pharma II test III DM

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pharma II test III DM
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2013-04-09 12:05:11
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pharma II test III DM
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pharma II test III DM
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  1. ultrashort acting insulin
    • lispro, aspart
    • onset .25h
    • duration 5h
  2. short acting insulin
    onset .5-1hr
    duration 5-8h
    regular
  3. shor acting insulin
    onset 1h
    duratoin 12-16h
    semilente
  4. intermediate acting insulin
    onset 1-3h
    duration 18-24h
    lente
  5. long acting insulin
    onset 4-8h
    duration 20-36h
    ultralente
  6. unique feature of ultralente compared with other insulins
    metabolized only renally
  7. 4 clinical signs of DM
    • polyuria
    • polydypsia
    • polyphagia
    • weight loss
  8. primary DM
    • type I
    • type II
    • MODY
  9. secondary DM
    • islet destruction
    •    infectious
    •    pancreatitis/tumors
    •    drugs - corticosteroids,endocrinopathy
  10. 8 risk factors of DM
    • family history (parent, sibling increase70%)
    • obesity
    • race/ethnicity
    • age >45yo
    • previous insufficient glucose tolerance
    • HDL <35mg/dl
    • history of GDM or >9lb baby
    • HTN (140/90)
  11. 5 points to remember for TI
    • autoimmune
    • absolute insulin deficiency
    • children
    • acute metabolic complications
    • ketoacidosis - cardiovascular
  12. 4 points to remember for TII
    • relative insulin deficiency
    • peripheral resistance
    • chronic vascular complication
    • microangiopathy - kidney,brain,retina,CV
  13. 4 diseases that are increased risk for developing due to diabetes
    • nephropathy
    • retinopathy
    • neuropathy
    • cardiovascular disease
  14. leading cause of death in diabetic patients
    heart disease
  15. 3 complications developed from DM
    • atherosclerosis
    • fibrosis
    • cardiomyopathy
  16. New guideline levels of fasting plasma glucose (FPG) for diagnosing diabetes
    126mg/dl
  17. hypoglycemic
    increase insulin secretion
    • insulin secretagogues
    •    sulfonylureas
    •    benzoic acid derivatives
  18. antihyperglycemic
    increase tissue glucose uptake
    • biguanides
    • thiazolidinediones
  19. antihyperglycemics
    decrease glucose production
    biguanides
  20. antihyperglycemic
    decrease GI glucose absorption
    • alpha glucosidase inhibitors
    • biguanides
  21. moa of sulfonylureas
    • 1. increase insulin release from the B cells by binding to the K/ATP channel, increasing intracellular Ca.
    • 2. reduction of glucagon levels by inhibiting A cells
    • 3. extrahepatic indirect effect of increasing insulin sensitivity by increasing: the number of receptors or affinity 
  22. efficacy and safety concern of sulfonylureas
    • increased CV risk
    • failure to maintain a good response over long term therapy - induces a refreactoriness in B cell response
    •    allow drug free window to decrease tolerance
  23. first gen sulfonylureal - time to peak effects and duration of action
    • chlorpropamide
    • peak - 2-7h
    • duration - 60h
  24. 2 second gen - time to peak and duration
    • glipizide XR
    •    peak  6-12h
    •    duration 24h
    • glyburide
    •    peak 2-6h
    •    duration 12-24
  25. meglitinde: MOA, time to peak and duration, when useful
    • repaglinide
    • modulate B cell insulin release through K channels, overlap with sulfonylurea action site
    • peak < 1h
    • duration T1/2 1h
    • useful in sulfa allergies
  26. biguanide: 2 moa, when useful
    • metformin
    • 1. decrease hepatic glucose output
    • 2. increase insulin/glucose uptake
    •        decrease fatty acid oxidation
    •        decrease GI carbohydrate absorption
    • #1 choice for glycemic shock
  27. 2 thiazolidinedione: MOA, CI
    • rosiglitizone - avandia
    • pioglitizone - actos
    • increase tissue glucose uptake- receptor affinity
    • CI - liver disease
  28. 2 alpha-glucosidase inhibitors: moa, 2 side effects
    • acarbose
    • miglitol
    • competitive inhibitor of the intestinal alpha-glucosidase and modulates the postprandial digestion and absorption of starch and disaccharides.
    • GI upset & hepatic injury w/ chronic use
  29. glucagon: metablolic effect, downside, clinical uses
    • recruits glycogen and induces gluconeogenesis
    • stimulates insulin release
    • clinical - unconsciousness
    •              significant hypoglycemia
    •              beta block poisoning

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