Test 4 Flashcards by Sydney R

What are the secretory products of Alpha A cells in the pancreatic islet mass

Glucagon proglucagon

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What percentage of the Islet of Langerhans mass is comprised of Beta B cells

75 percent

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What are the secretory products of Beta B cells

Insulin C-peptide proinsulin amylin

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What is the main function of amylin

Blocks glucagon secretion slows gastric emptying

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What is the stimulus for the release of insulin in the beta cell

Elevated blood glucose ATP production closes K channels depolarizes cell opens Ca channels Ca influx causes insulin release

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How does the polyol pathway lead to cell injury in chronic hyperglycemia

Glucose is converted to sorbitol which increases intracellular osmotic pressure attracting water leading to cell rupture

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What tissues are primarily affected by cell injury due to the polyol pathway

Eye lens nerves RBCs

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Type I diabetes is characterized by the loss of what function

Beta cell function autoimmune disorder causing absolute insulin deficiency

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List the three cardinal symptoms of diabetes The three Ps

Polydipsia polyuria polyphagia

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Which type of diabetes is non-insulin dependent and characterized by insulin insensitivity

Type II diabetes

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The insulin receptor is what type of receptor

Tyrosine kinase receptor

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What are the two major intracellular signaling pathways activated by insulin receptor binding

IP3 pathway and MAPK pathway

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The IP3 pathway drives the membrane translocation of which glucose transporter

GLUT-4 vesicles

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Which GLUT transporter is responsible for high affinity basal glucose uptake in RBCs and the brain

GLUT-1 and GLUT-3

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Which GLUT transporter is a low affinity transporter involved in glucose sensing in the liver and pancreatic beta cells

GLUT-2

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Name three examples of rapid acting insulin analogs

Lispro aspart glulisine

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Name two examples of long acting insulin analogs that mimic constitutive release

Glargine detemir

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What is the insulin calculation for carbohydrate coverage units RA insulin per gram of carbohydrate

1 unit of rapid acting insulin covers 12-15g of carbohydrate

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What is the insulin calculation for high glucose correction units RA insulin per glucose drop

1 unit of rapid acting insulin drops blood glucose by 50 mg/dL

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What is the first line pharmacologic therapy for Type 2 Diabetes Mellitus

Biguanides Metformin

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What is the MOA of Biguanides like Metformin

Reduces hepatic glucose production

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Which class of oral antidiabetic agents works by binding to the K channel causing depolarization and subsequent insulin release

Insulin Secretagogues Sulfonylureas or Meglitinides

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What is the major difference between 1st generation and 2nd generation Sulfonylureas

2nd generation drugs require lower doses milligrams and have longer action 10-24 hrs

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Which class of T2DM drugs decreases insulin resistance via PPAR mediation

Thiazolidinediones Tzds

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What is the black box warning associated with Thiazolidinediones like Rosiglitazone Avandia

Risk of MI especially when combined with insulin or nitrates

What is the MOA of a-glucosidase Inhibitors like Acarbose

Blocks enzymes that break down sucrose preventing monosaccharide absorption

GLP-1 Agonists and DPP-4 Antagonists are examples of what class of T2DM drugs

Incretin-based Therapies

What is the MOA of Gliflozins SGLT2 Inhibitors

Blocks glucose reabsorption in the Proximal Convoluted Tubule PCT resulting in glucosuria

Side effects of SGLT2 Inhibitors Gliflozins include glucosuria osmotic diuretic effects and what major complication for bedridden patients

UTIs

What is the target Hgb A1C level for Type 2 Diabetes treatment according to the algorithm

Less than 70 percent

Atherosclerosis is the leading cause of death in the US due to what process

Lipid deposits in coronary arteries leading to plaque formation and occlusion CAD

What cell type is created when macrophages engulf oxidized LDL cholesterol but fail to break it down

Foam cell

What is the storage form of cholesterol that is attached to a fatty acid

Esterified cholesterol

Cholesterol is a precursor to what four necessary biological compounds

Steroid hormones Cell membranes Vitamin D Bile salts

The rate-limiting enzyme in cholesterol synthesis that is targeted by statins is

HMG-CoA Reductase

Which lipoprotein is formed in the intestine from dietary fat and transports triglycerides and cholesterol

Chylomicrons

Which lipoprotein scavenges cholesterol from cells and is inversely associated with atherosclerosis risk

HDL

Desirable Total Cholesterol levels are less than

200 mg/dL

What is the primary mechanism of action MOA of Statins

Structural analogs of HMG-CoA inhibit HMG-CoA Reductase decrease cellular cholesterol synthesis and increase LDLR expression

What is the MAIN TOXICITY associated with Statins

Muscle pain may be severe

What is the MOA of Niacin Vitamin B3 in lowering lipid levels

Blocks transport of cholesterol to VLDL reducing VLDL secretion from the liver

What is the MAIN TOXICITY associated with Niacin dosing 2-6 g daily

Flushing

What is the MOA of Fibrates like Gemfibrozil Lopid

PPAR mediated lipolysis increase breakdown of lipids in the liver

Which hyperlipidemia drug class works by binding to bile acids to prevent their reabsorption in the gut

Binding Resins Cationic bile acid binding resins

Which drug inhibits intestinal sterol absorption by blocking the NPCL1 transporter

Ezetimibe

What is the MOA of PCSK9 Inhibitors Monoclonal Antibodies

Blocks the PCSK9 protein from binding to LDL receptors preventing LDLR degradation/lysosome destruction and allowing LDL receptor recycling to the cell surface

Combining Statins with PCSK9 Monoclonal Antibodies can lower LDL cholesterol by what percentage

65 percent

List a side effect of Intestinal Sterol Absorption Inhibitors Ezetimibe noted in the sources

Possible hepatic pending and PROMOTED arterial wall thickening

What are the key elements necessary for calculating daily insulin dose

Basal dose Bolus carbohydrate coverage and Correction dose

What is the risk associated with an LDL/HDL ratio of 6 for males

Twice average risk

What is the initial response to tissue injury mediated by autocoid groups

Acute inflammation

List three autocoid mediators of acute inflammation

Histamine Serotonin Bradykinin Prostaglandins Leukotrienes

The COX pathway metabolizes arachidonic acid AA into what end products

Prostaglandins Prostacyclin Thromboxane Prostanoids

The LOX pathway Lipoxygenases metabolizes arachidonic acid AA into what end products

HETEs Leukotrienes Lipoxins

All NSAIDs share what three general toxicity concerns

Gastric irritation Nephrotoxicity Hepatotoxicity

Differentiate COX-1 and COX-2 isoforms

COX-1 is constitutive housekeeping functions COX-2 is induced by inflammation

Inhibition of which COX isoform is considered undesirable due to its role in homeostatic functions like GI protection and platelet function

COX-1

What is the MOA of Aspirin on COX-1

Irreversible inhibition of COX-1 by acetylation of serine 529

How long does Aspirins antiplatelet effect last

8-10 days

Name a COX-2 selective inhibitor COXIB

Celecoxib Celebrex

What is the MOA for GI upset caused by all NSAIDs

Inhibition of GI protective prostaglandin synthesis

Which non-opioid analgesic is NOT considered an NSAID because it lacks anti-inflammatory properties

Acetaminophen

Acute effects of glucocorticoids include suppressing inflammation mobilizing energy stores improving cognitive function and what electrolyte effect

Salt and water retention

What is the MOA of Glucocorticoids in reducing inflammation

Induce transcription of anti-inflammatory proteins like Annexin-1 which suppresses Phospholipase A2

What drug class is targeted to joint disorders reduces inflammation Sed Rate CRP RF and is often given with NSAIDs

DMARDs Disease Modifying Anti-Rheumatic Drugs

What are the three endogenous opioid peptide families and their corresponding receptors

Endorphins mu Enkephalins delta Dynorphins kappa

What are the three afferent nerve fibers involved in sensation transmission

A-beta non-noxious A-delta sharp pain C-fiber slow burning pain

Which descending pathway structure in the midbrain has many mu opioid receptors and helps suppress pain signaling

Periaqueductal gray PAG

Opioids reduce pain neurotransmitter release and cause what effect on postsynaptic neurons

Hyperpolarize postsynaptic neurons

What is the opioid effect that is an objective clinical marker and occurs almost universally

Miosis pupil constriction

Opioids cause respiratory depression by affecting which brain structure

Brainstem

What common opioid is metabolized by Phase II conjugation to active forms like M3G and M6G

Morphine

Opioid toxicity is often an extension of therapeutic effects List three serious adverse effects

Respiratory depression Nausea and vomiting Increased intracranial pressure

Opioid tolerance develops rapidly through multiple mechanisms including receptor phosphorylation internalization and uncoupling with what protein

G-proteins

What two major opioid effects show minimal or no tolerance development

Miosis and Constipation

What is the opioid antagonist used to dramatically reverse opioid effects

Naloxone Narcan

Why might repeated doses of Naloxone be necessary

It has a short duration of action so the agonist effect may return

What strong agonist opioid is a Phenylheptylamine used for chronic pain and opioid abuse and has a long half-life of 25-50 hours

Methadone

What opioid a Phenylpiperidine is known for causing antimuscarinic effects tachycardia and seizures and is also used for post-op shivering

Meperidine Demerol

What common moderate agonist Phenanthrene is more effective when combined with acetaminophen Percocet or aspirin Percodan

Oxycodone

What is the main structural difference in the cell wall of Gram positive bacteria compared to Gram negative bacteria

Gram positive has a thick peptidoglycan layer Gram negative has a thin peptidoglycan layer between two membranes

List the five modes of action for antimicrobial agents The five ways antibiotics work

Inhibition of cell wall synthesis Disruption of cell membrane function Inhibition of protein synthesis Inhibition of nucleic acid synthesis Action as antimetabolites

Name three drugs that inhibit bacterial cell wall synthesis

Penicillin Bacitracin Cephalosporin Vancomycin Carbapenems

Beta-lactam antibiotics contain a Beta-lactam ring that targets enzymes involved in the crosslinking of what bacterial cell structure

Peptidoglycan

What enzyme produced by bacteria breaks open the beta-lactam ring leading to resistance

Beta-lactamase

What is often called the drug of last resort for MRSA that is resistant to beta-lactamase and can cause Red Neck syndrome

Vancomycin

What antibiotic mechanism is characterized by the widest spectrum of activity but can cause severe GI disorders and bone deposition disorder

Inhibition of Protein Synthesis Tetracyclines

What class of drugs is structurally similar to PABA and acts as an antimetabolite to inhibit bacterial folic acid synthesis

Sulfonamides

Fluoroquinolones like Ciprofloxacin inhibit nucleic acid synthesis by blocking what bacterial enzyme

DNA gyrase

What is the risk associated with premature termination of antibiotics

Relapse with highly resistant organisms

Viruses are considered obligate intracellular parasites because they cannot multiply unless they invade a specific host cell and instruct what cellular machinery

Host cells genetic and metabolic machinery

What is the key structural difference between Acyclovir and the natural substrate dGTP that causes DNA chain termination

Acyclovir is missing the 3 hydroxyl group

What is Acyclovirs primary use especially related to pregnancy

HSV1 HSV2 and VZV infections Reduces viral shedding and C-section rate when given in last trimester

Which influenza antiviral blocks neuraminidase and must be taken within 48 hours of symptom onset for early treatment

Oseltamivir phosphate Tamiflu

What is the MOA of the antiviral drug Remdesivir used for COVID-19

Chain terminator blocks viral RNA synthesis

The hallmark symptom of Parkinsonism is rhythmic movement around a joint occurring in what state

Tremor at rest

What acronym describes the core symptoms of Parkinsonism

TRAP Tremor Rigidity Akinesia Postural instability

Parkinsonism is characterized by the destruction of what type of neurons in the Nigro-striatal pathway

Dopaminergic neurons

Treatments for Huntington’s disease aim to decrease dopamine levels using drugs like Tetrabenazine and what antipsychotic agent

Haloperidol

What CNS muscle relaxant is released via an intrathecal pump to treat muscle hypertonia in Cerebral Palsy

Baclofen

Test 4 Flashcards

(100 cards)