Term
| what are the normal post-prandial glucose levels? |
|
Definition
|
|
Term
| what are the normal fasting glucose levels? |
|
Definition
|
|
Term
| blood sugar level of hypoglycemia |
|
Definition
|
|
Term
| symptoms of hypoglycemia - brain |
|
Definition
shakiness, diziness
nervousness, confusion
headache |
|
|
Term
| symptoms of hypoglycemia - tissues |
|
Definition
hunger
tingling extremities |
|
|
Term
| symptoms when blood glucose levels <2 mmol/L |
|
Definition
fainting
potentially death |
|
|
Term
| blood sugar level of hyperglycemia |
|
Definition
|
|
Term
| symptoms of hyperglycemia (5) |
|
Definition
1) increased glucose excretion through kidneys (frequent urination, excessive thirst)
2) fatigue, weakness, hunger, blurry vision (too little glucose in the tissues)
3) tissue damage
4)ketoacidosis
5) potentially death |
|
|
Term
| what does the pancreas do for glucose regulation |
|
Definition
| detect changes in glucose level |
|
|
Term
| what does the blood do for glucose regulation |
|
Definition
| send out hormone message signals |
|
|
Term
| what do the peripheral tissues do for glucose regulation |
|
Definition
| initiate glucose correction (uptake or release) |
|
|
Term
| what do the alpha cells of the pancreatic islet do |
|
Definition
during hypoglycemia
secretes glucagon
targets hepatocytes
increase glucose release, synthesis and gycogen breakdown; decreases glucose storage
Ultimately increase glucose levels |
|
|
Term
| what do the beta cells of the pancreatic islet do |
|
Definition
during hyperglycemia
secrete insulin
affects liver, fat and skeletal muscle
increase glucose uptake, increase glucose storage and utilization
decrease glycogen breakdown and glucose synthesis
ultimately decrease glucose levels |
|
|
Term
|
Definition
| autoimmune-mediated beta-cell destruction leading to reduction and eventual loss of insulin secretion |
|
|
Term
|
Definition
| primarily tissue resistance to the action of insulin, late stages associated with impaired insulin secretion |
|
|
Term
| symptoms and causes of severe hyperglycemia |
|
Definition
body wasting
glucose cannot get into tissues
no glucose for utilization or storage
cellular starvation |
|
|
Term
| adipose tissues send out ___________ for metabolic homeostasis |
|
Definition
adipokines
regulate energy metabolism - insulin sensitiviey, satiety, energy utilization |
|
|
Term
|
Definition
peripheral diabetic neuropathy (nerves)
CDV, nephropathy, ketoacidosis |
|
|
Term
| pharmacotherapy for type 2 diabetes |
|
Definition
metformin
insulin secretagogue
incretin agents
weight control agents |
|
|
Term
| since insulin degradation in the blood is very ____________, absorption speed largely determines 3 things |
|
Definition
rapid
1) onset of action
2) peak activity
3) duration of action |
|
|
Term
|
Definition
| fast onset of action, short duration |
|
|
Term
|
Definition
| slow onset of action, long duration |
|
|
Term
| How is insulin absoprtion altered |
|
Definition
| insulin analogues - amino acid modifications (easier or harder to break apart) |
|
|
Term
| natural insulin - onset, peak, duration |
|
Definition
hexamer
onset: 30 mins
Peak: 2hr
Duration: 6-8hr |
|
|
Term
| insulin lispro - onset, peak, duration |
|
Definition
reduced ability to self associate - speeds up absorption
onset: 15min
Peak: 30min
Duration: 4hr |
|
|
Term
| insulin glargine - onset, peak, duration |
|
Definition
soluble at pH 4.0 (slows absorption)
microprecipitation - depot-6-2-1
onset: 2-4 hr
Peak: none
Duration: 10-24 hr |
|
|
Term
| NPH - onset, peak, duration |
|
Definition
intermediate acting insulin
onset: 1-2 hr
Peak: 4-6 hr
Duration: 12-18 |
|
|
Term
| bolus insulin replacement |
|
Definition
mix of rapid, regular and intermediate insulin
taken just before a meal
dose calculated to balance predicted CHO intake and pohysical activity |
|
|
Term
| basal insulin replacement |
|
Definition
long acting insulin- glargine and NPH
administered 1-2 daily
important for overnight glucose release from liver |
|
|
Term
| what happens if insulin doe snot closely match with predicted daily diet and exercise |
|
Definition
|
|
Term
| common causes of hypoglycemia due to intensive insulin therapy |
|
Definition
inadequate CHO consumption
unusual physical activity
too large an insulin does |
|
|
Term
| what is a common adverse effect of insulin therapy |
|
Definition
weight gain
due to increased fat storage, decreased metabolic rate, eating to prevent hypoglycemia |
|
|
Term
| metformin: action, adverse effects, and administration |
|
Definition
increases insulin sensitivity
activates AMP dependent kinase
decreases basal and pos-prandial blood glucose
adverse: minimal , mild GI upset
oral |
|
|
Term
| insulin secretagogues: action, adverse effects, and administration |
|
Definition
promote beta cell depolarization - increasing insulin levels
adverse - weight gain, high hypoglycemia risk
administered orally |
|
|
Term
|
Definition
insulin secretague: glyburide
bind to sulfonylurea receptor, induces potassium channel closure |
|
|
Term
|
Definition
gastrointestinal hormones that stimulate a decrease in blood glucose following a meal
GLP-1 L enhances glucose stimulated insulin secreation (beta); decreases glucagon secration(alpha) |
|
|
Term
| GLP 1 rapidly degraded by |
|
Definition
| Dipeptidyl peptidase IV (DPP 4) |
|
|
Term
| DPP4 inhibitors action, adverse effects, and administration |
|
Definition
sitagliptin increase GLP-1 levels
adverse: minimal, pancreas (rare)
oral
low hypoglycemia risk |
|
|
Term
| incretin mimetics: action, adverse effects, and administration |
|
Definition
activate GLP-1 receptors
peptide GLP1 receptor agonist
adverse: nausea, pancreatitis (rare)
administered: injection BID
low hypoglycemia risk
combination therapy |
|
|
Term
|
Definition
weight loss therapy
increases basal metabolism
muscle and bone wasting |
|
|
Term
|
Definition
rapid weight loss
neuropathy |
|
|
Term
|
Definition
apetite suprressants, energy expenditure stimulation
abuse and addiction
multiple adverse events |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| orlistat - lipid absorption |
|
|
Term
| orlistat action, adverse effects, and administration |
|
Definition
promotes weight loss by inhibiting fat digestion and absorption in the intestines (inhibits pancreatic lipase)
adverse: flatulence, diarrhea, bloating, poor bowel control
administered orally |
|
|
Term
|
Definition
|
|
Term
|
Definition
| sulfonylureas or incretin agents |
|
|
Term
|
Definition
|
|
Term
| intensified insulin therapy |
|
Definition
|
|
Term
| what are the main functions of the kidneys |
|
Definition
maintain water/ electrolyte balance
regulate extracellular fluid volume
excretion of metabolic wastes and foreign substances |
|
|
Term
| extracellular fluid volume in the body is an important determinant of _______ |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
125 mL/min
180 L/day
2mL/sec |
|
|
Term
|
Definition
| solutes moving from blood to tubule |
|
|
Term
|
Definition
| solutes moving from tubule to blood |
|
|
Term
| ____% of filtered sodium is reabsorbed |
|
Definition
|
|
Term
| 3 types of regulation of solute and water reabsorption |
|
Definition
active - transport proteins and ATP
passive (water)- osmosis
passive (solute) - permeate membrane |
|
|
Term
| what happens to half life when kidneys are damaged |
|
Definition
half life increases
greater risk for drug toxicity |
|
|
Term
| how much fluid is filtered by the kidneys each day |
|
Definition
|
|
Term
| filtrate contains how much NaCl (Kg) |
|
Definition
|
|
Term
| in order from greatest to least where is most sodium reabsorbed |
|
Definition
proximal 67
loop of henle 25
distal tubule 5
collecting duct 3 |
|
|
Term
|
Definition
| inhibit sodium reabsorption at different sites of the renal tube |
|
|
Term
| targets sodium transport in the distal convoluted tubule |
|
Definition
|
|
Term
| targets sodium transport in the ascending limb |
|
Definition
|
|
Term
| targets sodium transport in the cortical collecting duct |
|
Definition
| potassium sparking diuretics |
|
|
Term
| hydrochlorothiazide and metolazone |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| potassium sparing diuretics |
|
|
Term
|
Definition
| potassium sparing diuretics |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
inhibit sodium chloride symporter (distal convoluted tube)
increase sodium and water removal
decreased BP
mild to moderate hypertension |
|
|
Term
|
Definition
inhibit sodium, potassium, chloridde symporter NKCC2 (thick ascending limb)
SEVERE hypertension |
|
|
Term
| potassium sparing diuretics |
|
Definition
inhibits membrane sodium channel ENaC (cortical collecting duct)
directly - amiloride
indirectly - aprinolactone (inhibits aldosterone)
ENHANCE effects of other diuretics |
|
|
Term
|
Definition
biologically active end product of the renin-angiotensin-aldosterone system
constrict blood vessels, increase extracellular fluid volume
INCREASE BP |
|
|
Term
| sites of blood pressure regulations (4) |
|
Definition
heart
kidneys
aterioles
veins |
|
|
Term
|
Definition
ACE inhibitors
angiotensin receptor blockers
renin inhibitors |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| angiotensin receptor blockers |
|
Definition
antagonize angiotensin receptor in the adrenal gland and the vasculature
for patients who do not tolerate ACE inhibitors well |
|
|
Term
| volume of blood that is completely cleared of substance per unit time |
|
Definition
|
|
Term
| breakdown product of muscle |
|
Definition
|
|
Term
| normal levels of creatinine in blood |
|
Definition
male: 50 micromol/L to 105 micromol/L
female: 45-100 micromol/L |
|
|
Term
| 3 factors that influence resistance in blood vessels |
|
Definition
length
viscosity of blood
radius of the vessel (main determinant) |
|
|
Term
| arrest of bleeding by physiological properties of vasoconstriction and coagulation or by surgical means |
|
Definition
|
|
Term
|
Definition
vasoconstriction
platelet plug formation
coagulation (clotting)
limitation of clot formation |
|
|
Term
|
Definition
adenosine diphosphate
promotes platelet aggregation |
|
|
Term
|
Definition
| vasoconstrictor and stimulates aggrgations |
|
|
Term
|
Definition
| platelet activator, vasocontrictor |
|
|
Term
|
Definition
intrinsic - initiated by activation of factor XII or VIIa by collagen
extrinsic - initiated by activation of clotting factor VII to VIIa by tissue factor
converge: factor Xa, (converts prothrombin into thrombin)
fibrinogen converts to fibrin |
|
|
Term
|
Definition
| reduce LDL- cholesterol levels |
|
|
Term
|
Definition
calcium channel blockers
vasodilator |
|
|
Term
|
Definition
alpha 1 adrenergic receptor blockers
vasodilator |
|
|
Term
|
Definition
|
|
Term
|
Definition
beta-andrenergic receptor blockers
decrease contractility of the heart |
|
|
Term
|
Definition
beta-andrenergic receptor blockers
decrease contractility of the heart |
|
|
Term
|
Definition
|
|
Term
| normal total cholesterol/HDL ratio |
|
Definition
|
|
Term
|
Definition
|
|
Term
| normal BP range for diabetic patients |
|
Definition
|
|
Term
|
Definition
|
|
Term
| mechanism of action for Statins |
|
Definition
reduce cholesterol synthesis in liver cells
INHIBITS HMG-CoA reductase - depletes intracellular cholesterol stores
INCREASES LDL recptors
INCREASED removal of LDL cholesterol |
|
|
Term
| mechanism of action - calcium channel blockers |
|
Definition
INHIBIT cell surface calcium channels
DECREASE actin-myosin interation which DECREASES VSM contraction |
|
|
Term
| mechanism of action - alpha 1 adrenergic receptor blockers |
|
Definition
INHIBIT edogenous catecholamines which
DECREASE calcium release
DECREASE actin-myosin interaction
DECREASE VSM contraction |
|
|
Term
| mechanism of action - nitric oxide donors |
|
Definition
nitric oxide INCREASES production of cyclic guanosine monophosphate which
REDUCES actin-myosin interactions
sublingual spary or tablet |
|
|
Term
| mechanism of action - beta-adrenergic receptor blockers |
|
Definition
INHIBIT increase in calcium
BLOCK catecholamines
DECREASED actin-myosin interactions |
|
|
Term
| selective beta1-AR blockers are favourable for managing |
|
Definition
| hypertension because blockade of beta2-ARs in other tissues can have undesirable effects |
|
|
Term
| what will the blockade of beta2-ARs have in the CNS |
|
Definition
| diziness and imparied muscle coordination |
|
|
Term
| what will the blockade of beta2-ARs have in the lungs |
|
Definition
| prevents bronchodilation - worsen asthma |
|
|
Term
| secondary prevention in CV pharmacology |
|
Definition
antiplatelet drugs
anticoagulants
fibrinolytics |
|
|
Term
| acetylsalicylic acid (ASA) |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| indirect acting anticoagulants |
|
|
Term
|
Definition
| indirect thrombin inhibitors |
|
|
Term
|
Definition
| direct thrombin inhibitor |
|
|
Term
|
Definition
|
|
Term
| ASA adverse effects and mechanism of action |
|
Definition
COX inhibitor which INHIBITS TXA2 - platelet activator
Adverse: increased GI bleeding |
|
|
Term
| ADP receptor antagonists - mechanism of action and adverse events |
|
Definition
ADP induces platelet agregation
BLOCKS this mechanism
adverse: bleeding, neutropenina |
|
|
Term
| GP IIb/IIIa antagonists - mechanism of action and adverse events |
|
Definition
prevents fibrinogen from cross linking platelets
reduces platelet agregation
adverse: increased bleeding and thrombocytopenia |
|
|
Term
| indirect acting anticoagulants - mechanism of action and adverse events |
|
Definition
prevents reactivation of vit K
prevents synthesis of vitamin K dependent clotting factors
adverse: excessive bleeding, many drug interactions |
|
|
Term
| indirect thrombin inhibitor - mechanism of action and adverse events |
|
Definition
interact with antithrombin and enhance inactivation of clotting factors
adverse: increased bleeding |
|
|
Term
| direct thrombin inhibitors - mechanism of action and adverse events |
|
Definition
interact directly with inhibiting actions of thrhombin
DECREASED conversion of bibrinogen to fibrin
advers: increased bleeding |
|
|
Term
| fibrinolytics - mechanism of action and adverse events |
|
Definition
breakdown clot after its formation
binds to fibrin, converts plasminogen to plasmin - breakdown clot
MI use within 6-12 hours; stroke 3 hrs
adverse: increased risk of bleeding, allergic reaction |
|
|
