Test 2 - L11/12 Diabetics

Question 1

Rapid Insulin: Compare/contrast to endogenous Insulin
and Regular insulin

(do not need to know specifics just know RAPID)

Answer 1

• Rapid insulin readily form monomers in solution V.S Regular Insulin although still classified as a Rapid therapy needs more time to break down into monomers from its hexameric state

-given preprandial/ prior to meal to mimic insulin stimulation via nutrient intake

Question 2

What is the route of admin for DPP4 inhibitors
A) slow IV infusion
B) syringe
C) Butt chug
D) oral

Answer 2

D) oral

Question 3

The 2 drugs which were used by celebrities for weight loss (not lizzo tho)

Answer 3

Semaglutide was the main one
tirzepatide also mentioned

Question 4

A) which of the 3 DPP4 inhib drugs are eliminated through biliary excretion
B) why is this beneficial for diabetic patients

Answer 4

A) Linagliptin eliminated via biliary secretion,

B) Beneficial in diabetic patients since it’s not being eliminated in kidneys. So no dose adjustment is required

(remember that CKD is common in diabetic patients)

Question 5

Regular Insulin (Intravenous Injection)

Compare/contrast to endogenous Insulin:
- Rate
- Mech

Answer 5

• Regular Insulin is slower than endogenous Insulin but is still considered RAPID
• Delay is caused by Regular insulin forming NON-COVALENT HEXAMERS in solution. (requires time to break into monomers; active form)

*Regular Insulin is only suitable for intravenous use and given preprandial/ prior to meal to mimic insulin stimulation via nutrient intake

Question 6

1) What was a severe side of DPP4 inhibitors

2) what was a possible side effect of DPP4 and GLP1 drugs but has not yet shown in human data

Answer 6

1) Increased risk of pancreatitis (severe)

2) Pancreatic cancer seen in animals but not in humans so far

Question 7

Intermediate Insulin:
- Name
- Composition
- cause of time delay

*other concerns about absorption

Answer 7

• NPH Insulin :
• is a suspension of human sequence insulin aggregated with protamine and zinc
• protamine and Zinc are aggregates causing delayed activity

-Intermediate and Long acting insulin mimic 24hr basal insulin secretion

** NPH action is unpredictable bc of variable rate of absorption. You can also find drugs which come as a mix of regular and NPH insulin

Question 8

1) what is the usual 1st line treatment in T2DM IF the patient does not suffer from any renal deficiencies.

2) what happens if the person suffers from renal impairment and cannot eliminate the drug from their body
****
(This is Black box I forgot to mention on the main card)

Answer 8

1) Metformin

2) Metabolic acidosis

Question 9

Long Insulin (3)
- names
- Why does it take longer/ Administration
(2 act similar, 1 has its own mechanism)
- purpose

Answer 9

Insulin: Glargine, Detemir, Degludec

A) Glargine soluble at pH 4 but poorly soluble at pH7
making it take longer to solubilize staying in system longer.When injected SUBCUTANEOUSLY forms fine precipitant in interstitial fluid.

B) Both Detemir and Degludec are insulin administrations prolonged by binding to albumin in the blood. (normal insulin is never bound)

C) Intermediate and Long acting insulin mimic 24hr basal insulin secretion

Question 10

Metformin

A) class
B) mechanism
C) use
D) Sides/metabolism

Answer 10

A) Biguanide drug

B) Inhibits Gluconeogenesis in Liver
-* Unlike insulin does not cause Hypoglycemia or Weight Gain (Sulfonylureas/Insulin = fat)

C) **most common 1st LINE THERAPY for T2DM

D) Bc Metformin is 100% excreted by Kidneys as active compound it should be used with caution in patients with decrease GFR/CKD why?

** BC improper elimination of Metformin can lead to increased metabolic acidoses

** Since Metformin acts locally on liver it affects hepatic metabolism of lactic acid = accumulation
(do not confuse this with drug being metabolize by liver. it is not)

** GI side effects of nausea, diarrhea

Question 11

Aside from controlling/lowering blood glucose through stimulation of B cells and inhibiting gluconeogenesis what were the other 2 unique positive benefits (1 of is tech a side effect)

Answer 11

DRUG: GLP1-agonist
2) 1) benefit is that is cardio protective
2) Unique side is its effect on CNS for feeling of satiety

Question 12

Glyburide, Glimepiride, Glipizide

A) class
B) use/requirements
C) MECH

Answer 12

A) Sulfonylurea drugs; But also Insulin Secretagogues

B) Used in early T2DM If Metformin alone cannot control blood Glucose and require functioning B cells
(useless in T1D)

C) Blocks K+ channelse making inside of cell more positive leading to Ca+ Channel depolarization. Ca+ leads to B- Cell depolarization and INSULIN secretion

Question 13

These 2 drugs are both responsible for side effects of Nausea/ vomiting , Diarrhea and GI effects

Answer 13

Metformin and GLP-1 ( glp1 only nausea/vomit)

Question 14

Sulfonylureas:
Glizipide: 1/2 life; admin when
+ general side effects (including the other sulfur drugs)

Answer 14

Glizipide -Shortest half life and administered pre-prandial

Sulfonyl Side Effects:
- weight gain -> increased appetite **
- Hypoglycemia
- Sulfer allergy
- increased CV mortality **

Question 15

Repaglanide

A) class (alt drug)
B) mechanism
C) use
D) side

Answer 15

A) Alternative to Sulfonylurea drugs
(which also enhance B-cell insulin release; secretagogue)

B) They inhibit K ATP channels in B cells for insulin release via depolarization through ca+ mech

C) They can be used as an alternative T2DM drug in patients who may have Sulfer allergy

D) Hypoglycemia

Question 16

GLUTIDE/TIDE drugs (suffix)

A) class
B) mechanism
C) metabolism
D) sides

Answer 16

A) GLP1 Agonist (Liraglutide , Dulaglutide, Semaglutide (Ozempic), Exenatide
Tirzepatide (special one on separate card)

B) Has actions in 4 places:
1) CNS, -> reduced BW, producing satiety feeling (+ side effect)
2) muscle/fat, -> enhances insulin sensitivity
3) liver -> inhibits glujconeogeneis
4) Pancreatic B cell -> enhances Insulin synth, B cell Prolif, decreases B cell Apoptosis

C) Drugs given subcutaneously except for Rybelsus which is oral tablet
All drugs metabolized by DPP4

D) Nausea and vomit beginning of treatment

Question 17

Tirpezatide why it diff than other GLP1… lets get racist.. lets go to the beach

Answer 17

Tirpezatide is dif. from the other GLP1 Agonist bc it is a dual agonist working on GLP1 and GIP.
-“GIP released from K-cells in GI, same effect as GLP-1 on β-cells in pancreas
but additionally promotes fat storage and bone formation

Question 18

LIPTIN Drugs

A) class
B) mechanism/use
C) Admin and Metabolism **
D) Sides **

Answer 18

A) DPP4 inhibitors/ antagonist

B) Inhibit breakdown of GLP-1 so it stays in system longer but NOT AS EFFICIENT at reducing blood glucose as GLP-1 agonist is

C)*** Of DPP4 inhib. Linagliptin is only excreted primarily by biliary secretion and as a result doesn’t require dose adjustment for renal dysfunction or CKD

D) possible increase risk of pancreatitis however data was only seen in animal but not human data

Question 19

GLIFOZIN Drugs

A) Class
B) Mech
C) use/requirements to use
D) Sides ** (+1 & -1)/ pro/con

Answer 19

A) SGLT-2 inhibitors

B) Inhibit SGLT2 in proximal tub. reducing Gluc. reabsorption

C) Bc it acts on kidneys its efficacy is reduced in CKD patients. — Metabolism ->fecal elim

D) (pro) + side effect is reduced body weight as glucose is not being absorbed.
(con) increased risk of genital/ UTI bc bacteria munch on ur PP glucose

Question 20

SGLT-2 Side effects/warnings

what are the main 2 side effects and the drug which came with a black box warning

Answer 20

Side 1) increased risk of UTI and genital tract infections

(bc urinating glucose -> residual glucose on genitals -> bacteria eat)

Side 2) FOR insulin DEPENDENT T2DM
glucose remains normal while taking SGLT-2 inhibitors so insulin is withheld resulting in diabetic ketoacidosis

Black Box) Canaglifozin: increased risk of lower limb amputations due to infection

Question 21

How is circulating Insulin different in T2DM patients versus healthy individuals

Answer 21

T2DM have 10-20% total circulating insulin as proinsulin which still contains C peptide

Question 22

(1/4) T2DM Therapeutic approach: Education

Answer 22

• Educate them about diet, exercise smoking
• reducing body weight by 5-10% can reduce risk of T2DM by almost 60%

Question 23

(2/4) T2DM Therapeutic Approach: Medication

Answer 23

1) After changing lifestyle then Metformin can be introduced to lower blood glucose

2) Metformin + “others” - if greater reduction needed in blood glucose (Others = DPP4, GLP1 etc..)

3) If that doesn’t work: Metformin + “others” + Insulin

Adding insulin poses issue with weight gain cuz T2DM patients usually already fat

Question 24

(3/4) T2DM Therapeutic Approach: patients W/ atherosclerosis and CV disease

Answer 24

1) Use semaglutide; GLP1 Agonist

Promotes weight loss but also has protective heart functions

Question 25

(4/4) T2DM Therapeutic Approach: patients w/ MINOR Renal impairment or MINOR CKD

Answer 25

1) use SGLT2 inhib ; Glifozin drugs
(empagliflozin, canagliflozin, dapagliflozin)

2) SGLT2 inhibitors can reduce progression of CKD. If CKD is severe drugs don’t work for example a patient on DIALYSIS

3) You would use SGLT2 inhibitors in comb. with other drugs because it has lesser glycemic reducing effect
*NOT METFORMIN tho cuz it can make CKD worse/ requires healthy kidney function

Question 26

Pioglitazone

1) class
2) mech
3) use
4) side effects

Answer 26

1) class: Meglitinide drug

2) mech: increases expression of GLUT 1 & 4 in muscle, adipose and liver tissues

3) use: similar to metformin; effects on peripheral tissues to decrease blood glucose

4) side effects increase cardiac related health problems increase fluid retention - LIMITS USE OF DRUG
cardiac problem mentioned: angina pectoralis

Question 27

Insulin delivery:
- what is the most common route of administration
+ other routes
- cybersecurity issue

Answer 27

1) most common is injection via syringe
2) other routes:
Insulin pen (same shit)
Inhaling dry powder (Doing lines of that pow)

3) Remote insulin pump - people were hacking other peoples pumps LMAO