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GIR Test 3 > B5-003 Diabetes Mellitus Drugs > Flashcards

B5-003 Diabetes Mellitus Drugs Flashcards

1
Q

bind receptors to:
* increase glucose storage as glycogen in liver
* increase glycogen and protein synthesis in muscle
* increase TG storage in fat
* increase K+ uptake at the cell membrane

what drug class

A

insulin preparations

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2
Q

rapid acting insulin preparations

A

Lispro
Aspart
Glulisine

no LAG

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3
Q

intermediate acting insulin preparation

A

NPH

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4
Q

long acting insulin preparations

A

determir
glargine

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5
Q

very long acting insulin preparation

A

degludec

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6
Q

adverse effects of insulin preparations

4

A
  • hypoglycemia
  • lipodystrophy
  • hypersensitivity rxn
  • weight gain
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7
Q

inhibits mGPD causing the inhibition of hepatic gluconeogenesis and the action of glucagon

A

metformin

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8
Q

increases glycolysis, peripheral glucose uptake, and insulin sensitivity

A

metformin

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9
Q

adverse effects of metformin

A
  • GI upset
  • lactic acidosis (caution with renal insufficiency)
  • B12 deficiency
  • weight loss
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10
Q
  • activates PPAR-y to increase insulin sensitivity and levels of adiponectin
  • leads to regulation of glucose metabolism and FA storage
A

pioglitazone

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11
Q

adverse effects of pioglitazone

A
  • weight gain
  • edema
  • HF
  • increased risk of fractures
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12
Q

pioglitazone has a delayed onset of action of […]

duration

A

several weeks

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13
Q

what 2 drugs work to increase insulin sensitivity

A

pioglitazone
metformin

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14
Q

what drugs work to increase insulin secretion?

2 groups

A

sulfonylureas
meglitinides

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15
Q

close K+ channels in pancreatic B cell membrane causing the cell to depolarize and increasing insulin release via the Ca+ influx

A

sulfonylureas
meglitinides

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16
Q

1 gen sulfonylureas

2

A

chlorpropamide
tobutamide

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17
Q

2nd gen sulfonylureas

2

A

glipizide
glyburide

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18
Q

meglitinides

2

A

nateglinide
repaglinide

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19
Q

adverse effect of 1st gen sulfonylureas

A

disulfram-like reaction

rarely used

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20
Q

adverse effects of 2nd gen sulfonylureas and meglitinides

A
  • hypoglycemia (greater in renal insufficiency)
  • weight gain
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21
Q

what drug classes work to increase glucose-induced insulin secretion?

A

GLP-1 analogs
DPP-4 inhibitors

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22
Q
  • decrease glucagon release
  • delay gastric emptying
  • increase glucose-dependent insulin release
  • decrease appetite
A

GLP-1 analogs

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23
Q

adverse effects of GLP-1 analogs

A
  • nausea/vomiting
  • pancreatitis
  • weight loss
  • increased satiety
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24
Q

GLP-1 analogs

3

A

exenatide
liraglutide
semaglutide

-glutide

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25
Q

DPP-4 inhibitors

3

A

linagliptin
saxagliptin
sitagliptin

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26
Q

inhibit enzyme that deactivates GLP-1, giving similar effects as GLP-1 analogs

A

DPP-4 inhibitors

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27
Q

adverse effects of DDP-4 inhibitors

A
  • RTIs and UTIs
  • pancreatitis
  • weight neutral
  • increased satiety
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28
Q

what drug classes work to decrease glucose absorption?

2

A

SGLT2 inhibitors
a-glucosidase inhibitors

29
Q

-flozins

A

SGLT2 inhibitors

30
Q

-gliptin

A

DDP-4 inhibitors

31
Q

-glinide

A

meglitinides

32
Q

block reabsorption of glucose in proximal convoluted tubule

A

SGLT2 inhibitors

33
Q

adverse effects of SGLT2 inhibitors

A
  • glucosuria (UTI, GU infection)
  • dehydration –> hypotension
  • weight loss
  • caution with renal insufficiency
34
Q

a-glucosidase inhibitors

2

A

acarbose
miglitol

35
Q
  • inhibit intestinal brush-border enzymes causing delayed carbohydrate hydrolysis and glucose absorption
  • decreases postprandial hyperglycemia
A

a-glucosidase inhibitors

36
Q

adverse effects of a-glucosidase inhibitors

A

GI upset- flatulence, bloating, etc

37
Q

pramlintide is a

A

amylin analog

Pramlintide

38
Q

decreases glucagon release and delays gastric empyting
promotes satiety

A

pramlintide

39
Q

adverse effects of pramlintide

A
  • hypoglycemia
  • nausea
  • increased satiety
40
Q

which medications are not recommended in renal insufficiency?

4

A
  • a-glucosidase inhibitors
  • SGLT2 inhibitors
  • meglitinides, sulfonylureas
  • metformin
41
Q

goal
fasting glucose:
2 hr post prandial:
HbA1C:

A

fasting glucose: 90-120
2 hr post prandial: below 150
HbA1C: 7

42
Q
  • takes a couple hours to reach peak
  • effective for about 6 hrs

which type of insulin

A

short (regular)

43
Q
  • onset within 30-45 min
  • shorter duration of action

which type of insulin

A

rapid acting

no LAG

44
Q
  • slower onset
  • duration of about 12 hrs

which type of insulin

A

intermediate NPH

45
Q

very long half lives to stabilize insulin long term

which type of insulin

A

long acting

46
Q

treatment of DKA

A

IV insulin (0.1) + glucose to prevent hypoglycemia

fluids and electrolytes

47
Q

bind to SUR1 to close the K/ATP channel

A

sulfonylureas
meglitinides

48
Q

bind to SUR1 with higher affinity so less dose required

A

sulfonylureas Gen 2

49
Q

contraindications of sulfonylureas

A
  • DM1
  • pregnancy/breastfeeding
  • significant hepatic/renal insufficiency
50
Q

really cheap DM2 option

A

sulfonylureas

51
Q

-glinide

A

meglitide

52
Q

first line therapy for DM2

A

metformin

53
Q

-glitazone

A

thiazolidinediones

54
Q

PPARy agonists with PPARa agonist activity

A

thiazolidinediones

55
Q

removed from market due to hepatotoxicity

A

troglitazone

56
Q
  • promote transport of serum lipids to adipose
  • promote insulin sensitivity
A

thiazolidinediones

57
Q

adverse effects of thiazolidinediones

A
  • weight gain
  • hepatotoxicity
  • CHF
58
Q

incretins (GLP and GIP) are released from L cells in the

A

ileum

59
Q

-glutide

A

GLP-1 analog

60
Q

GIP analog that activates both GLP-1 and GIP receptors

A

tirezepatide

mounjaro

61
Q

principles of combination therapy

A
  • different MOA
  • target different proteins

advantages: lower doses, fewer adverse effects

62
Q

options for DM 2 monotherapy

4

A
  • metformin
  • GLP-1
  • SGLT2
  • DDP-4

add others as needed to get target A1C, add insulin last if needed

63
Q

second choice agents in DM2 therapy

2

A

sulfonylureas
TZDs

64
Q

metformin requires […] daily dosing

A

twice

65
Q

sulfonylureas and DDP4i offer […] daily dosing

A

once

66
Q

what drug classes are contraindicated in patients with a hx of pancreatitis?

A

GLP-1 and DPP-4i

67
Q

inhibits GI glycosidases leading to an increas in the accumulation of complex sugars in the GI tract

A

a-glucosidase i

68
Q

cause flatulence and diarrhea

A

a-glucosidase inhibi.

69
Q

has a sulfonamide structure and is contraindicated in patients with sulfa allergies

A

glyburide

GIR Test 3 (16 decks)

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