glucagon

Front 4

Beta cells in the pancreas

Back 4

Produce insulin

Front 5

Beta cells are found

Back 5

Islets of Langerhans

Front 6

Delta cells in the pancreas

Back 6

Produce Somatostatin

Front 7

Product of proinsulin cleavage used to assess insulin abuse

Back 7

C-peptide

Front 8

Exogenous insulin

Back 8

Little C-peptide

Front 9

Endogenous insulin

Back 9

Normal C-peptide

Front 10

Very rapid acting insulin, having fastest onset and shortest duration of action

Back 10

Lispro (Humalog)

Front 11

Rapid acting, crystalline zinc insulin used to reverse acute hyperglycemia

Back 11

Regular (Humulin R)

Note: Before the development of rapid-acting insulins, it was the primary form of insulin used for controlling postprandial glucose concentrations, and requires 1 h or more before a meal.

Front 12

Long acting insulin

Back 12

Ultralente (humulin U)

Front 13

Ultra long acting insulin, has over a day duration of action

Back 13

Insulin glargine

Note: provides a peakless basal insulin level lasting more than 20 h.

Front 14

Major SE of insulin?

How do you treat?

Back 14

Hypoglycemia

Sugar or candy. Glucagon as well.

Front 15

Important in synthesis of glucose to glycogen in the liver

Back 15

GLUT 2

Front 16

Important in muscle and adipose tissue for glucose transport across muscles and TG storage by lipoprotein lipase activation

Back 16

GLUT 4

Front 17

Examples of alpha-glucosidase inhibitors (AGI)

Back 17

Acarbose, miglitol

Front 18

MOA of AGI's

Back 18

Act on intestine, delay absorption of glucose

Front 19

SE of AGI's

Back 19

Flatulence (do not use beano to tx), diarrhea, abdominal cramps

Front 20

Alpha-glucosidase inhibitor associated with elevation of LFT's

Back 20

Acarbose

Front 21

Amino acid derivative

Back 21

Nateglinide

Front 22

MOA of nateglinide

Back 22

Insulin secretagogue

Front 23

What is the major drug in the class biguanide?

Back 23

Metformin

Front 24

MOA of metformin

Back 24

Decreases hepatic glucose production, slows down intestinal glucose absorption, increase insulin sensitivity, and increases peripheral utilization of glucose.

Front 25

Most important potential SE of metformin

Back 25

Lactic acidosis.

Note: in liver disease, alcoholism, lactic acidosis can be further complicated.

Front 26

What are some drugs that belong to the class meglitinides?

Back 26

Repaglinide and nateglinide. Suffix: -glinide

Front 27

MOA of repaglinide

Back 27

Insulin release from pancreas; faster and shorter acting than sulfonylurea.

They bind to K channel, but a different binding site than sulfonylureas; therefore, they are secretagogues as well.

Front 28

First generation sulfonylurea

Back 28

Chlorpropamide, tolbutamide, tolazamide, etc.

Front 29

Second generation sulfonylurea

Back 29

Glyburide, glipizide, glimepiride, etc.

Front 30

MOA of both generations

Back 30

Insulin release from pancreas by modifying K+ channels

Front 31

Common SE of sulfonylureas, repaglinide, and nateglinide

Back 31

Hypoglycemia

Front 32

Sulfonylurea NOT recommended for elderly because of very long half life

Back 32

Chlorpropamide

Front 33

What are some thiazolidinediones?

Back 33

Pioglitazone, Rosiglitazone. Suffix: -glitazone


Note: Troglitazone (withdrawn/d from market)

Front 34

Reason troglitazone was withdrawn from market

Back 34

Hepatic toxicity

Front 35

MOA of thiazolindinediones

Back 35

Stimulate PPAR-gamma receptor to regulate CHO and lipid metabolism

Front 36

SE of Thiazolindinediones

Back 36

Fluid retention, edema, mild anemia

Front 37

Hyperglycemic agent that increases cAMP and results in glycogenolysis, gluconeogenesis, reverses hypoglycemia, also used to reverse severe beta-blocker overdose and smooth muscle relaxation

Back 37

Glucagon

Front 38

Question: A 13 year old boy with T1DM is brought to the hospital complaining of dizziness. Laboratory findings include severe hyperglycemia, ketoacidosis, and blood pH of 7.15.

1) To achieve rapid control of the severe ketoacidosis, the appropriate antidiabetic agent to use is?

2) The most likely complication of insulin therapy in this PT is?

Back 38

1) Crystalline zinc insulin (rapid-acting insulin given intravenously)

2) Hypoglycemia

Front 39

Question: A 24 year old women with T1DM wishes to try tight control of her diabetes to improve her long-term prognosis. What regimen is appropriate?

Back 39

Morning injections of insulin glargine, supplemented by small amounts of insulin lispro at mealtimes. (glargine controls basal level; lispro is short-acting)

Front 40

Question: What drug promotes the release of endogenous insulin?

Back 40

Glipizide. Also, glyburide and glimepiride. All three are sulfonylureas.

Also meglitinides (repaglinide and nateglinide)

Front 41

Question: An important effect of insulin is?

Back 41

Increased glucose transport into cells

Front 42

Question: A 54 year old obese PT with T2DM and a history of alcoholism probably should not receive metformin because it can increase the risk of?

Back 42

Lactic acidosis.

Front 43

Question: The PPAR-gamma receptor that is activated by thiazolidinediones increases tissue sensitivity to insulin by?

Back 43

Regulating transcription of genes involved in glucose utilization--metabolism of carbohydrates and lipids.

Front 44

Question: What drug is taken during the first meal for the purpose of delaying the absorption of dietary carbohydrates?

Back 44

Acarbose or miglitol, which inhibits alpha-glucosidase.

Note: inhibition of alpha-glucosidase delays uptake of carbohydrates.

Front 45

Question: What drug is MOST likely to cause hypoglycemia when used as monotherapy in the treatment of T2DM?

Back 45

Insulin secretagogues (glyburide, glipizide, glimepiride, tolbutamide, chlorpropamide, repaglinide, and nateglinide).

Note: biguanides, thiazolidinediones, and alpha-glucosidase inhibitors are unlikely to cause hypoglycemia when used alone.

Front 46

Question: What type of PT is MOST likely to be treated with IV of glucagon?

Back 46

A 62 year old man with severe bradycardia and hypotension resulting from ingestion of an overdose of atenolol.

Note: Atenolol is a beta blocker--could be the most effective for stimulating the depressed heart because it increases cardiac cAMP without requiring access to beta receptors.

Front 47

What is alpha glucosidase?

What drug can inhibit it for T2DM?

What is the reason for this?

Back 47

An enzyme in the GI tract that converts complex starches and oligosaccharides to monosaccharides.

Acarbose and miglitol

By inhibiting this enzyme, absorption of glucose from the GI is slowed down.

Front 48

What is an intermediate acting insulin?

Back 48

NPH insulin.

Is often combined with regular and rapid-acting insulins.

Front 49

What are the four noninsulin drugs used to treat T2DM?

Back 49

Secretagogues (sulfonylureas), biguanide (metformin), thiazolidinediones (rosiglitazone), and alpha0glucosidase inhibitors (acarbose, miglitol)

Front 50

What is the MOA of secretagogues?

Back 50

Promotes closure of K channels in beta-cells which result in depolarization of the cell that triggers insulin release.

Front 51

SE of secretagogues?

Back 51

Hypoglycemia and weight gain.

Front 52

Why is metformin the DOC for T2DM?

Back 52

Unlike insulin, secretagogues, or thiazolidineiones, it does not increase weight gain. It also does NOT cause hypoglycemia.

Front 53

What is the SE of alpha-glucosidase inhibitors?

Back 53

Acarbose and miglitol cause flatulence and diarrhea.

Note: flatulence from fermentation of unabsorbed carbohydrates by flora.

Front 54

What is pramlintide, and its SE?

Back 54

Injectable synthetic analog of amylin, which is produced by beta-cells.

Pramlintide suppresses glucagon release, slows gastric emptying, and works in the CNS to reduce appetite.

Hypoglycemia and GI disturbances.

Front 55

What is glucagon-like peptide-1 (GLP-1)?

What is an analog that can treat T2DM and its SE?

Back 55

It is released from endocrine cells in the epi of the bowel in response to food. It augments glucose-stimulated insulin release. It produces a feeling of satiety.

Exenatide.

SE: hypoglycemia and pancreatitis.

Front 56

What the MOA of sitagliptin and its SE?

Back 56

An inhibitor of dipeptidyl peptidase-4 (DPP-4), an enzyme that degrades GLP-1 and other incretins.

Upper respiratory tract infection.

Front 57

Metformin MOA?

Back 57

mechanism is unknown
possibly decrease gluconeogenesis
increase glycolysis
decrease serum glucose levels
overall acts as an insulin senstitizer