Anti-Diabetics

Question 1

Insulin

Answer 1

Rapid acting: LISPRO, ASPART; Short Acting: Regular; Intermediate acting: NPH, Isophane, Long acting: Detemir

Question 2

Oral Hypoglyemic agents

Answer 2

DPP4 inhibitors, sulfonylureas, glinides, biguanides, thiazolidinediones, alpha glucosidase inhibitors

Question 3

DPP4 inhibitors

Answer 3

alogliptin, saxagliptin

Question 4

Sulfonylureas

Answer 4

Glimepiride, glyburide, glipizide

Question 5

Glinides

Answer 5

repaglinide

Question 6

Biguanides

Answer 6

metformin

Question 7

Thiazolidinediones

Answer 7

pioglitazone, rosiglitazone

Question 8

Alpha glucosidase inhibitors

Answer 8

acarbose, miglitol

Question 9

Objective in treatment

Answer 9

maintain glycemia levels as close to normal as possible without complications (micro and macroangiopathy)

Question 10

Antidiabetic pharmacological treatment does not exclude

Answer 10

strict diet and control of physical effort

Question 11

Indications for insulin administration

Answer 11

Diabetes type 1, diabetes type 2 after more than 10 years with oral antidiabetic drugs/ glycemia levels too high, diabetes type 2 in case of infections, tuberculosis, acute myocardial infarction, stroke, diabetes 2 with contraindication to oral anti diabetic drugs, diabetes during pregnancy

Question 12

Insulin administration method

Answer 12

subcutaneously, 1-1,5 cm needles into abdomen (fastest absorption), thighs, or deltoid (slowest absorption), absorption rate must be taken into consideration before changing region

Question 13

Administration of different types of insulin

Answer 13

short acting: 30 minutes before meal, intermediate acting: 45 minutes before meal, long acting: 60 minutes before meal

Question 14

Each patient older than 12

Answer 14

should know how to self inject insulin

Question 15

Insulin administration should be

Answer 15

painless. Reason for pain could be intradermic administration (delayed absorption), traces of alcohol on skin or cold insulin. Insulin should be stored at 5 degrees in fridge and warmed up before administration. Intermediate and slow insulins should be agitated before administration.

Question 16

Side effects of insulin

Answer 16

Hypoglycemia (sweating, tachycardia, hunger, nervousness, confusion) corrected by fruit juice or other soluble carbohydrates, intramuscular glucagon in profiled syringe; local reactions like lipoatrophy rotating sites of injection, infection, local allergic reactions, blurred vision due to refraction areas at the beginning of treatment, with fluctuations of glycemia level, disappears in 2-3 weeks; insulin resistance, patient requires 100 IU/day, antigenic response, with excessive antibodies, patient receiving animal origin insulin.

Question 17

Drugs modify response to insulin

Answer 17

read

Question 18

Treatment with insulin can be

Answer 18

read

Question 19

Sulfonylureas

Answer 19

most widely used anti diabetic drugs, administered 15-20min before meal (during meal in digestive intolerance)

Question 20

Side effects of sulfonylureas

Answer 20

hypoglycemia (more frequent in elderly/liver/renal diseases), digestive problems (diarrhea, anorexia, nausea, vomiting, abdominal pain), pruritus and maculopapular rash

Question 21

Hypoglycemic effect of sulfonylureas

Answer 21

read

Question 22

Administration of sulfonylurea should be avoided during

Answer 22

pregnancy, because of risk of inducing malformations

Question 23

When efficiency of treatment of sulfonylurea decreases

Answer 23

they are associated with other oral anti diabetic drugs, if still no satisfactory response, patient will take insulin.

Question 24

Biguanides are administered in patients with

Answer 24

type 2 diabetes and obesity 3 doses per day before meal. May reduce excessive weight and plasmatic concentration of triglycerides and VLDL

Question 25

Side effects of biguanides

Answer 25

digestive intolerance (diarrhea, intense anorexia, metallic taste, nausea and vomitting), decreased absorption of B12 and folic acid, lactic acidosis occurs rarely (dangerous, favored by high doses of biguanides)

Question 26

Alpha glucosidase inhibitors are administered

Answer 26

as adjuvant therapy, to decrease digestive glucose absorption

Question 27

Thiazolidinediones are administered as

Answer 27

monotherapy, or in association with biguanides, no longer considered as first line treatment because of side effects: stroke, myocardial infarction, bone fractures, edema, anemia, risk of urinary bladder cancer (after pioglitazone)