Antidiabetic drugs

Question 1

An incretin inactivated by Dipeptidyl peptidase-4 (DPP-4). And example.

Answer 1

GLP-1

Sitagliptine

Question 2

Which Sulfonylurea produces mild duiresis and which has antidiuretic activity? Give other drug examples of 1st, 2nd and 3rd generations.

Answer 2

Glyburide; Chlorpropamide

1st: Tolbutamide, Chlor
2nd: Glyburide, Gliclazide
3rd: Glimepiride

Question 3

They are structurally similar to sulfonylureas but substituted by benzoic acid derivatives, no sulfa allergy.

Answer 3

Meglitinides (Nateglinide and Repaglinide)

Question 4

Acid or base

Metformin Meglitinides Rosiglitazone and Pioglitazone

Answer 4

Metformin = basic

Meglitinides, Rosiglitazone and Pioglitazone = acid

Question 5

Acarbose inihibits what receptor?

Answer 5

Alpha glucosidase (inhibitor)

Question 6

Thiazolidinediones (-glitazones) agonist of what receptor? And MOA.

Answer 6

Peroxisome-proliferator activated receptor-y. PPAR-y binds to DNA activating transcription (antihyperglycemic)

Question 7

Indicated when diet, exercise and these drugs alone result to insulin resistance.

Answer 7

Metformin + Rosiglitazone

Question 8

These drugs make kidneys filter glucose out of the blood then, decreases reabsorption and increases excretion of glucose.

Answer 8

Sodium glucose transport protein 2 (SGLT2) inhibitors: Canagliflazin (Invokana) -flozins

Question 9

Onset of action of Insulins

Very Short Rapid Intermediate

Answer 9

Very Short 5-10mins
Rapid 1/2-1h
Intermediate 2-4h

Question 10

Duration of action of Insulins

Very Short Rapid Intermediate Long acting

Answer 10

Very Short 2-3h
Rapid 5-7
Intermediate 14-18h
Long acting 24h

Question 11

Very Rapid acting insulin analogs: clear

Answer 11

Insulin aspart - NovoRapid
glulisine - Apidra
lispro - Humalog

Question 12

This insulin is an amorphous precipitate with Zn acetate buffer, and by mixing what two protions of insulin?

Answer 12

Insulin NPH (N) Isophane by mixing regular insulin and protamine.

Question 13

All insulins are clear except? And which can’t be administered IV?

Answer 13

Intermediate (NPH),

this and insulin glargine can’t be IV

Question 14

Example of Mixed insulins.

Answer 14

Insulin regular/NPH (Humulin 20/80, 30/70)

Insulin lispro/lispro protamine (Humalog Mix25)

Question 15

These are long acting insulins. Should not be mixed with other insulins, single daily dose.

Answer 15

Insulin glargine (Lantus) and Detemir (Levemir)

Question 16

Among the Sulfonylureas, which has the highest and least hypoglycemia?

Answer 16

Glyburide highest

Glimepiride least

Question 17

MOA of Acarbose and SEs. And usually used together with what antihyperglycemic drug class?

Answer 17

Decrease absorption of starch and sucrose (NOT GLUCOSE)
Bloating, flatulence and diarrhea
+ Sulfonylureas

Question 18

DI and CIs of Thiazolidinediones.

Answer 18

DI: Gemifribrozil (inc. repaglinide conc.)
CI: CHF pts, can be used by renally impaired pts
Inc risk of pregnancy and DON’T USE with insulin

Question 19

Thiazolidinediones SEs

Answer 19

has the most weight gain, fluid retention edema, anemia ~1% mild increased HDL

Question 20

Blood sugar levels is a person is diabetic.

Answer 20

Fasting BSL >7.1 mmol/L
Random >11
HbA1C >7%

Question 21

Drugs that increase glucose uptake.

Answer 21

Metformin, Thiazolidinediones and Acarbose

Question 22

Drugs that increase insulin secretion

Answer 22

Sulfonylureas 1st and 2nd generations, Meglitinides

Question 23

Drugs that should be taken with first bite

Answer 23

Meglitinides, Acarbose

Question 24

Drugs that are withdrawn due to heart failure SE

Answer 24

Thiazolidinediones

Question 25

Examples of rate limit of insulin may include:

Answer 25

Capillary passage Zinc crystalline insulin NOT Protein binding

Question 26

Insulin overdose or mild hypoglycemia symptoms

Answer 26

sweating and clamminess, chills, lightheadedness or dizziness, mild confusion, anxiety or nervousness, shakiness, rapid heartbeat (not HTN), hunger NOT DIARRHEA