Pharm 2 - Endocrine 1

drraythe's version from 2015-11-09 15:40

Moore's Worksheet 1

Question Answer
What do α-cell secrete? What is their effect on blood Glucose?α-cells secrete Glucagon, which ↑ blood Glucose
What do β-cells secrete? What is their effect on blood Glucose?β-cells secrete Insulin & Amylin. Insulin allows cells to take Glucose from blood ↓ing Glucose levels in the blood.
Amylin is co-created & synergistic w/ insulin (Amy the Betta doesnt want sugar in her water)
What do Delta cells secrete? What is their effect on blood Glucose?Delta cells secrete Somatostatin, which inhibits Glucagon & Insulin secretion (↑ blood Glucose) (The SWEETIE came up & STOPPED (static) for the D)
Which Glucose transports are in the liver, pancreas, muscle & fat cells?(1) GLUT-2 → Liver & pancreatic β-cells
(2) GLUT-4 → Muscle & fat cells
(2 focuses inward (organs) & 4 focuses outward (mm & fat) )
Does a β-cell bcm polarized or depolarized when stimulated to release Insulin?Depolarized, close K channels
What are some stimulators & inhibitors of Insulin secretion?(1) Stimulators: Glucose, amino acids, fatty acids, GI hormones
(2) Inhibitors: Somatostatin, α-2 agonist
Does Diabetes Insipidus have anything to do w/ insulin?No, related to ADH
What are 2 forms of Diabetes Insipidus? What are their czs?(1) Central Diabetes Insipidus - ↓ ADH secretion from the posterior pituitary
(2) Nephrogenic Diabetes Insipidus - cells in kidney do not respond to normal or elevated levels of ADH
What CS have been related to Diabetes Mellitus?Polyuria
Weight loss
What are the differences between Diabetes Mellitus Type 1 & Type 2?(1) Type 1 = PTx does not produce Insulin (dmged β-cells)
(2) Type 2 = Results from Insulin resistance/ tissues bcm less responsive to Insulin (receptors desensitized or downregulated)
Which form of Diabetes Mellitus is most common in dogs, humans, cats?Dog - Type 1
Humans - Type 2
Cat - Type 2
What are the steps which result in ketoacidosis?Deficiency of Insulin → metabolism of triglycerides & muscle → ↑ serum glycerol, alanine, FFA → Glucagon stimulates glycerol & alanine use in gluconeogenesis & FFA conversion into ketones (Acetone & Acetoacetic acid) (β-hydroxybutyric acid is also made but isn't a keytone)
What are the normal blood Glucose levels?80-120mg/dl
What are some signs of chronic HypERglycemia? (3)(1) Glycated proteins (cz dmg to blood vessels & defective myelin in nerves)
(2) Glycated hemoglobin
(3) Neural & ocular dmg (sorbitol accumulation - osmotic swelling & cataracts)
The Merck manual recommended different diets for diabetic cats & dogs. How do they differ?DOG: High fiber & complex carbohydrates
CAT: High protein & low carbohydrates (cats are carnivores, can't do much with carbs anyway)
Cats 1st dx w/ Diabetes Mellitus have a high percentage of remission in the 1st 3-4 months of treatment when given which Insulin?Glargine Insulin
(GLARGINE the great loves his pet kitty, even 3-4mos after he got her)
In what 3 ways can the effectiveness of Diabetes Mellitus management be assessed?(1) Glycosated hemoglobin (Glucose bound to hemoglobin)
(2) Fructosamine (complex of carbohydrates & proteins resulting from glycated proteins)
(3) Glucose curve (measuring Glucose over time)
In veterinary medicine are levels of glycosylated hemoglobin routinely tested in diabetic patients? Why/Why not?No, due to long half-life of RBCs
Which test can tell if glycemic control has been effective in the last 2-4 weeksFructosamine (2-4 fruits a day are good for you!)
When running a Glucose curve on a PTx what is the range of blood Glucose that is ideal? (max & min)100-250 mg/dl
Somogyi effect is czd by what?Result of a dose of Insulin that is too high (leads to rebound HypERglycemia) (Somogyi overdosed, poor guy)
How does a veterinarian determine that Somogyi effect is present?Detected by doing a Glucose curve
What are some peripheral neural signs of HypOglycemia?Sweating
“Inner trembling” related to catecholamine release
How do Sulfonylureas work in relation to Diabetes management? What are some examples? How are they administered?Stimulate Insulin release from β-cells by inhibiting ATP-dependent K+ channels.
Examples incld Glipizide/Glucotrol, Glimepiride/Amaryl. ORAL administration
(eating sulfur will make your Insulin go crazy & your body will GLUGLIP & GLIAM all over)
Would it be effective to give a Type 1 diabetic PTx a Sulfonylurea drug? So would a Sulfonylurea drug be effective in the majority of diabetic dogs?No, bc Ptx cannot produce Insulin (the drug's MOA is to stim Insulin release from β-cells which have been destroyed)
No, bc the majority of dogs have Type 1 (βs are gonna be pretty stimulated if you put SULFur in their water!)
In the long term are Sulfonylurea drugs a good choice to treat diabetic cats?No, even thought cats usually have Type 2 Diabetes, the long term success rate is 15% (bcm Glucose resistant)
(it's just working the system harder, not smarter)
What was the source of the Biguanide drugs?Galega officinalis
Give an example of a BiguanideMetformin (Met was Bi, FORMally OR I formally Met a Big guy)
Metfromin a human drug used to treat Diabetes Mellitus is unlikely to cz HypOglycemia bc of its MOA. How does Metformin work? What doesn’t it stimulate?GI absorption of Glucose
Hepatic Glucose output
Glucose transport into skeletal muscles
Stimulates Glucose utilization
IT DOESNT stim β-cells! (it's metFROM everything but the pancreas! Go fig!)
What type of drug is Acarbose? How does it work? Why is it unpopular as a human drug?Acarbose is a α-glucosidase inhibitor. It works by competitively inhibiting small intestine enzymes used to break down carbohydrates, ↓ absorption of carbohydrates from intestinal tract. It is unpopular in human med bc of its GI side effects: flatulence, bloating, diarrhea (CARBS BLOAT up your SIDES(α-glucoSIDase) & people think you're nasty (fart, diarrhea), so take some A-CARB (A = w/o) so you don't break it down & absorb it)
Where are incretins secreted from? What stimulates their secretionSecreted by GIT, Stimulated by ingestion of food (INcretins IN skIN from INgesting)
What are 2 major incretins? (briefly, what do they do?)(1) GLP-1 (Stimulates Insulin release & ↓ Glucagon production)
(2) GIP (Stimulates Insulin release & ↑ Insulin secretion)
GLP-1 has how many actions?2 (Stimulates Insulin release, ↓ Glucagon production) (The GREAT LOWER PRINCE wants to be INSULated & doesn't want you to put GLUE on him)
Exentidine was derived from the saliva of what animal?Gila monster (GILA will EX you out!)
How is DPP4 related to GLP-1?DPP4 degrades GLP-1 (The D Degrades) (GLP-1 is a incretin, which is a GIT hormone which ↑ Insulin secretion)
What are the 3 actions of Pramlintidine in humans?Slows gastric emptying
Prevents rise in Glucagon after meal
(I would go to the PRAM, but my stomach is too full (slows the emptying) & I'm not hungry & I don't have any Glucagon, so I'm missing out on the dinner part!)


Question Answer
Describe Insulin’s effects on carbohydrate metabolism↑ Glucose uptake → ↑ GLUT 4, glycogen synthesis
↑ Glycolysis
↓ Gluconeogenesis
Describe Insulin’s effects on fat metabolism↑ uptake/storage
↑ lipogenesis
↓ lipolysis (why are diabetic people usually fat? Bc less lipolysis w/ more uptake, storage & production of it)
Describe Insulin’s effect on protein metabolism↑ AA uptake
↑ protein synthesis
↓ protein degradation
↓ gluconeogenesis
What receptor is associated w/ Glucose uptake in fat cells?Tyrosine kinase (TYROne was KINd but got FAT from taking up all that sugar)
How does Insulin affect potassium in the body?Insulin activates Na/K-ATPase activity → ↑ K inside cells
What Insulin is most similar to dog Insulin?Pig Insulin (dogs are just piggies anyway)
What Insulin is most similar to cat Insulin? How many AA are different?Bovine, 1 AA ( Cat & Cow both start w/ C - also 1 difference!)
Cattle, sheep, horses & dogs Insulin differ in how many AA?3 AA
How is Insulin measured?In units, 1 unit of Insulin is equal to the amount required to ↓ the concentration of blood Glucose in a fasting rabbit to 45 m/dl
How many units of Insulin per ml are held in a U-40 syringe? U-100 syringe?(1) U-40 → 40 units per ml
(2) U-100 → 100 units per ml
Why is Insulin crystallized?Slows down absorption & ↑ duration of action
Route of admin, time until onset, time until max or peak effect & duration of action of....FAST ACTING INSULIN (what is this 1 called?)Recombinant human InsulinIV - immediate onset, max effect 0.5-2hrs, duration 1-4hrs. IM - onset 10-30 min, max effect 1-4 hrs, duration 3-8 hrs. SC - onset 10-30 min, max effect 1-5 hrs, duration 4-10 hrs. (of course humans get the fast stuff!)
Route of admin, time until onset, time until max or peak effect & duration of action of....Isophane Insulin (NPH Insulin) (what range does this Insulin fall under?)(INTERMEDIATE ACTING) → It is SC route only
Dog - onset 0.5-2hrs, peak effect 2-10 hrs, duration 6-18hrs
Cat - onset 0.5-2hrs, peak effect 2-8 hrs, duration 4-12 hrs (Isophane, Intermediate. & IN the skIN.)
Route of admin, time until onset, time until max or peak effect & duration of action of....Porcine Insulin zinc suspension (LENTE, Vetsulin) (what range does this Insulin fall under? Who is this for?)(INTERMEDIATE ACTING) DOG (bc dogs & pigs are most similar) )
SC route (pigskin, lol), onset 0.5-2hrs, peak effect 4hrs & 11 hrs, duration 14-24 hrs
Route of admin, time until onset, time until max or peak effect & duration of action of....Protamine ZINC Insulin (PZI vet) (what range does this fall under?)(LONG ACTING INSULIN) SC ROUTE
DOG: Onset 1-4 hrs, peak effect 4-8 hrs, duration, 6-28hrs
CAT: Onset 1-4 hrs, peak effect 4-8 hrs, duration 6-24 hrs
(slice the skin w/ the protein-zinc sword. For dogs this will take longer bc they have more tight skin)
Route of admin, time until onset, time until max or peak effect & duration of action of....Insulin Glargine (Lantus) (What range does this fall under?)(LONG ACTING INSULIN) - IM & IV - rapid release similar to regular Insulin
SC - slow release, constant conc/time profile over 24 hrs w/ no pronounced peak (GLARGINE the great! Will get under your skin quite consistently)
List 2 intermediate acting Insulins(1) Isophane Insulin (NPH Insulin)
(2) Porcine Insulin zinc suspension (LENTE, Vetsulin) (ISO-(intermediately) PHAME-us as a PORKY VET)
Vetsulin has how many peaks?2 (The letter V has 2 peaks facing upward)
List 2 long acting Insulins(1) Protamine ZINC Insulin (PZI vet)
(2) Insulin Glargine (Lantus) (GLARGINE the great w/ his protein-&-zinc sword will last long in the battle)
PZI is what percentage beef Insulin & pork Insulin?90% beef, 10% pork
(although it starts w/ P, it's only 10% P, so, WHERE THE BEEF? in the PZI!)
Why does Glargine Insulin not have pronounced peak effect when given SC?Acidic solution is neutralized → forms microprecipitates → small amounts are slowly released, resulting in relatively constant/time profile over 24 hrs (GLARGINE the great gets under your skin for a long time, leaking into your mind 1 precipitate at a time)