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50 Cards in this Set

  • Front
  • Back
where is insulin produced
Beta cells in the Islets of Langerhans
what messenger is used in the signaling pathway for insulin
MAP kinase (tyrosine kinase pathway)
insulin causes the uptake of glucose in the skeletal muscle and adipose tissue via which receptors
GLUT-4
insulin causes the uptake of glucose in the liver and kidney via which receptors
GLUT-2
insulin activates what enzyme in adipose tissue
capillary LPL
how does insulin affect K+ serum levels
causes K+ to shift INTO the cell causing hypokalemia
what are the rapid-acting insulins
Lispro (Humalog)
Apsart
Glulisine
Crystalline zinc
Regular insulin (Humulin-R)
what are the intermediate-acting insulins
Lente and NPH
what is NPL
combination and Lispro and NPH
what are the long-acting insulins
Glargine (Lantus)
Detemir
Ultralente (Humulin-U)
what's the purpose for checking C-peptide levels
differentiate between endogenous and synthetic insulin (synthetic has NO C-peptide)
prototype biguanide
metformin
4 main actions of biguanides
decreases gluconeogenesis
increases glycolysis
increases peripheral uptake of glucose
increases insulin sensitivity
metformin can sometimes be used to treat this condition unrelated to diabetes
can help restore fertility in anovulatory women with polycystic ovarian disease
most serious SE of metformin
lactic acidosis
most COMMON SE of metformin
GI disturbances (nausea, vomiting, diarrhea, flatulence etc...)
metformin is contraindicated in people with what organ dysfunctions
contraindicated in people with renal, cardiac, and liver disease
why should metformin NOT be given to an alcoholic
increases risk for lactic acidosis
does metformin cause hypoglycemia
NO
MOA of sulfonylureas
closes K+ channels causing insulin release
sulfonylureas are contraindicated in people with what organ dysfunctions
contraindicated in people with liver disease
do sulfonylureas cause hypoglycemia
YES
1st generation sulfonylureas
Tolbutamide and Chlorpropamide
SE of 1st generation sulfonylureas
disulfiram-like reactions and weight gain
2nd generation sulfonylureas
Glyburide, Glimerpiride, and Glipizide
newer sulfonylureas that are faster but shorter acting than 1st and 2nd generation sulfonylureas
"Metiglinides" (eg. repaglinide and nateglinide)
which generation of sulfonylureas have the longest half-life
1st generations
where in the body do alpha-glucosidase inhibitors exert their effects
intestinal brush border
major effect of alpha-glucosidase inhibitors
decreases postprandial glucose absorption
SE of alpha-glucosidase inhibitors
GI disturbances (i.e. flatulence, diarrhea, and abdominal pain)
which alpha-glucosidase inhibitor do you have to monitor LFTs
acarbose
2 main alpha-glucosidase inhibitors
acarbose and miglitol
MOA of thiazolidinediones
binds to PPAR-y receptors which increases glucose uptake in muscle and fat
which class of diabetes drugs increases your risk of MI
thiazolidinediones
thiazolidinediones are contraindicated in people with what organ dysfunctions
contraindicated in people with liver and cardiac disease
desirable SE that thiazolidinediones have on serum lipid levels
decreases triglycerides and increases HDL
which class of diabetes drugs induce p450 enzymes
thiazolidinediones
2 main thiazolidinediones
Rosiglitazone and Pioglitazone
how do incretins help treat type II diabetes
increases insulin release AND decreases glucagon release
2 main incretins
Exenatide and Sitagliptin
how do the MOA differ in exenatide vs. sitagliptin
exenatide: activates GLP-1
sitagliptin: inhibits DPP-4
prototype amylin analog
pramlintide
amylin analogs activate amylin by binding to what ligand
RANK
2 classes of diabetes drugs that can treat BOTH type I and type II diabetes
insulins and amylin analogs (pramlintide)
which classes of diabetes drugs can treat ONLY type II diabetes
biguanides
sulfonylureas
alpha-glucosidase inhibitors
thiazolidinediones
incretins
glucagon can be used to treat what overdose
B-blocker overdose
MOST common 1st line drug therapy for type II diabetes
metformin combined with a sulfonylurea
most common drug used to reverse acute severe DKA
crystalline zinc insulin
most common insulin drug regimen in someone with type 1 diabetes
long-acting insulin in the morning along with rapid-acting insulin after meals
40 year old, overweight patient presents with polyuria and polydipsia
FH is remarkable for HTN, CHF, and arrhythmias
PE reveals HTN
UA reveals 3+ glucosuria and 4+ proteinuria, but no blood in the urine
Glucose tolerance test: 225 after 2 hours

What 2 drugs should he be started on?

Later that night, he is found in a coma... upon medical stabilization, he admits to overdosing on one of his medications... which medication did overdose on, and would this coma be considered a hyper or hypoosmolar coma?
ACE inhibitor (for the renal and HTN concerns)
Sulfonylurea (for the type II diabetes-- metformin and thiazolidinediones would be contraindicated due to his renal and cardiac risks)

He overdosed on the sulfonylurea and it was a HYPOosmolar coma (major SE of sulfonylureas is hypoglycemia)