Pharm Chapter 32
Card Set Information
Pharm Chapter 32
Pancreatic Hormones Treatment DM
T/F: Pancreas functions as endocrine and exocrine gland.
: excretes digestive enzymes into duodenum via pancreatic duct
: Insulin and glucagon regulate blood glucose (Insulin also plays a role in protein and lipid metabolism and several aspects of growth and development)
What synthesizes and secretes pancreatic hormones?
Islets of Landerhans
Four primary cell types
1. Alpha (A) cells
: produce glucagon
2. Beta (B) cells
: produce insulin
3. Delta (D) cells
: produce somatostatin (regulates GI absorption and motility)
4. F cells
: produce pancreatic polypeptide
What is the primary effect of insulin?
Lower blood glucose by facilitating entry of glucose into peripheral tissues
Stored in liver
: Hepatic cells permeable to glucose, even w/o insulin
Stored in other tissues
: Most relatively impermeable to glucose and need facilitated diffusion
How does insulin effect the glucokinase system?
Phosphorylates glucose and traps molecule in hepatic cell
↑ activity of enzymes promoting glycogen synthesis, inhibits those promoting glycogen breakdown
How does insulin promote storeage of protein and lipid in muscle and adipose tissue?
: stimulates aa uptake, ↑ DNA/RNA activity, inhibits protein breakdown
: stimulates TG synthesis, inhibits hormone sensitive lipase (which breks down stored lipids)
What is the hormonal antagonist of insulin, and what is its primary effect?
Increases blood glucose to maintain levels and prevent hypoglycemia
Produces ↑ in glycogen breakdown in liver (glycogenolysis)
Stimulates ↑ in hepatic glucose production (gluconeogenesis) to sustain blood glucose levels
How does Glucagon affect the cAMP system in the liver cells?
Binds to hepatic cell membrane and stimulates activity of adenyl cyclase enzyme
Transforms ATP to cAMP (this stimulates enzymes to ↑ glycogen breakdown and stimulates gluconeogenesis)
What is normal blood glucose levels? What maintains these levels? What happens if it gets too high/low?
80-90mg/100mL of blood
Insulin and glucagon maintain blood glucose withing finite range
: can result in coma or death
: can result in neural and vascular changes
What is the primary factor affecting pancreatic hormone release?
Level of glucose in the bloodstream
Blood glucose rises
: insulin released from beta cells
Blood glucose falls
: glucagon released from alpha cells
What is type 1 diabetes?
Unable to synthesize enough insulin
Destruction of beta cells
Need exogenous insulin to survive
What is diabetes mellitus and what are the types?
Insufficient insulin secretion or decrease in peripheral effects of insulin
: Insulin-dependent diabetes mellitus (IDDM)/ Juvenile diabetes
: Non-insulin dependent diabetes mellitus (NIDDM)
What causes Type II diabetes?
Poor diet, obesity, lack of exercise
Usually in older individuals
What is the primary problem in type II diabetes?
Decreased sensitivity of peripheral tissues to circulating insulin (insulin resistance)
Target cell defect causes decreased resonse of cell to insulin
Cellular response is inadequate
What is a secondary problem in type II diabetes aside from insulin resistance?
Pancreatic beta cells intact, can produce insulin
Insulin is release continuously, even when fasting
After meal, beta cells don't ↑ insulin release in proportion to ↑ glucose levels
What are complications of DM?
: ↑ glucose excretion by kidneys (kidneys can't adequately resorb glucose)
: osmotic force promotes fluid excretion
: Loss of glucose in urine causes shift towards fat and protein mobilization for energy
: Abnormalities in small blood vessels leads to occlusion (can damage retina and kidneys)--->poor wound healing and ulcers!!
T/F: Exogenous insulin is used for both type I and type II diabetes.
TRUE: used in type 2 b/c other interventions may not be adequate to control disease
What is a type of insulin preparation?
Slower than endogenous insulin
Preparations can be fast or slow acting; slow acting allows more sustained levels
What are ways of administering insulin?
Nasal spray (Exubera)
IV in emergency
T/F: Insulin is often administered orally.
FALSE: b/c of large polypeptide structure
What is done in intensive insulin therapy?
Self-administering 3 or more dosages/day
Monitor blood glucose levels
Reduces long-term complications
What are adverse effects of Insulin Therapy?
Strenuous activity can cause this by having insulin-like effect
Avoid by decreasing insulin by 30-35%
10-15 g D-glucose restores blood glucose in early hypoglycemia
T/F: Oral antidiabetic drugs are effective for type I and type II diabetes.
FALSE: only type 2 (by mouth)
What do Sulfonylureas do? Examples?
Act on beta cells to stimulate release of insulin
Released into hepatic portal vein to liver to inhibit glucose production
Early stages of type II
Type of Immunosuppressant
Minimizes beta cell loss
Type of Glucagon-like Peptide 1
Released after meal
Increases after meal
↑ ability of blood glucose to stimulate insulin release from beta cells
What is sometimes used to Rx acute hypoglycemia?
Nonpharmacologic Intervention in DM
Diet, weight loss
Tissue transplants and gene therapy of pancreas