Term
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Definition
| Primarily role in regulation of glucose metabolism |
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Term
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Definition
| Increases hepatic glucose output and blood glucose concentration |
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Term
–Resting pancreatic beta cells
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Definition
| store Insulin in secretory vesicles |
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Term
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Definition
–Promotes the uptake, utilization and storage of glucose
–Thereby lowers plasma glucose concentration.
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Term
Inulin exist as prepro-Insulin, which is converted to ___ and _____
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Definition
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Term
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Definition
–Released at a low basal rate
–Released at a higher rate (stimulated) in response to a variety of stimuli
•GLUCOSE, amino acids and Vagal (parasympathetic) stimulation.
–High blood glucose is the main trigger, but other hormones and autonomic mediators are involved
Digestive hormones |
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Term
Drugs that can stimulate insulin release |
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Definition
Sulfonylureas
Meglitinides
B2- agonists
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Term
| Mechanism of Insulin secretion |
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Definition
-Glucose is taken up by B- cells (bia glucose transporter GLUT2)
-Glucose undergoes Glycolysis with production of high energy ATP
-This process is phosphorylation
-Intracellular ATP levels increase
-ATP dependent K+ channels close, leading to membrane depolarization
-Influx of Ca2+ which causes the exocytosis of Insulin |
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Term
| An increased Ca2+ level causes activation of _____, which cleaves the membrane_______ into_______ and_____. |
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Definition
Phospholipase C
Phosphatidyl Inositol 4,5- bisphosphate
Inositol 1,4,5 triphospate(IP3)
Diacylglycerol (DAG) |
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Term
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Definition
| Increases aminio acid uptake |
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Term
| Insulin in adipose tissues |
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Definition
| Increases uptake of fatty acids |
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Term
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Definition
| Inceases glucose movement into cells |
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Term
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Definition
| Syndrome of heterogenous metabolic disorders that have hyperglycemia in common |
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Term
| Chronic Complications of DM |
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Definition
Premature atherosclerosis
Retinopathy
Nephropathy
Neuropathy
Muscle and tissue wasting
Ulceration
Ketoacidosis
Coma
Death |
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Term
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Definition
Elevated blood glucose causes non enzymatic glycosylation of proteings
Hemoglobin gets glycosylated on its Caline residue (A1c)
Higer levels of HbA1c are found in people with persistently eleveated blood suger
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Term
The international Diabetes federation and American Colege of Endocrinology reccommend HbA1c values below____%
The American Diabetes Association recommends that the HbA1c be below ___% for most patients |
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Definition
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Term
DM Type __
5-10% of Diabetes in the US
Autoimmune
Severe/absolute deficiency of production
Destruction of pancreatic beta cells |
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Definition
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Term
| Destruction of pancreatic Beta cells |
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Definition
No circulation insulin
Starvation like response of the body
Glycogenolysis and glucongeogenesis occur
Constant deliveery of glucose to the blood
Muscle breakdown and amino acids fuel gluconeogenesis
Adipose tissue: Kentones which for acetoacetates which cause serum bicarbonate depletion
Metabolic acidosis results |
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Term
| Clinical features of Type 1 Diabetes |
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Definition
Tired, unwell
weightloss:inability to thrive
Polyuria, polydipsia, prone to ketoacidosis |
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Term
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Definition
Insulin
Exogeneous insulin, at the time of diagnosis to maintain acceptable levels of Glycosylated hemoglovin and avoid ketoacidosis
Start with lower doses to avoid hypoglycemia, adjust dose upwards |
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Term
| Rapid- acting Insulin preperation |
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Definition
Insulin Lispro
Insulin Aspart (Ultra-short) |
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Term
| Short-acting insulin preperation |
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Definition
|
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Term
| Intermediate acting Insulin preperation |
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Definition
NPH (Isophane)
Lente (Insulin zN) |
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Term
| Long-acting Insulin Preperations |
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Definition
Ultralente
Insulin Glarginine
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Term
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Definition
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Term
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Definition
Hypoglycemia
Localized fat hypertrophy at injection site
Allergic reations (rare with human insuling
Immunne-mediated insulin resistance (rare with human insulin) |
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Term
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Definition
| Sweating, remors, tachycardia, hunger, sensation of weakness |
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Term
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Definition
Confusion;altered behavior;disorientation progression to seizures and coma
-Unconscious patient- 1mg of Glucagon IM/SC, followed by intake of carbohydrate |
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Term
| What should you give for a Type 1 DM patient that is malnourished or has alcohol induced hypoglycemia. |
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Definition
| IV of 50% dextrose because glucagon is not effective |
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Term
Question: The following are all mechanisms involved in the secretion of Insulin EXCEPT:
A.Glucose is transported by GLUT 2
B.Phosphorylation occurs
C. ATP dependent Na+ channels close
D. Ca++ influx causes release of Insulin
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Definition
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Term
Type __ DM is non-insulin-dependent
-late onset
-Overall insulin production is decreased by up to 50%
-Sufficient insulin ot prevent ketoacidosis
-Subnormal or inadequate because of tissue insensitivity or tissue resistance
-Obesity is a major factor
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Definition
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Term
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Definition
-Deficiency in B-cell response to glucose
-Tissue insensitivity and impared B cell response is further compounded by Hyperglycemia
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Term
Antidiabetic drugs
(ORAL) |
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Definition
-Sulfonylureas: Tolbutamide, Glyburide
–Biguanides: Metformin
–Meglitinides: Repaglinide; Nateglinide
–Alpha glucosidase Inhibitors: Acarbose; Miglitol
–Glitazones: Rosiglitazone; Troglitazone
–Dipeptidyl peptidase 4 inhibitors: Sitagliptin; Saxagliptin
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Term
Antidiabetic Drugs
(INJECTED) |
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Definition
–Incretinmimetics: Exenatide; Liraglutide
–Amylinomimetics: Pramlinitide |
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Term
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Definition
•1st generation
–Tolbutamide (Orinase); Chlorpropamide (Diabinese);
•2nd generation
–Glyburide (Diabeta)
–Glibenclamide (Dianase)
–Glimepride (Amaryl)
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Term
Sulfonylureas
(Tolbutamide, Glyburide) |
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Definition
Increase release of insulin form the functioning pancrease
-Binds to sulfonyurea receptor associated with B cells
-Inhibits efflux of potassium ions
-Results in depoarization which causes calcium influx, promoting insulin release
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Term
| Sulfonylureas (Tolbutamide, Glyburide) Adverse Effects |
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Definition
-Hypoglycemia
-worst effects with Chlorpropamide
-Skin rash, nausa, vomiting
-Cholestatic jaundice more frequent with chlorpropamide
-Disulfiram like reaction may occur with alcohol
-Allergy: Cross-sensitivity with Sulfa Drugs |
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Term
Sulfonylureas (Tolbutamide, Glyburide) Drug Interactions
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Definition
Interacts with a large number of drugs
-Alcohol
-Anticoagulants
-Auntifungal: Azoles
-Corticosteroids; Thiazides; ACE inhibitors (agents with intrinsic hyperglycemeic activity)
-Beta adrenergic Agents, decereas hypoglycemic effects
-H2 antagonist |
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Term
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Definition
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Term
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Definition
-Only biguanide approved for in the US
-Decrease hepatic glucose production
-Lower glucose absorption and enhance insuli-mediated glugose uptake
-Used alone it does not cause hypoglycemia
-May potentiate the hypoglycemic effects of insulin and sulfonyureas
-improves tissue sensitivity to insulin
-increase peripheral glucose uptake
-Decrease intestinal absorption of glucose
-Increases tissue sensitivity to insulin
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Term
| Biguanides (Metformin) do NOT depend on a functioning pancreas for their action (TRUE or FALSE) |
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Definition
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Term
| Biguanides (Metformin) Adverse Effects |
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Definition
Nausea
Vomiting
Flatulence
Cramps
Lactic acidosis may be fatal in 50%
-CONTRAINDICATED in Renal disease, hepatic ds |
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Term
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Definition
Repaglinide (Prandin)
Nateglinide |
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Term
| Rapaglinide and Nateglinide |
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Definition
-Are Meglitindes
-Used only in pts with functioning pancreatic cells
-Short acting, should be taken only with or before meals
-Fasting glucose usually drops after about a month of regular use
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Term
| Repaglinide and Nateglinide Mechanism of Action |
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Definition
| Act on the Potassium channel and cause closing of this channel, thus stimulating Insulin release |
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Term
| Repaglinide and Nateglinide Drug Interactions |
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Definition
| NSAIDS, Azoles and Macrolides may potentiate the effects of Meglitinides by decreasing breakdown |
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Term
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Definition
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Term
| TZDs (Rosigliazone, Pioglitazone) Mechanismgg |
|
Definition
-Activate PPAR-g (Peroxisome proliferator- activated receptor-gamma: Gene expression)
-Increase tissue insulin sensitivity
-Increase glucose transport
-Inhibit hepatic gluconeogenesis
-lower both blood andglucose and circulating insulin levels
-Increase peripheral glucose uptake
-Inhance fat cell sensitivity
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Term
| ___________ carry a "Black Box' warning for CCF and MI |
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Definition
Thiazolinediones
(Rosiglitazone and Pioglitazone) |
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Term
| TZDs (Rosiglitazone and Pioglitazone) Adverse Effects |
|
Definition
-Cardiovascular
-fluid retention, exacerbationof heart failure
-Dose-related weight gain
-Hepatitis, elevated hepatic enzymes
-Ovulation in some perimenopausal anovulatory women |
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Term
| TZD (Rosiglitazone and Pioglitazone) Drug Interactions |
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Definition
-Decrease the blood levels of Midazolam
-May inactivate Oral Contraceptives |
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Term
| alpha-glucosidase inhibitors |
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Definition
|
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Term
|
Definition
-Present in the intestinal brush bordeer
-Cleaves complex C2H22O12 to yeild simple Glucose
-Aids in the absorption of starch and plysaccaharides
-Maltase, isomaltase, sucrose |
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Term
| Dipeptidyl peptidase 4 inhibitors: |
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Definition
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Term
|
Definition
-Completitively inhibits the enzyme Dipeptidyl peptidase 4 (DPP-4)
-This enzyme breaks down incretins and GIP that are released in response to a measl |
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Term
|
Definition
-Incretin mimetic
-is administered as subcutaneous inj. 30-60 minutes before the first and last meal of the day
-Exenatide enhances glucose dependent insulin secretion by pancreatic beta-cell and suppresses inappropriately elevated glucagon secretion |
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Term
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Definition
| is a 37- amino acid peptide neurohormone that is co-secreted wiht insulin form the pancreatic beta cells in response to meals |
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Term
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Definition
Amylinomimetics (pramlintide)
-it lowers serum glucose by decreasing glucagon release, slowing gastirc emptying, and decreasing food intake |
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Term
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Definition
Women without previously diagnosed diabetes may exhibit high blood glucose diabetes
•Babies born to mothers with gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, and jaundice
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Term
| DM Implication in Denistry |
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Definition
•Hypoglycemic (hunger, weakness, tachycardia, pallor, sweating). Patient taking non-selective beta blockers may have severe hypoglycemia
•Infections: patient may frequently need antimicrobial therapy
•AM appointments are usually better for diabetic patients because that minimizes the chance of stress induced hypoglycemia
•Numbness, tingling, burning pain may be misdiagnosed
•Oral paresthesias are common
•Xerostomia, poor healing and increased secondary infection
•Candidiasis, caries, gingivitis, periodontal disease
•Patient taking α-glucosidase inhibitors need glucose not sucrose because breakdown of sucrose may be inhibited by these drugs
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Term
|
Definition
•Female sex hormones
•Secreted by Ovaries
•Synthesized by Adrenal cortex, liver, fat cells, brain, testes from Cholesterol
•Circulation Estradiol, Estrone and Estriol promote development of secondary sex characteristics and Menstrual Cycle
•In pregnancy: Enlargement of Uterus, development of breast tissue and relaxation of joints
•Hormonal contraceptives: Estrogen + Progestins
•Inhibit secretion of FSH and LH which cause Ovulation
•ERT and HRT used for Cardioprotective effects
•Menstrual disorders: Amenorrhea and Dysmenorrhea
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Term
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Definition
–Clomiphene
•Ovulation stimulation in infertility
–Tamoxifen
•Blocks estrogen receptor, does not allow Estrogen to bind
•Estrogen dependent tumors shrink
•SERM (Selective Estrogen Receptor Modulator)
•Clinical use: Estrogen sensitive breast cancer
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Term
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Definition
–Anabolic steroids
–Testosterone (Masculinizing effects)
•Clinical uses:
–Supplement therapy (hypogonadism)
–Growth: in boys with pituitary dwarfism
–Endometriosis
– Unapproved, increase lean body mass, muscle strength and aggressiveness.
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Term
|
Definition
•Androgen receptor antagonists (Flutamide)
–Nonsteroidal agent that competes with testosterone for androgen receptor
–Used in PCO as well
–Finasteride: Prevents conversion of Testosterone to Dihydrotestosterone
–Use: Prostate Cancer
–2/3rd of Prostate cancer are slow growing
–Aysmptomatic, no pain, non detectable
–1/3rd Aggressive, metastasis to bone/ lymph nodes
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Term
| Major Classes of Contraceptives |
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Definition
•Combination pills
•Progestin pills
•Progestin implants
•Post-coital contraception or emergency contraception
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Term
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Definition
•Estrogen + Progestin
•Constant low dose of estrogen over 21 days + low but increasing dose of progestin over 3 successive 7-day periods (triphasic)
•21 days on then 7days off
•Ethinylestradiol, mestranol + norethindrone
•Very effective
•Low failure rate
•Safe throughout the reproductive years
•Readily reversible method
•Allows women to manipulate menstrual cycle
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Term
|
Definition
• thromboembolic risk
–Estrogen increases production of vitamin K dependent clotting factors
–Reduces antithrombin activity
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Term
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Definition
•Depot preparation (Injectible)
•150 mg medroxyprogesterone IM q12 +2 weeks
–Administration > every 14 weeks requires a (-) pregnancy test to restart
•MOA: inhibits FSH and LH to produce an atrophic endometrium and thick cervical mucus
•99.7% efficacy
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Term
| Drugs used for Osteoporosis |
|
Definition
–Pharmacologic choices
•Antiresorptive
–Estrogen
–Bisphosphonates (alendronate; cyclical etidronate)
–Ealoxifene
–Salmon Calcitonin
•Supplements - Dietary; Vitamin D and Calcium
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Term
|
Definition
–Estrogen (±) progesterone
•First-line therapy in postmenopausal women
•Conjugated estrogen (Premarin)
–Raloxifene (Evista)
•Selective estrogen receptor modulator
•Estrogen like action on bone and lipid metabolism
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Term
|
Definition
–Increases bone mass, antiresorptive
–Analgesic properties
–Safe, but expensive
–Nasal spray, once a day formulation or sc
–Binds directly to receptors on osteoclasts,
•Increase cAMP, inhibit osteoclast activity, decrease bone resorption, reduce bone pain
•Long term use, decrease osteoclast numbers
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Term
| Osteoporosis: Bisphosphonates |
|
Definition
•Alendronate (Fosamax)
•Risedronate (Actonel)
•Etidronate (Didrone)
•Pamidronate (Aredia)
•Zoledronic Acid (Zometa) IV
•Ibandronate (Boniva)
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Term
| Osteoperosis- Bisphosphonates |
|
Definition
–Alendronate (Fosamax)
–Prevent bone resorption
•Inhibit osteoclast activity
–Inhibit attachment of osteoclast and their ability to resorb bone.
»Inhibition of tyrosine phosphatase activity
»Under therapy, normal bone tissue develops, and alendronate is deposited in the bone-matrix in pharmacologically inactive form |
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Term
| Aldronate Sodium (Fosamax) Adverse Effects |
|
Definition
–Adverse Effects
•Gastrointestinal mucosa irritation: May cause irritation to upper gastrointestinal mucosa. Esophagitis, esophageal ulcers, esophageal erosions, and esophageal stricture (rare).
• Use with caution in patients with dysphagia, esophageal disease, gastritis, duodenitis, or ulcers (may worsen underlying condition).
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Term
| Aldronate Sodium (Fosamax) Drug Interactions |
|
Definition
–Drug Interactions
•Aspirin: May enhance the adverse/toxic effect of alendronate; specifically gastrointestinal adverse events.
•Nonsteroidal anti-inflammatory drugs (NSAIDs): May enhance the gastrointestinal adverse/toxic effects (increased incidence of GI ulcers) of bisphosphonate derivatives.
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