pharm_exam2

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Author:
itzlinds
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263336
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pharm_exam2
Updated:
2014-02-22 14:22:43
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diabetes
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diabetes
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  1. the structure responsible for the secretion of several enzymes that assist in the chemical breakdown of nutrients is the:
    pancreas
  2. clusters of cells responsible for the secretion of glucagon and insulin are the:
    islets of langerhans
  3. insulin is secreted by:

    what is the fxn of insulin:
    • secreted by: beta cells
    • fxn: decrease blood glucose levels
  4. glucoagon is secreted by:

    fxn:
    • secerted by: alpha cells
    • fxn: increase blood glucose leves
  5. list 4 hormones that have a hyperglycemic  (blood glucose to rise) effect:

    list 3 drugs that are hyperglycemic:
    • hormones
    • epinephrine
    • thyroid hormone
    • growth hormone
    • glucocorticioids

    • drugs
    • phenytoin (dilantin)
    • NSAIDS
    • diuretics
  6. list 4 drugs with a hypoglycemic effect:
    • alcohol
    • lithium
    • angiotension converting enzyme (ACE) inhibitors
    • beta-andrenergic blockers
  7. which type of diabetes results from lack of insuline secretion:

    what is the origin of this type:
    • Type I
    • origin: autoimmune
  8. which type of diabetes is the result of lack of insuline receptors:
    type II
  9. 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
  10. pharmacologists have modified human insulin to create advangtagses, the modified forms are called:
    insulin analogs
  11. what is the pregnancy category for insulin:
    category B
  12. what does insulin 70/30 contain:
    • 70% NPH (isophane insuline, intermediate acting)
    • 30%¬† regular insuline

    • Humuline 70/30
    • Novolin 70/30
  13. humuline 50/50 contains:
    • 50% NPH
    • 50% regular insuline
  14. what are the s/sx of hypoglycemia are:
    • pale, cool, moist skin
    • blood glucose less than 50
    • sudden onset of symptoms
  15. what are the contraindications of regular insulin:
    • caution with pregnancy
    • renal impariment or failure
    • fever
    • thyroid disease
    • should not be adminstered to pts with hypoglycemia
    • hypokalemia
  16. 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
  17. 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)
  18. 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
  19. target cells becoming unresponsive to insuline due to a defect in insulin receptor fxn is called:
    • insuline resistance
    • type II
  20. 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)
  21. the sulfonlureas have 2 generations, which one has fewer rx-rx interactions:
    2nd generation
  22. 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
  23. what are the adverse effects of sulonylureas:
    • most common is hypoglycemia
    • weight gain
    • hypersensitivity rxns
    • GI distress
    • hepatotoxicity (jaundice)
    • when taken with alcohol, disulfiram like rxn
  24. list 3 commonly prescribed sulfonylureas:
    • glimepiride ( amaryl)
    • glipizide (glucotrol)
    • glyburide (diabeta, micronase)
  25. metformin (glucocphage) is the only drug in this class:
    biguanides
  26. 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
  27. which medication for diabetes does not cause hypoglycemia:
    biguanides (metformin)

    alpha-glucosidase inhibitors (when used alone)
  28. what are the adverse effects for biguanides (metformin)
    • GI related
    • nausea
    • vomiting
    • abdominal discomfort
    • metallic taste
    • diarrhea
    • anorexia
    • lactic acidosis if impaired liver fxn
  29. 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
  30. what is the prenancy category for
  31. what is the prenancy category for oral hypoglycemics:
    category B
  32. alpha- glucosidase inhibitor

    Precose
    acarbose
  33. 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
  34. 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
  35. what is the MOA for thizaolidinediones (glitazones):
    • reduce blood sugar by decreasing insulin resistance and inhibiting hepatic gluconeogenesis (liver glucose production)
    • increasing insuline uptake
  36. what are the adverse effects of thiazolidinediones (glitazones):
    • fluid retention
    • headach
    • weight gain
    • hepatotoxic
    • fluid overload (worsening or causing CHF)
  37. what are the contraindications of thiazolidinedions (glitazones)
    • serious heart failure
    • pulmonary edeam
    • risk of myocardial ischemia
  38. thiazolidinediones (glitazones)...

    actos
    pioglitazone
  39. thiazolidinediones (glitazones)

    avandia
    rosiglitazone
  40. what is the MOA for meglitinides:

    adverse effects:
    increases insuline release

    adverse effect: hypoglycemia
  41. meglitinides

    starlix
    nateglinide
  42. meglitinides

    prandin
    repaglinide
  43. 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)
  44. 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
  45. 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
  46. 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
  47. 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
  48. list the 2 short acting regular insulins:

    when are they usually given:
    • Humulin R
    • Novolin R

    • given: to cover meals
    • peak action: 2-4 hrs
    • duration: 6 hrs
  49. list the 2 intermediate acting insulin:
    • Humulin N
    • Novolin N
  50. long acting insulin..

    levemir
    insulin detemir
  51. long acting insulin..

    lantus

    when is it usuall given:
    insuline glargine

    usually given: HS
  52. 1st generation sulfonylurea

    tolinase
    tolazamide
  53. 1st generation sulfonylurea

    orinase
    tolbutamide
  54. 2nd generation sulfonylurea

    amaryl
    glimepiride
  55. 2nd generation sulfonylurea

    glucotrol
    glipizide
  56. 2nd generation sulfonylurea

    diabeta,micronase
    glyburide

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