Pharamcology Chapter 31 Insulin, Oralhypoglycemics, and Glucagon

The exocrine system comrprises the _______ cells, which secrete digestive enzymes

acinar

What is the principal stimulus of insulin

glucose

How does insulin decrease blood glucose concentration

Increase glucose uptake and increase glucose use

Decrease glucose production

Insulin stimulates glucose transport into muscle and fat by promoting translocation of the intracellular transporter, _______, to the cell surface

GLUT4

Insulin act by synthesis of second messengers _______

IPG

Hemoglobin is glycosylated on its amino terminal valine residue to form the glycosyl valine adduct, termed hemoglobin ______

A1c

Ultrashort-acting insulin are insulin ______

Short-acting insulin are ______ insulin

analogue (aspart, glulisine, lispro)

regular (Humulin R and Novulin R)

Insulin glargine, detemir, and degludec are long acting

________ is the most common adverse reaction to insulin.

Hypoglycemia

________ is a oral antihyperglycemic agent that are only effective in pt with functioning pancreatic B cells

It is for what type of diabetes?

Sulfonylureas

Type 2

Stimulate release by blocking ATP-K+ current in pancreatic Bcells

What is glimepriride

Sulfonylureas

Increase release of insulin by blocking ATPK channel

Also increase sensitivity of peripheral tissues to insulin

What is the side effect of sulfonylurea or glimepriride

Hypoglycemia

What are repaglinide and nateglinide

Meglitinides

Only effective with functioning pancreatic B cells

Stimulate release of insulin by blocking ATPK channel in B cells

Why shouldn’t meglitinide and sulfonylurea be used together

Both stimulate release of insulin by blockign ATPK channel in B cells

Very high risk for hypoglycemia

_______ is currently the only biguanide approved for use in the United States

Metformin

Phenformin can cause lactic acidosis

Biguanide stimulate _______ thereby decreasing blood glucose concentration

AMPK

Decrease hepatic gluconeogenesis

Improve sensitivity to insulin

Increase glucose uptake and use

The action of _______ does not depend on functioning pancreatic β cells, and they are often used in combination with sulfonylureas and other hypoglycemic agents such as thiazolidinediones.

biguanides

Sulfonylurea and meglitinide need functioning b cells

What is the contraindication of biguanide or metformin

In renal or hepatic disease because it can cause lactic acidosis

What are pioglitazone and rosiglitazone?

Thiazolidinediones

What are agonist PPARy

Thiazlidinediones and increase insulin sensitivity in tissues

Which oral antihyperglycemic drug contain black box warning due to risk of heart failure and MI

Thiazolidinediones

It has long been known that ______ glucose produces greater release of insulin than _____ glucose

oral, IV

GLP-1 is a ______ that is secreted from GI tract to stimulate insulin secretion

incretin

DPP-4 inactivates _______

GLP-1

What are drugs that end with liflozin such as canagliflozin

SGLT2 inhibitor

Decrease reabsorption of glucose in kidney

Which diabetes is SGLT-2 inhibitor used for

Type 2

Very contraindicated in ketoacidosis cause by type 1

Pramlintide is an analogue of ______

amylin

Cosecreted with insulin by b cell

Maintain glucose homeostasis and decrease glucagon secretion

______ and ______ are a-glucosidase inhibitors

Acarbose and Miglitol

Facilitate digestion of complex starches allowing them to be absorbed in small instestine

Delay absorption of most carbohydrates and liimits postprandial increase in glucose

Do not affect insulin secretion

α-Glucosidase inhibitors are taken at the ______ of meals

beginning

Adverse effect is diarrhea

Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers have been shown to delay the onset and reduce significantly the progression of diabetic ______

nephropathy

_______ is used in severe hypoglycemia

Glucagon

Ketoacidosis is in ______glycemia

hyper

Muscle can’t use the glucose due to no insulin

_______ may have burning mouth syndrome or loss of sensation

Diabetics

Diabetics are ______ susceptible to infection and may need antimicrobial therapy more often. ______ appointments are usually better for diabetic patients because that minimizes the chance of stress-induced hypoglycemia.

more, morning

Blood glucose levels tend to be more stable in the ______

morning

Can diabetic pt use epinephrine

Yes but it can cause transient hyperglycemia so let them use hypoglyemic medication before appointment

Epinephrine inhibits insulin and activate secretion of glucagon