Pharm- Insulin+Anti-diabetics

kelseyfmeyer's version from 2015-04-16 18:49


Question Answer
What do alpha cell secrete? What is their effect on blood glucose?Alpha cells secrete glucagon, which inc. blood glucose
what do beta cells secrete? What is their effect on blood glucose?Beta cells secrete insulin and amylin. Insulin allows cells to use glucose in blood/lowers glucose levels in blood. Amylin is co-created and synergistic with 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 and insulin secretion (inc blood glucose) (The SWEETIE came up and STOPPED(static) for the D)
Which glucose transports are in the liver, pancreas, muscle, and fat cells?(1) GLUT-2→ liver and pancreatic B-cells. (2) GLUT-4 →muscle and fat cells (2 focuses inward (organs) and 4 focuses outward (mm and fat) )
Does a Beta cell become polarized or depolarized when stimulated to release insulin?Depolarized, close K channels
What are some stimulators and inhibitors of insulin secretion?(1) Stimulators: Glucose, amino acids, fatty acids, GI hormones (2) Inhibitors: Somatostatin, alpha 2 agonist
Does diabetes insipidus have anything to do with insulin?no, related to ADH
What are 2 forms of Diabetes insipidus? What are their causes?(1) Central Diabetes- decreased ADH secretion from the posterior pituitary (2) Nephrogenic diabetes insipidus- cells in kidney do not respond to normal or elevated levels of ADH
What clinical signs have been related to diabetes mellitus?Polyuria, glucosuria, ketoaciduria, polydipsia, weight loss, fatigue, depression, coma
What are the differences between diabetes mellitus type 1 and type 2?(1) Type 1= patient does not produce insulin (2) Type 2= Results from insulin resistance/ tissues become less responsive to insulin (receptors desensitized or decreased)
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 and muscle→ increases serum glycerol, alanine, FFA → Glucagon stimulates glycerol and alanine use in gluconeogenesis and FFA conversion into ketones (beta-hydroxybutyric acid and acetoacetic acid)
What are the normal blood glucose levels?80-120mg/dl
What are some signs of chronic hyperglycemia? (3)(1) Glycated proteins (cause damage to blood vessels and defective myelin in nerves) (2) Glycated hemoglobin (3) Neural and ocular damage (sorbitol accumulation- osmotic swelling and cataracts)
The Merck manual recommended different diets for diabetic cats and dogs. How do they differ?(DOG) high fiber and complex carbohydrates. (CAT) high protein and low carbohydrates
Cats first diagnosed with diabetes mellitus have a high percentage of remission in the first 3-4 months of treatment when given which insulin?Glargine insulin (GLARGINE the great loves his pet kitty, even 3-4months after hes had her)
Describe insulin’s effects on carbohydrate metabolismIncreased glucose uptake→ increase GLUT 4, glycogen synthesis, increased glycolysis, decreased gluconeogenesis
Describe insulin’s effects on fat metabolismIncreased uptake/storage, increased lipogenesis, decreased lipolysis (why are diabetic people usually fat? bc less lipolysis with more uptake, storage, and production of it)
Describe insulin’s effect on protein metabolismIncreases AA uptake, increased protein synthesis, decreased protein degradation, decreases gluconeogenesis
What receptor is associated with glucose uptake in fat cells?Tyrosine kinase (TYROne was KINd but had a lot of sugar (GLUCOSE) and got FAT)
How does insulin affect potassium in the body?Insulin activates sodium-potassium ATPase activity→ increased 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 and Cow both start with C---also ONE difference!)
Cattle, sheep, horses, and dogs insulin differ in how many AA?3 AA
How is insulin measured?In units, one unit of insulin is equal to the amount required to reduce 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 and increases duration of action
Route of admin, time until onset, time until max or peak effect and duration of action of....FAST ACTING INSULIN (what is this one called?)Recombinant human insulin--> IV- 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 and duration of action of....Isophane insulin (NPH insulin) (what range does this insulin fall under?)(INTERMEDIATE ACTING)--> It is SC route only, For Dog- onset 0.5-2hrs, peak effect 2-10 hrs, duration 6-18hrs. For Cat- onset 0.5-2hrs, peak effect 2-8 hrs, duration 4-12 hrs (Isophane, Intermediate. and IN the skIN.)
Route of admin, time until onset, time until max or peak effect and duration of action of....Porcine insulin zinc suspension (LENTE, Vetsulin) (what range does this insulin fall under? who is this for?)(INTERMEDIATE ACTING, for DOG (bc dogs and pigs are most similar) ) SC route (pigskin, lol), onset 0.5- 2hrs, peak effect 4hrs and 11 hrs, duration 14-24 hrs
Route of admin, time until onset, time until max or peak effect and duration of action of....Protamine Zinc Insulin (PZI vet) (what range does this fall under?)(LONG ACTING INSULIN) SC ROUTE For DOG: onset 1-4 hrs, peak effect 4-8 hrs, duration, 6-28hrs. For CAT: onset 1-4 hrs, peak effect 4-8 hrs, duration 6-24 hrs (slice the skin with the protein-zinc sword. For dogs this will take longer because they have more tight skin)
Route of admin, time until onset, time until max or peak effect and duration of action of....Insulin Glargine (Lantus) (What range does this fall under?)(LONG ACTING INSULIN)-- IM and IV- rapid release similar to regular insulin. SC- slow release, constant conc/time profile over 24 hrs with 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 two peaks facing upward)
List 2 long acting insulins(1) Protamine Zinc insulin (PZI vet) (2) Insulin Glargine (Lantus) (GLARGINE the great with his protein-and-zinc sword will last long in the battle)
PZI is what percentage beef insulin and pork insulin?90% beef, 10% pork (although it starts with 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, leeking into your mind one precipitate at a time)
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 and 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 patient what is the range of blood glucose that is ideal? (max and min)Maximum and minimum- 100-250 mg/dl
Somogyi effect is caused 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, Weakness, Hunger, Tachycardia, “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 form beta cells by inhibiting ATP-dependent potassium channels. Examples include Glipizide/Glucotrol, Glimepiride/Amaryl. ORAL administration. (eating sulfur will make your insulin go crazy and your body will GLUGLIP and GLIAM all over)
Would it be effective to give a type 1 diabetic patient a sulfonylurea drug? So would a sulfonylurea drug be effective in the majority of diabetic dogs?No, because pt cannot produce insulin(the drug's MOA is to stim insulin release from B-cells), and no, because majority of dogs have type 1 (Betas 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, long term success rate is 15% (become 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)
Metfromin a human drug used to treat diabetes mellitus is unlikely to cause hypoglycemia because of its mode of action. How does Metformin work? What doesn’t it stimulate?Decreased GI absorption of glucose, decreases hepatic glucose output, increases glucose transport into skeletal muscles, stimulates glucose utilization. IT DOESNT stim beta cells! (it's metFROM anything but the pancrease! go fig!)
What type of drug is acarbose? How does it work? Why is it unpopular as a human drug?acarbose is a Alpha-glucosidase inhibitor. It works by competitively inhibiting small intestine enzymes used to break down carbohydrates, decreases absorption of carbohydrates from intestinal tract. It is unpopular in human med because of its GI side effects: flatulence, bloating, diarrhea (CARBS BLOAT up your SIDES(alpha glucoSIDase) and people think you're nasty (fart, diarrhea), so take some A-CARB (a meaning without) so you don't break it down and absorb it)
Where are incretins secreted from? What stimulates their secretionSecreted by GIT, Stimulated by ingestion of food (INcreatins IN skIN from INgesting)
What are 2 major incretins? (briefly, what do they do?)(1) GLP-1 (Stimulates insulin release and decreases glucagon production) (2) GIP (Stimulates insulin release) (INcretins INcrease INsulin secretion)
GLP-1 has how many actions?2 (Stimulates insulin release, Decrease glucagon production) (GREAT LOWER PROSTATE wants to be INSULated and doesn't want you to GLUE it around)
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 inc insulin secretion)
What are the 3 actions of Pramlintidine in humans?Slows gastric emptying, prevents rise in glucagon after meal, satiety (I would go to the PRAM, but my stomach is too full (slows the emptying) and I'm not hungry, and I don't have any glucagon, so I'm missing out on the dinner part!)

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