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150 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Normal Fasting Glucose Level
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80-100 mg/dL
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Pre-Diabetic Fasting Glucose Level
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100-125 mg/dL
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Diabetic Fasting Glucose Level
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126 or over mg/dL
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Diabetes is the ______ major cause of death in the US
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4th
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The ________ is cleaved out of pro-insulin by the ___ cells in the pancreas
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C peptide; beta
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Type 1 Diabetes:
Other name and cause |
Juvenile Onset; loss of beta cells in pancreas, inability to produce insulin
10% of cases |
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Type 2 Diabetes:
Other name and cause |
Adult Onset; make insulin but your cells are resistant to it, partial loss of ability to produce insulin
90% of casess |
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Insulin is ______
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anabolic
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Epinephrine and Glucocorticoids are_________
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catabolic
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In the absence of Insulin, characteristics of blood:
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-increased AAs
-increased triglycerides and FFAs= hyperlipemia -increased glucose= hyperglycemia -decrease in pH= acidosis -decrease in H2O |
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In absence of Insulin, characteristics of Kidneys:
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-can't handle large amounts of glucose so it spills into urine= glucosuria
-decreased H2O concentration -increased volume of urine= polyurea -lose electrolytes like K+ and Na+= dehydration -drinking a lot= polydipsia |
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In absence of Insulin, characteristics of Liver:
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-decreased glycogenesis
-increased glycogenolysis -increased gluconeogenesis -increased acetoacetic acid and Beta-hydroxy Butyric acid= ketone bodies= smell of acetone on breath |
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cause of Diabetic Coma
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prolonged untreated diabetes
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Diabetic Coma symptoms
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-elevated glucose
-ketoacidosis -acidic blood -acetone on breath -dehydration, loss of electrolytes -cool body temp -can die of cardiovascular collapse -slow in onset |
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Diabetic Coma treatment
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-begin w/ infusion of glucose b/c you will need to treat w/ insulin later on---avoid hypoglycemia
-give isotonic saline -change pH -give a SHORT ACTING insulin in small, divided doses slowly -infuse K+ and monitor heart -don't treat w/ insulin too quickly or you will get Cerebral Edema |
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cause of Hypoglycemic Coma
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-if patient decides to fast or exercise more than usual then insulin is not needed as before and you will get an overdose of insulin= hypoglycemia
-Type 1 or 2 |
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Hypoglycemic Coma symptoms
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-onset is rapid
-mental confusion -headache -sweat -blurry vision -muscle trembling(epinephrine release) -tachycardia -convulsions |
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Hypoglycemic Coma treatment
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-consistent regimen of insulin is important to avoid this
-if conscious, give glucose -if unconscious, IV glucose -DO NOT GIVE INSULIN! |
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cause of Hyperosmolar Coma
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excess sugar in system b/c of increased glucocorticoids and renal shutdown
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Hyperosmolar Coma symptoms
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-common in elderly, Type 2
-as you age, you become resistant to insulin -stress/infection increase glucocorticoids -dehydration-----too far and get renal shutdown -blood sugar levels too high |
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Hyperosmolar Coma treatment
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give insulin
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Gestational Diabetes
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as mother gains weight and hormones change, she gets more glucocorticoids
-increases risk of intrauterine death -congenital malformation -macrosomia=large baby |
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Insulin receptor activity depends on ______
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pH
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In acidosis, the activity of the insulin receptor is __________
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reduced
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Obesity contributes to Type 2 Diabetes problem because:
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increased food intake= increased glucose= increased insulin levels= receptor activity decreased b/c they are internalized= CHRONIC INSULIN RECEPTOR LOSS
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Type 2 Diabetes can be prevented with ______ and _______
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diet, exercise
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Insulins that can be given IV are:
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Rapid and Short Acting
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Which drugs should not be given to Type 1 Diabetics?
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Hypoglycemic Agents b/c they don't make insulin so it does them no good to take a drug that will increase the production of insulin!
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list oral hypoglycemic agents
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Tolbutamide
Tolazamide Chlorpropamide Glipizide Glyburide Glimepiride Repaglinide Nateglinide |
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list oral anti-hyperglycemic agents
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Metformin
Rosiglitazone Pioglitazone Acarbose Miglitol |
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list modified insulins
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Glargine
Lispro Aspart NPH Lente Ultralente |
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RAPID ACTING INSULINS
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Lispro
Aspart |
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SHORT ACTING INSULINS
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Insulin
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INTERMEDIATE ACTING INSULINS
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NPH
Lente |
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LONG ACTING INSULINS
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Ultralente
Glargine |
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sperm can live in female tract for ____ days
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3
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ovulation happens on day ____
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14
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the ovum is fertile for _____
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24 hours
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What can you give to abort a pregnancy?
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Anti-Progestins
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Estradiol
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-produced by follicle
-negative feedback on FSH -positive feedback on LH= LH Surge -responsible for secondary sex characteristics |
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LH
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-induces rupture of follicle (ovulation)
-formation of corpus luteum -stimulates Progesterone |
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embryo produces HCG at day _____
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21 (7 days after fertilization if fertilization occurs on day 14)
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ovum enters the uterus _____ days after ovulation
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5
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Condoms have a _____% failure rate
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10% or less
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Diaphragms have a _____ failure rate
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25%
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female condoms have a _____ failure rate
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10%
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cervical caps have a _____ failure rate
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25%
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Spermicides have a ___ failure rate
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25%
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Oral Contraceptives have a ____ failure rate
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less than 3%
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Combination Birth control pill
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contains estrogen and progestin
-prevent LH surge so ovum is not released -100% effective |
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minor side effects of "the pill"
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-nausea
-weight gain -sore, swollen breasts -spotting -lighter periods -mood changes |
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major side effects of "the pill"
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ACHES
-abdominal pain -chest pain -headache -eye problems (blurred) -swelling/aching in legs |
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Minipill
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progestin only, 3 mechanisms to prevent pregnancy:
1. prevent ovulation- 80% 2. thicken cervical mucous- 80% 3. alters uterine environment- 80% -0.8% failure rate combined |
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side effects of minipill
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-weight gain
-no periods -break through bleeding -tender breasts -no blood clotting problems b/c no estrogen like "the pill" |
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Ortho Evra patch
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-transdermal
-take once a week -dose is relatively constant |
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NuvaRing
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-transdermal
-take once a month -dose is relatively constant |
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Depo-Provera
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-long acting Progesterone
-take every 3 months |
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Norplant
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-long acting Progesterone
-lasts 5 years |
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RU-486
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-abortifacient
-64-85% effective -given 2-7 weeks after contraception -4-9 weeks after last period |
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Morning After Pill
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-Preven- 75% effective
-Plan B- 90% effective |
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Anticholinergic side effects
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-cause memory disturbances
-dry mouth -constipation -cyclopegia -avoid in elderly |
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Antiadrenergic side effects
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-cause tachycardia
-cause reduced blood pressure -sedation |
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Antihistaminergic side effects
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-sedation
-weight gain |
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Typical Antipsychotics
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-treat mostly + symptoms of schizo
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List Typical Antipsychotics
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-Phenothiazine------Chlorpromazine
-Thioxanthine--------Thiothixene -Butyrophenone-------Haloperidol -Thioridazine -Fluphenazine |
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List Atypical Antipsychotics
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-Clozapine
-Risperidone -Olanzapine -Ziprasidone |
CROZ
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Fluphenazine
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high extra-pyramidal effects
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Haloperidol
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high extra-pyramidal effects
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Thioridazine
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causes impotence
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Clozapine
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-used only when patient is non-responsive to 2 other drugs b/c can cause agranulocytosis in 1% of patients:
*WBCs are greatly decreased in # *this is potentially lethal *can also cause seizures |
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Olanzapine
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causes stroke
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Risperidone
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causes stroke
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Ziprasidone
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causes cardiac arythmia
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Atypical Antipsychotics
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-treat both + and - symptoms of schizo
-have low EP effects -dose is chosen based on trial and error -lowest dose possible should be given -lipophillic -metabolized at kidneys and biliary= feces |
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Neuroleptics with long half lives are used for ________ patients
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hostile or non-compliant
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List some SSRIs
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-Fluoxetine (prozac)
-Sertraline (zoloft) -Escitalopram (lexapro) -Paroxetine (paxil) -Citalopram (celexa) |
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Generalized anxiety disorder affects ______of population
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4%
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Panic attacks affect ______ of population
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4-7%
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____and _____respond well to SSRIs
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OCD and PTSD
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List Competitive, Non-Depolarizing Agents
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-Atracurium
-Vecuronium -Pancuronium -Doxacurium |
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List Non-Competitive, Depolarizing Agents
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-Succinylcholine
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Succinylcholine
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-cannot be reversed
-shortest acting NMJ blocker -used b/c has very short half life |
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NMJ Blocking Agents
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-charged so cannot cross membranes
-safe to give if prego -have no CNS effects -used for torture |
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Side effects of Stimulants (coke and amp)
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-delirium
-dizziness -confusion -headaches -increased heart rate -arythmia -increased force of contraction of heart -vasoconstriction -contraction of urinary bladder -decreased hunger |
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Coke and Amp have an ______effect on catecholamine synapse.
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indirect
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Coke and Amp lead to a ______release of neurotransmitters and ____the reuptake of neurotransmitters. The response is greater/lesser?
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greater, block, greater
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Low Dose of Stimulant=
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Norepinephrine
-RAS -tremor -motor -pleasure |
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Medium Dose of Stimulant=
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Dopamine
-locomotion -stereotypic behavior -intense pleasure |
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High Dose of Stimulant=
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Serotonin
-altered perceptions -paranoia -aggression -hallucinations -psychoses |
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Chronic use of Stimulants will......
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deplete catecholamine stores
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Catecholamines are degraded by what at the POST synaptic neuron?
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COMT
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Catecholamines are degraded by what at the PREsynaptic neuron?
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MAO
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List the catecholamines
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-Epinephrine (adrenaline)
-Dopamine -Norepinephrine |
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Cocaine's chemical properties include:
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1. Procaine
2. Amphetamine |
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Analgesia in brain
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DOP-1
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Analgesia in spinal cord
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KOP-2 and MOP-3
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Sedation
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KOP-2
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Euphoria
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DOP-1 and MOP-3
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Respiratory Depression
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MOP-3
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Tolerance to Mu Agonists
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NOP-4
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MOP receptors bind:
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enkephalins and endorphins
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DOP receptors bind:
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enkephalins and endorphins
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KOP receptors bind:
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dynorphins
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Opiate CNS effects
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-analgesia
-dysphoria -euphoria -respiratory depression |
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Opiate GI Tract effects
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-constipation
-nausea -vomiting -diarrhea |
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Opiate Autonomic Nervous System effects
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-miosis
-impotence -difficulty urinating |
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R groups on morphine:
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R1= H
R2= H |
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R groups on heroin:
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R1= acetyl
R2= acetyl |
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R groups on codeine:
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R1= methyl
R2= H |
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List Opiate Agonists
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-heroin
-codeine -morphine -methadone |
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List Opiate Antagonists
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-Naloxone
-Naltrexone |
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List Endogenous Opiates
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-beta-endorphins
-enkephalins -dynorphins |
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Uses of Glucocorticoids
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-anti-inflammatory
-immunosuppression -reduce brain edema -enhance survival of premature babies -GI inflammatory diseases -auto-immune diseases -asthma |
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During periods of starvation, glucocorticoids levels are________
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high
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the Zona Fasciculata of the Adrenal Cortex produces what?
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cortisol
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NPH insulin contains the modifier protein ______
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Protamine
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What does Protamine do?
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Protamine mixed w/ insulin forms an insoluble complex which delays absorption and onset and extends the duration of action
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Clinical Problems- Insulin
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-Hypoglycemia
-visual disturbances -peripheral edema -local or systemic allergic reactions -coma -seizures -brain damage -death |
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Clinical Problems-Sulfonylureas
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-hypoglycemia
-GI disturbances -hematological disturbances -ethanol intolerance -drug interactions |
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Clinical Problems- Metformin
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-Lactic acidosis
-GI problems |
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Clinical problems-Thiazolidinediones
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-weight gain
-edema -hepatic toxicity |
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Clinical Problems- Alpha Glucosidase Inhibitors
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-gas
-abdominal pain -diarrhea |
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______ is the main endogenous glucocorticoid in the body.
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cortisol
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______ is the major mineralcorticoid in the body
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aldosterone
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Aldosterone is regulated by ________
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Angiotensin 2 (the renin-angiotensin system)
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Aldosterone is responsible for ______________
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maintaining sodium and potassium concentrations in the extracellular fluid
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Glucocorticoids are used for:
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-replacement therapy in adrenal insufficiencies
-antiinflammatory and immunosuppressive action -myeloproliferative diseases |
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Mineralcorticoids are used for:
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-replacement therapy in primary adrenal insufficiencies
-hypoaldosteronism |
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Physical Stress is regulated by the _______ system.
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Reticular Activating System (RAS)
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Emotional Stress is regulated by the ________ system.
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Limbic
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Cortisol has a _____ feedback effect on the pituitary to decrease POMC gene transcription and ACTH secretion.
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negative
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____ to ____% of Cortisol binds to ___________, leaving _____to____% of free active cortisol.
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80 to 90, cortisol binding globulin (CBG), 3 to 10
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CBGs cannot bind to______
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dexamethasone
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Increased levels of estrogen during pregnancy, the concentration of CBGs is _______.
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elevated
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the free active concentration of glucocorticoids during pregnancy or steroid use is________
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decreased
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Increased levels of glucocorticoids causes:
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-thymus involution
-muscle breakdown -fat breakdown |
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Addison's Disease
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-don't make enough glucocorticoids
-no feedback inhibition on hypothalamus or pituitary so you continue to make more ACTH -dark complexion due to MSH -mental dullness -decreased Na+ levels in blood -decreased blood pressure -hypoglycemia -muscle weakness |
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Cushing's Disease
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-make excess glucocorticoids
-pituitary tumor likely culprit -iatrogenic -increased levels of Na+ in blood -hypertension -edema -K+ levels decrease -muscle weakness, atrophy -fat redistribution= buffalo hump, moon face -low immune response b/c of lymph involution |
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Symptoms of Mineralcorticoid Toxicity
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-hypernitremia (increased Na+)
-hypogalemia (decreased K+) -hypertension -alkalosis (decreased H+) -muscle weakness -cardiac arythmia |
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Symptoms of Glucocorticoid Toxicity
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-osteoporosis
-poor wound healing -hyperglycemia -thymus involution -poor resistance to infections -males: hypogonads -females: amenhorrea, increased hair growth, increased clitoris, increased sex drive -if iatrogenic, aseptic bone necrosis, pancreatitis, glaucoma |
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Synthesis of Mineralcorticoids
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1. Cholesterol
2. Adrenal Cortex- Zona Glomerulosa 3. Deoxycorticosterone 4. *Aldosterone* |
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Positive symptoms of Schizo
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-auditory hallucinations
-paranoia -aggression -hostility -suspicion -ideas of reference -delusions of grandeur and persecution |
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Negative Symptoms of Schizo
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-blunted affect (mask to external world)
-lack of motivation -anhedonia (don't enjoy social pleasures) -withdrawal from social situations -diminishment of speech -compliance problems -lack of trust |
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Onset age of schizophrenia
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18-30
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what percent of population affected by schizophrenia?
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1%
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Environmental factors that increase risk for schizophrenia
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- RH incompatibility in mother and fetus
- mother exposed to flu or starvation -stress factors double the risk for child |
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How can you reduce kidney failure in Diabetic?
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give ACE Inhibitors which will reduce blood pressure by blocking Angiotensin 2
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Opiate Antagonists have 2 uses:
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1. treat acute overdose
2. check for addiction |
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side effects of neuroleptics
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-high dose= catatonia (rigid immobility)
-EP effects (extra-pyramidal) *Parkinsons-like symptoms -acute dystonia- painful twisting/contraction of muscles within first week of treatment -expressionless face -bradykinesia= slow movements -resting tremor -akathesia=restlessness in motor system, build up a feeling of tension, stress -Tardivedyskinesia=can't control facial muscles, grimacing -more common in women and with typical agents -1/4 of patients -can't be reversed -reason that atypical agents are more widely used |
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endocrine effects of neuroleptics
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-amenhorrea
-pseudopregnancy -men develop breasts -Neuroleptic Malignant syndrome: causes heat to build up in body -heat stroke -fatal in 10% of cases -Typical Antipsychotics |
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