Antidiabetic Agents

Question 0

Incretin mimetics

Answer 0

Drugs name is Byetta
Mimics class of hormones which normally enhance glucose-driven insulin secretion
Suppress excessive glucagon secretion and delays gastric emptying
Used to treat Type 2 diabetes

Question 1

Amylin mimetics

Answer 1

Drug name pramlinitide
Mimics a natural hormone secreted by the beta cells
Slows gastric emptying
Suppressed glucagon secretion and hepatic glucose production
Increased satiety
Injectable
Can be used for Type 1 and 2 diabetex

Question 2

Alpha-Glucosidase Inhibitors

Answer 2

Action: delays digestion of carbohydrates by blocking action of enzymes in the intestins
Ex: Precose-acarbose, Glyset-migitol
Adverse effects to: GI, Liver

Question 3

What are the advantages and disadvantages of alpha-Glucosidase Inhibitors?

Answer 3

Advantages: Non-systemic, few contraindications, no weight gain, no hypoglycesmia, prevents diabetes

Disadvantages: moderate reduction in A1C, pre-meal dosing, GI symptoms

Question 4

Thiaizolidinediones (TZD)

Answer 4

Action: decrease insulin requirements by acting at receptor sites and also inhibiting hepatic gluconeogenesis. Usually given to people who haven’t responded well to other antidiabetic drugs
Ex: Actos-pioglitazone
Significant interactions: oral contraceptives
Adverse effects: hypoglycemia (rare) usually only when in combination with other oral hypoglycemics, weight gain, edema

Question 5

What are the advantages and disadvantages of TZD’s?

Answer 5

Advantages: preserves beta cells, decreases insulin resistance, minimal hypoglycemia, can be combined with other oral hypoglycemics

Disadvantages: heart and liver damage, slow effect, expensive, peripheral edema, weight gain

Question 6

Meglitinides “GLINIDES”

Answer 6

Action: stimulates insulin secretion (similar to SFU, but more rapid onset, short duration of action to lower post-prandial glucose levels
Adverse effects: hypoglycemia, but less than with the SFU, give prior to meal
Ex: Prandin-repaglinide, Starlix-nateglinide

Question 7

What are the advantages and disadvantages of Glinides?

Answer 7

Advantages: well tolerated, less hypoglycemic than SFU

Disadvantages: expensive, three times a day, weight gain

Question 8

Sulfonylureas (SFU)

Answer 8

Action: increases insulin secretion
Adverse effects: hypoglycemia, weight gain
Ex: Diabeta-glyburide, Glucotrol-glipizide, Amaryl-glimepiride

Question 9

What drug group has been the cornerstone of managing Type 2 diabetes?

Answer 9

SFU

Question 10

What are the advantages and disadvantages of Sulfonylureas?

Answer 10

Advantages: once daily dosing, immediate beneifits, well-tolerated, inexpensive

Disadvantages: hypoglycemia, weight gain, caution in patients with hepatic and renal dysfunction

Question 11

Oral hypoglycemics are used to treat?

Answer 11

Type 2 diabetes

Question 12

Insulin is always required for which type of diabetes?

Answer 12

Type 1 diabetes

Question 13

What do oral anti-diabetic agents effect?

Answer 13

Stimulate insulin secretion
Decrease production of glucose
Decrease insulin resistance
Have multiple side effects and interactions with other drugs

Question 14

What is the action of Biguanides?

Answer 14

Decreased hepatic glucose production
Decreased glucose absorption
Increases glucose uptake into skeletal muscle
Decreases triglyceride concentrations, LDL cholesterol, total cholesterol, body weight and increases HDL cholesterol

Question 15

What is an example of biguanides?

Answer 15

Glucophage-Metformin

Question 16

What are the adverse effects of biguanides?

Answer 16

GI disturbances, lactic acidosis

Use with caution in elderly and those with CHF or renal failure

Question 17

What are the advantages and disadvantages of Biguanides?

Answer 17

Advantages: no weight gain, good lipid effects, no hypoglycemia, long record of safety,decreased microvascular complications, prevents diabetes

Disadvantages: multiple contraindications, creatinine > 1.5 mg/dl, CHF, GI side effects

Question 18

What should be considered when choosing an antihyperglycemic agent?

Answer 18

Glucose lowering effect
Effect on diabetes complications
Effect on cardiovascular disease risk factors
Contraindications 
Adverse effects
Cost

Question 19

What different types of insulin are there?

Answer 19

Rapid acting - aspart, lispro
Short acting - regular
Intermediate acting - NHP
Long acting - glargine (Lantus)
Combinations

Question 20

Which types of insulin can be given through IV?

Answer 20

Regular, aspart, lispro

Question 21

What is used to measure the amount of insulin?

Answer 21

Units - U-100 or U-500

Very concentrated!

Question 22

Rapid acting insulin

Answer 22

Lispro, aspart, glulisine
Onset of action: 5 to 10 min
Peak: 1 to 2 hr
Duration of action: 3 to 5 hr

Question 23

Short acting insulin

Answer 23

Regular
Onset of action: 30-60 min
Peak: 2-3 hr
Duration of action: 6-10 hr

Question 24

Intermediate acting insulin

Answer 24

NHP Onset of action: 1-2 hr Peak: 4-8 hr Duration of action: 10-18 hr

Question 25

Long-acting insulin

Answer 25

Glargine, detemir Onset of action: none Peak: flat Duration of action: 22 hrs (+ or - 4 hr)

Question 26

What is a fixed combination? And the combinations are?

Answer 26

Contains one intermediate acting and one rapid acting insulin 70/30; 50/50; 75/25

Question 27

Fixed combination

Answer 27

Onset of action: 1-2 hr Peak: unknown Duration of action: up to 24 hr