Pharmacology Test 3 - Insulin/Hypoglycemics
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Created by:
Ashleighbriody on September 9, 2011
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67 terms
Terms | Definitions |
|---|---|
 insulin | causes cells to uptake glucose from blood, storing as glygogen in liver and muscle |
| insulin | produced/secreted by Beta cells |
| glucagon | produced/secreted by Alpha cells |
| GLUT-4 | how glucose gets into cells |
| insulin in liver | stimulates enzymes involved in glycogen synthesis, inhibits glycogenolytic and gluconeogenetic enzymes, net effect = inhibition of glucose output |
| insulin in muscles | facilitates glucose metabolism = energy for contractions, stimulates glycogen synthesis, inhibits protein catabolism and AA output |
| insulin in adipose tissue | stimulates conversion of glucose to fatty acids for storage as trigycerides; promotes uptake and esterification of fatty acids; inhibts lipolysis |
| type 1 diabetes mellitus | autoimmune disease leading to destruction of B-cells, absolute deficiency of insulin, ketosis-prone, require insulin to live, typically starts in youth |
| rapid acting insulin | onset 0-15 minutes, peak 30-90 minutes, duration < 5 hours |
| rapid acting insulin | covers needs for meals eaten at same time as injection |
| short acting insulin | onset 30-45 minutes, peak 2-4 hours, duration 5-7 hours |
| short acting insulin | covers needs for meals eaten w/i 30-60 minutes |
| intermediate acting insulin | onset 1-4 hours, peak 6-14 hours, duration 18-24 hours |
| intermediate acting insulin | covers needs for about half the day or overnight |
| long acting insulin | covers needs for about one full day |
| ultralente | onset 4-6 hours, peak 18-26 hours, duration > 30 hours |
| insulin glargine | onset 1-2 hours, peak none w/ steady level, duration 20-24 hours |
| detemir | onset 1-2 hours, peak 6-8 hours, duration up to 24 hours |
| rapid acting insulin | insulin lispro |
| short acting insulin | regular insulin (R) |
| intermediate acting insulin | lente or NPH |
| long acting insulin | ultralente |
| long acting insulin | insulin glargine |
| long acting insulin | detemir |
| acute complications of diabetes | hypoglycemia, ketoacidosis, diabetic coma |
| long term complications of diabetes | CV disease, blindness, difficulty hearing |
| chronic complications of diabetes | retinopathy, nephropathy, ED, coronary and cerebrovascular disease, neuropathy, foot problems |
| type 2 diabetes mellitus | insulin present but insufficient to meet metabolic needs, not ketosis-prone, imparied insulin secretion and resistance, obesity is present in 60-80% or patients, Tx: diet/exercise, oral hypoglycemic agents |
| secretagogues | sulfonylureas |
| sulfonylureas | tolbutamide/glyburide |
| tolbutamide/glyburide | inc insulin release, inc sensitivity to insulin, dec glucagon SE: hypoglycemia |
| secretagogues | meglitinides |
| meglitinides | repaglinide/nateglinide |
| repaglinide/nateglinide | close K+ channels in islet cell leading to inc release of insulin, before meal (not w/o meal!!), t1/2 = 1 hr multiple uses, alone or in combo w/ metformin,MB in the liver (patients w/ impaired liver!!) |
| sensitizers | biguanides |
| biguanides | metformin |
| metformin | dec glucose production by liver and dec absorption in gut, inc insulin sensitivity (muscle and adipose), does not cause insuin release, no hypoglycemia when used alone, do not give w/ renal, liver, or heart failure SE: GI disturbances, diarrhea |
| sensitizers | thiazolidinedione |
| thiazolidinediones | rosiglitazone/pioglitazone |
| rosiglitazone/pioglitazone | agonits for nuclear peroxisome proliferator-activated receptor gamma |
| rosiglitazone/pioglitazone | reduce insulin resistance in peripheral tissues, activation leads to upregulation of genes that regulate carb and lipid metab (GLUT4), inc glucose transport in muscle and adipose, 6-12 weeks to be effective, watch liver function |
| rosiglitazone | heart failure: restricted in US, banned in Europe |
| a-glucosidase inhibitors | acarbose, voglibose, miglitol |
| acarbose, voglibose, miglitol | inhibit a-glucosidase in gut (given w/ meal) to dec intestinal absorption of starch, dextrin, disaccharides SE: flatulence, abdominal bloating |
| peptide analogs | glucagon-like peptide (GLP) agonists |
| GLP agonists | exenatide, liraglutide |
| exenatide, liraglutide | augement glucose-dependent insulin secretion and decrease glucagon release, Rx: w/ diet/exercise, drugs interaction: reduce absorption of drugs that are taken orally SE: nausea, HA, pancreatitis, vomiting, hypoglycemia, thyroid c cell tumors |
| peptide analogs | dipeptidyl peptidase-4 (DPP-4) inhibitors |
| DPP-4 Inhibitors | sitagliptin, saxagliptin |
| sitagliptin, saxagliptin | MOA: inc blood concentration of incretin GLP-1 Rx: w/ diet and exercise Admin: oral Drug interactions: combo w glimepiride get hypoglycemia SE: rare nausea, pancreatitis?, cancer? |
| peptide analogs | amylin |
| amylin | pramlintide |
| pramlintide | MOA: slows gastic emptying, promotes satiety and suppresses glucagon Rx: type 1 and 2 admin: subcutaneous counter indications: delayed gastic emptying SE: hypoglycecmia 3hrs after inj, nausea |
| liver w/ increased glucose production | dec metformin, dec thiazolidinediones |
| digestion of polysaccharides in stomach | dec a-glucosidase inhibitors |
| pancreas w/ impaired insulin secretion | inc sulfonylureas, inc meglitinides |
| skeletal muscle w/ dec glucose uptake and utilization | inc metformin, inc thiazolidinediones |
| adipose w/ inc FFA | dec thiazolidinediones |
| sulfonylureas | inc insuiln, no effect on lipids, inc body weight, MSE - hypoglycemia |
| meglitinides | inc insulin, no effect on lipids, inc body weight, MSE - hypoglycemia |
| biguanides | dec insulin, dec TG and LDL, inc HDL, dec body weight, MSE - GI disturbances |
| pioglitazone | dec insulin, dec TG and LDL, inc HDL, inc body weight, MSE - fluid retention, dec Hb |
| rosiglitazone | dec insulin, no effect on TG, inc LDL and HDL, inc body weight, MSE - fluid retention, dec Hb |
| a-glucosidase inhibitors | no effect on insulin, lipids, or body weight, MSE - GI disturbances |
| incretin, GLP1 | stimuluate insulin release and inhibit glucagon |
| DPP4 | enzyme that inactivates GLP1 |
| lowers blood glucose | stimulate insulin; inhibit glucagon |
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