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the structure responsible for the secretion of several enzymes that assist in the chemical breakdown of nutrients is the:
pancreas
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clusters of cells responsible for the secretion of glucagon and insulin are the:
islets of langerhans
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insulin is secreted by:
what is the fxn of insulin:
- secreted by: beta cells
- fxn: decrease blood glucose levels
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glucoagon is secreted by:
fxn:
- secerted by: alpha cells
- fxn: increase blood glucose leves
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list 4 hormones that have a hyperglycemic (blood glucose to rise) effect:
list 3 drugs that are hyperglycemic:
- hormonesepinephrine
- thyroid hormone
- growth hormone
- glucocorticioids
- drugsphenytoin (dilantin)
- NSAIDS
- diuretics
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list 4 drugs with a hypoglycemic effect:
- alcohol
- lithium
- angiotension converting enzyme (ACE) inhibitors
- beta-andrenergic blockers
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which type of diabetes results from lack of insuline secretion:
what is the origin of this type:
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which type of diabetes is the result of lack of insuline receptors:
type II
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what is the principle of insulin:
the right amount of insulin must be available to cells when gluocse is present inthe blood
when glocose is not present in the blood, insulin can lead to hypoglycemia or coma
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pharmacologists have modified human insulin to create advangtagses, the modified forms are called:
insulin analogs
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what is the pregnancy category for insulin:
category B
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what does insulin 70/30 contain:
- 70% NPH (isophane insuline, intermediate acting)
- 30% regular insuline
- Humuline 70/30
- Novolin 70/30
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humuline 50/50 contains:
- 50% NPH
- 50% regular insuline
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what are the s/sx of hypoglycemia are:
- pale, cool, moist skin
- blood glucose less than 50
- sudden onset of symptoms
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what are the contraindications of regular insulin:
- caution with pregnancy
- renal impariment or failure
- fever
- thyroid disease
- should not be adminstered to pts with hypoglycemiahypokalemia
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what lab tests are used to monitor the effectivenss of insulin:
- it may decrease levels of serum potassium, calcium, and magnesium
- it may increase urinary valillylmandelic acid
- it may interfere with liver tests and thyroid fxn tests
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when should insulin be held:
- if the blood sugar is less than normal (120)
- or
- if it is unlikely the pt. will eat when needed (30 minutes before the administration of insulin)
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when is hypoglycemia most likely to occur:
- when insulie level peaks
- during exercise
- rcv too much insulin due to med error
- pt. skips a meal
- illness
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target cells becoming unresponsive to insuline due to a defect in insulin receptor fxn is called:
- insuline resistance
- type II
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therapy for type II antidiabetic drugs are not effective for persons with Type I
list the 6 groups of antidiabetic drugs for type II
- alpha glucosidase inhibitors
- biguanides
- incretin enhancers
- meglitinides
- sulfonylureas
- thiazolidinedions (or glitzaones)
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the sulfonlureas have 2 generations, which one has fewer rx-rx interactions:
2nd generation
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what is the MOA for sulonylureas:
stimulating the release of insulin from pancreatic islet cells and by increasing sensitivity of insulin receptors on target cells
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what are the adverse effects of sulonylureas:
- most common is hypoglycemiaweight gain
- hypersensitivity rxns
- GI distress
- hepatotoxicity (jaundice)
- when taken with alcohol, disulfiram like rxn
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list 3 commonly prescribed sulfonylureas:
- glimepiride ( amaryl)
- glipizide (glucotrol)
- glyburide (diabeta, micronase)
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metformin (glucocphage) is the only drug in this class:
biguanides
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what is the MOA for biguanide:
reduces fasting and postprandial (after a meal) glucose levels by...
decreasing the hepatic production of glucose (gluconeogenesis)
and
reducing insulin resistance
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which medication for diabetes does not cause hypoglycemia:
biguanides (metformin)
alpha-glucosidase inhibitors (when used alone)
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what are the adverse effects for biguanides (metformin)
- GI related
- nausea
- vomiting
- abdominal discomfort
- metallic tastediarrhea
- anorexia
- lactic acidosis if impaired liver fxn
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what are the contraindications for biguanides:
- impaired renal fxn
- heart failure
- liver failure
- hx of lactic acidosis
- 2 days before/after radiographic dye contrast tests
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what is the prenancy category for
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what is the prenancy category for oral hypoglycemics:
category B
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alpha- glucosidase inhibitor
Precose
acarbose
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what is the MOA for alpha glucosidase inhibitors:
blocking enzymes in the small intestine that are responsible for breaking down complex carbohydrates into monosaccharides...thus slowing glucose release
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what are the adverse effects of alpha glucosidase inhibitors:
increased complex carbohydrates in the GI tract that can cuase....
- gas
- diarrhea
- abdominal cramps
impaired liver fxn
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what is the MOA for thizaolidinediones (glitazones):
- reduce blood sugar by decreasing insulin resistance and inhibiting hepatic gluconeogenesis (liver glucose production)
- increasing insuline uptake
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what are the adverse effects of thiazolidinediones (glitazones):
- fluid retention
- headach
- weight gain
- hepatotoxic
- fluid overload (worsening or causing CHF)
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what are the contraindications of thiazolidinedions (glitazones)
- serious heart failure
- pulmonary edeam
- risk of myocardial ischemia
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thiazolidinediones (glitazones)...
actos
pioglitazone
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thiazolidinediones (glitazones)
avandia
rosiglitazone
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what is the MOA for meglitinides:
adverse effects:
increases insuline release
adverse effect: hypoglycemia
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meglitinides
starlix
nateglinide
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meglitinides
prandin
repaglinide
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chemicals that are released by the intestines in response to food, stimulating insulin secretions and decreasing liver glucagon production are called:
which drug mimics incretin:
- incretins
- there is a decreased production of incretins with diabetes
drug mimics: exenatide (byetta)
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what lab tests are used to monitor the effectivness of oral hypoglycemics:
- glucose levels
- electrolytes and osmolarity WNL
- HbA1c levels demonstrate adequate control of glucose
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what is a basal bolus insulin regimen:
a long acting insuline may be taken daily to provide a basal blood level and supplemented with a rapid acting insuline given shortely before a meal
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what is the onset of action for the following types of insulin..
rapid:
short:
intermediate:
long:
- rapid: 5-30 minutes
- short: 30-60 minutes
- intermediate: 1-2 hr.
- long: gradual over 24 hr
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list the 2 rapid acting insulin preparations:
novolog:
humalog:
what is the usual dose:
when is the dose given:
- novolog: insulin aspart
- humalog: insuline lispro
- usual dose: 10-15 units
- when given: SQ (subcantenous) right before eating to cover carbohydrate in the food consumed
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list the 2 short acting regular insulins:
when are they usually given:
- given: to cover meals
- peak action: 2-4 hrs
- duration: 6 hrs
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list the 2 intermediate acting insulin:
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long acting insulin..
levemir
insulin detemir
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long acting insulin..
lantus
when is it usuall given:
insuline glargine
usually given: HS
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1st generation sulfonylurea
tolinase
tolazamide
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1st generation sulfonylurea
orinase
tolbutamide
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2nd generation sulfonylurea
amaryl
glimepiride
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2nd generation sulfonylurea
glucotrol
glipizide
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2nd generation sulfonylurea
diabeta,micronase
glyburide
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