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40 Cards in this Set
- Front
- Back
Treatment Strategies for:
-DM1 -DM2 |
-Low sugar diet, insulin replacement
-dietary modification & exercise for wt loss; oral hypoglyemics |
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Insulin types:
name them(5) long/short/intermediate acting? |
1. Lispro (short-acting)
2. Insulin (short-acting) 3. NPH (intermediate) 4. Lente (long-acting) 5. Ultralente (long-acting) |
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Insulin:
-mechanism -effects on liver, mm, fat |
-Binds insulin receptor (tyrosine kinase activity)
-Liver: increase glucose sotred as glycogen -Muscle: increase glycogen and protein synthesis, K+ uptake -Fat: aids TG storage |
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Insulin:
-clinical use |
-for Type 1 DM
-for life-threatening hyperkalemia -for stress-induced hyperglycemia |
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Insulin:
-toxicity |
-hypoglycemia
-hypersensitivity reaction (v. rare) |
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Sulfonylureas: name them
-1st generation (2) -2nd generation (3) |
1st: Tolbutamide, Chlorpropamide
2nd: Glyburide, Glimepiride, Glipizide |
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Sulfonylurea
-mechanism |
Close K+ channel in beta cell membrane -> depolarizes -> Ca2+ influx -> trigger insulin release
|
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Sulfonylurea
-clinical use |
-stim release of endogenous insulin in DM2
-require some islet function (useless in DM1!) |
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Sulfonylurea
-toxicity |
1st gen: disulfiram-like effects
2nd gen; hypoglycemia |
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Disulfiram-like reaction:
sxs what is disulfiram |
flushing, nausea, vomiting, thirst, palpitations, chest pain, vertigo, and hypotension
-disulfiram is an aldehyde dehydrogenase inhibitor |
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Bigaunide - name it (1)
|
Metformin
|
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Metformin
-mechanism |
-exact mech unknown
-possibly decreases gluconeogenesis, increases glycolysis, decreases serum glucose levels |
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Metformin
-clinical use |
-oral hypoglycemic
-can be used in pts without islet function |
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Metformin
-toxicity |
LACTIC ACIDOSIS (most grave effect)
|
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Glitazones: name them (2)
|
-pioglitazone
-rosiglitazone |
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Glitazone
-mechanism |
-increases target cell response to insulin
|
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Glitazone
-clinical use |
used as monotherapy in DM2 or combined with other agents
|
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Glitazone
-toxicity which one is no longer use? |
-weight gain
-edema *Troglitaozone - no longer used |
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alpha-Glucosidase inhibitors:
name them (2) |
Acarbose
Miglitol |
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Acarbose, miglitol:
-mechanism |
-inhibit intestinal brush border alpha-glucosidases
-delayed sugar hydrolysis and glucose absorption lead to decreased postprandial hyperglycemia |
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Acarbose, miglitol:
-clinical use |
Used as monotherapy in DM2 or in combination with other agents
|
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Acarbose, miglitol:
-toxicity |
GI disturbance
|
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Orlistat
-mechanism (inhibits which enzymes?) |
Alters fat metabolism by inhibiting PANCREATIC LIPASES
|
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Orlistat
-clinical use |
Long-term obesity mgmt (in conjunction with modified diet)
|
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Orlistat
-toxicity |
-steatorrhea
-GI discomfort -reduced fat-soluble vitamin absorption -HA |
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Sibutramine
-mechanism |
sympathomimetic serotonin and norepinephrine reuptake inhibitor (SNRI)
|
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Sibutramine
-clinical use |
Short term and long term obesity management
|
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Sibutramine
-Toxicity |
HTN
tachycardia |
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Propylthiouracil, Methimazole
-Mechanism -extra effect of PTU? |
inhibit organification and coupling of thyroid hormone synthesis
PTU also decreases peripheral conversion of T4 to T3 |
|
GH
-clinical use |
-GH deficiency
-Turner's syndrome |
|
Somatostatin
-other name? |
Octreotide
|
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Somatostatin
-clinical uses |
-acromegaly
-carcinoid -gastrinoma -glucagonoma |
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Oxytocin
-clinical uses |
-stimulates labor
-uterine contractions -milk-letdown -controls uterine hemorrhage |
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ADH
-other name (exogenously given) |
Desmopressin
|
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Desmopression
-clinical use |
Pituitary diabetes insipidus (central, not nephrogenic)
|
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Levothyroxine, Triiodothyronine
-mechanism -clinical use -toxicity |
-thyroxine replacement
-for hypothyroidism -for myxedema -toxicity: tachycardia, heat intolerance, tremors |
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Glucocorticoids
-name them (5) |
- hydrocortisone
- prednisone - triamcinolone - dexamethasone - beclomethasone |
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Glucocorticoid
-mechanism |
-decreases the production of LTs and PGs by inhibiting phospholipase A2 and expression of COX-2
|
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Glucocorticoid
-clinical use |
-Addison's disease
-inflammation -immune suppresion -asthma |
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Glucocorticoid
-toxicity |
Iatrogenic Cushing's syndrome:
-buffalo hump -moon facies -truncal obesity -mm wasting -thin skin -easy bruisability -osteoperosis -adrenocortical atrophy -PUD -Diabetes (if chronic) |