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Flashcards in Anti-Diabetes Deck (52):
1

Insulin of choice in emergent sitautions

IV regular insulin

2

Low risk of hypoglycemia insulins VRS High risk of hypoglycemia insulins. Name please

rapid acting (lispro, aspart, glulisine) and long acting (glargine, detremir) = low risk VRS higher risk: short acting (regular insulin) and intermediate (NPH)

3

drugs that can interefere with diabetic meds and make them more prone to hyPOglycemia

beta blockers - stop effects of catecholamines
EtOH - prevents gluconeogenesis
Salicylates - increases insulin secretion and acts a wee bit like insulin @ periphery

4

drugs that can interfere wtih diabetic meds and make pts more prone to hyPERglycemia

epinephrine, corticosteroids, atypical antipsychotics, HIV protease inhibitors = make tissue less responsive

phenyoin, clonidine, calcium channel blockers = decreased insulin secretion

diuretics = deplete K (alters ability of K to play roel in exocytosis of insulin in response to sugra SUR/KIR channel)

5

first gen sulfonylureas please

tobutamide - short duration of action
chlorporpamide - longer duration of action

6

a/se of chlorporpamide

hyperglycemia @ elderly = dont give
hyperemic flush @ OH = dont drink
SIADH = dont pee

DONT GIVE OLD, DONT DRINK LOTS, DONT PEE MUCH

7

second gen sulfonylureas, now preferred bc better a/se profile = ?

glyburide - hyperglycemia @ 20-30%
glupizine - hyperglycemia @ least DOC***
glimepride - hyperglycemia @ 3-4%

8

anti-diabetic drugs that cause WEIGHT GAIN

1) sulfonlyureas - tolbutamide, chlorpropamide, glyburide, glipizine, glimepride
2) meglinitides - repaglinide, nateglinide

9

Please name the Meglitinides

Repaglinide
Nateglinide

10

Describe kinetics and use of the meglitinides

shorter duration of action and more rapid onset than sulfonylureas --> thefeore used for post pradial (omit if you skip a meal)

11

A/se of meglitinides

repaglinide and natiglinide: hypoglycemia and weight gain

12

MOA of meglitinides and sulfonylureas

bind to SUR of ATP-K sensitive --> causes less K+ out of cell --> depolarizes --> opens vg Ca++ channels --> depolarizes --> exocytosis of insulin and increased transcription of insulin --> hurrah

13

MOA of metformin key words please

no insulin increase (decreases insulin levels due to improved glycemic control)
stops gluconeogen @ liver
increases insulin effects @ muscle and liver

14

Effects unique to metformin ***small group too , high yeild probly**

decreases TAG
does not cause weight gain

15

First line for DMii

metformin (because doesnt cause weight gain and decreases TAG)

16

When I say metformin, you think of this intracellular protein causeing all its effects

AMPK

17

A/se of metformin

a) gi messy time
b) B12 deficeincy - bc of gi messy time
c) lactic acidosis - bc liver cant use lactic acid for gluconeogenesis since metformin blocks it via AMPK

18

Dont use metformin for these 4 types of patients

liver dz
renal dz
OH-ics
hypoxic patients - resp dz

19

TZDs name them please

pioglitazide
rosiglitazone

20

MOA TZDs please

pioglitazide, rosiglitazone
a) decrease insulin resistance
b) agonists of PPARgamaa = alter gene expression and therefore take weeks to months to take effect

21

What does pioglitazone do better than rosiglitazone?

all good things
* decreased LDL particle concentration and size
* increase HDL
* decreased TAG

22

What blood tests MUST you order if pt is taking TZDs

liver function tests (also perform with alpha glucosidase inhibitors - acarbose)

23

SHARK STYLE: If you have a diabetic patient with liver problems, dont give these drugs if you can

metformin
TZDs
acarboseo - glucosidase inhibitor

24

SHARK STYLE: If you have a diabetic patient with a crapy lipid profile, these drugs will help

metform
TZDs (the glitta-zones)
insulin
coveleselam (decreases LDL but icnreases TAG)

25

SHARK STYLE: if someone drinks alcohol + DM

chronic - no metformin (contraindicated)
once in a while or chronic - no first gen sulfonylureas (tolbutamide, chlorporpramide)

26

MOA: exenatide

glucagon like polypeptide 1 - an incretin analoug = stimulates insulin secretion

27

the many effects of exenatide please.

enhances glucose dependent insulin secretion therefore suppresses postprandial glucagon release

slows gastric emptying therefore keeps more food suppresse appetite drive = decreases appeitie

may increase beta cell proliferation

28

a/se of exenatide

nausea, vomit, diarrhoe,
ACUTE PANCREATITIS
contraindicated in gastroparesis patients (but diabetes can cause gastropareisis :S) - bc causes gastric emptying slowing

29

how come exenatide doesnt get degraded

resistant to dipeptidyl peptidase IV

30

Sitagliptin MOA

DDP IV inhibitor --> increases levels of GLP-1 and insulin

31

a/se of sitagliptin

pancreatitis (just like exenatide - also GLP-1)
hypersensitivity reactions (urticaria, angioedema, anaphylaxis, Steven Johnson etc)

32

Pramlintide MOA

analogue of amyline (cosecreted from beta cells)
- decreased glucagon secretion
- inhibits food intake
- slows gastric emptying

33

Colesevelam

bile acid sequestrant used to lower LDL via MOA unknown

34

SHARK STYLE: what drug to not give people with III or IV CHF?

TZDs - glitter-zones

35

SHARK STYLE: which antidiabetic drugs do NOT cause weight gain

metformin
alpha-glucosidase inhibitiors
sitagliptine

36

SHARK STYLE: which antidiabetic drug causes weight loss?

exenatide**

37

SHARK STYLE: list dugs you shouldnt give if someone has issues with the following organ systems: a) heart/cvs b) pancreas c) Renal d) liver e) hyperesensivitiies f) gastroparesis

a) heart/chf - no TZDs
b) pancrease - no exenatide or sitagliptine
c) renal - no metformin
d) liver - no metformin, monitor TZDs and acarbose (alpha glucosidase inhibitors)
e) steven johnson - sitagliptine
f) exenatide - slows gastric emptying

38

Effective treatment for people with HbA1c < 9%

metformin alone as monotherapy may be effective

39

If monotheraphy doesnt work over three motnhs

metformin PLUS oral agent, exenatide or insulin

40

SHARK STYLE: Which anti-diabetics do not cause weight gain

metformin
alpha glucosidases
exenatide - decreases
sitaglitpine
plamlitidine

41

If dual theraphy doesnt work then what would be the most ''robust'' option be

insuline

42

~*~* What level of HbA1c would favour the transition to insulin?

> 8,5%

43

What is the most effective of diabetes medications to lower glycemia?

Insulin - has no ceiling

44

~~~When is insulin warranted as INITIAL THERAPY

DM II use insuline as initial therapy when:

@ significant hyperglycemic symptoms
@ ketonuria
@ HbA1c >10% (>8.5 for tri therapy addition)
@ random glucose > 300 mg/dl

45

~ If a diabetic has X treat with ? series

HYPERTENSION

ACEi and ARB

46

~If a diabetic has X treat with ? series

albuminuria

If a diabetic has X treat with ? series

47

~If a diabetic has X treat with ? series

distal symmetric polyneuropathy

ADGOPVV
Amytriptyline
Duloxetine
Gabapentin
Opioids
Pregablin
Valproate
Venlafexin

48

~If a diabetic has X treat with ? series

gastropareisis

CONTRAINDICATED - exenatide
metoclopramide
erythrmycin
ME

49

~If a diabetic has X treat with ? series

Erectile dysfunction

PDE5 inhibitor

50

~ DOC at pregos

regular insulin - short acting
IV (Emerg use of choice as well)

51

Glucagon uses times four please

1) severe hypoglycemia @ DM pts who o/d insulin
2) radiology of bowel b/c relaxes intestion
3) beta b poisoning - O/D antidote
4) glucagon C peptide test - to assess beta cell function

52

~ things i think will be super high yield and are bolded in notes
** things i think are high yield hurrah
SHARK - get these before you move on to next card.

15 qs on last years exam.