Antidiabetics

Question 1

Types of insulin

Answer 1

Human, Porcine, Bovine

Question 2

Examples of Insulin

Answer 2

Neutral Protamine Hagedorn (NPH)
Regular
Lente
Ultralent

Question 3

Common mixture of insulin

Answer 3

70% NPH + 30% Regular

Question 4

Ultra-short acting insulin analogues

Answer 4

Aspart and Glulisine- 3-5

Lispro-2-5

Question 5

Short Acting

Answer 5

Regular (soluble crystalline)-5-8

Question 6

Intermediate

Answer 6

NPH (isophane)-18-24

Question 7

Long acting

Answer 7

Detemir-20-22

Glargine-18-24

Question 8

Ultra long acting

Answer 8

Degludec

>40

Question 9

Administration of most insulin analouges

Answer 9

SUBCUTANEOUS

Question 10

Analogs that increase in duration when dose is increased

Answer 10

NPH, Regular

Question 11

Amino acid PROLINE at position 28 is replaced by Aspartic Acid

Answer 11

Aspart

Question 12

Proline at B 28 interchanged with Lysine at B 29

Answer 12

Lispro

Question 13

Glutamine for Proline

Answer 13

Glulisine

Question 14

Quickly dissociates into monomers therefore faster absorption. Also the shortest acting of them all

Answer 14

Lispro

Question 15

Difference long acting in terms of dissociation

Answer 15

It is bound together in the solution that’s why it is slowly dissociating

Question 16

Instantl converted to monomers if given IV, short acting

Answer 16

Regular

Question 17

Added to Regular insulin to improve stability and shelf life

Answer 17

Zinc

Question 18

Delayed action so that insulin and protamine in an uncomplexed form

Answer 18

NPH

Question 19

Long acting insulin are also called

Answer 19

Peakless- broad plasma concentration plateau

Question 20

Responsible for controlling fasting blood sugar

Answer 20

Long acting

Question 21

Responsible for controlling postprandial blood sugar

Answer 21

Short acting

Question 22

Given a px whose on Glargine (taken before bedtime) and Lispro (taken before breakfast, lunch and dinner) who is complaining of palpitation, tremors and hunger pangs before lunch time. What is your management?

Answer 22

Reduce Lispro before breakfast

Question 23

Common multi dose insulin regimen

Answer 23

1. Short acting before meals and long acting at nighttime
2. Short acting or regular and NPH before breakfast and supper
3. Insulin in bolus

Question 24

Insulin ADR

Answer 24

Hypoglycemia
Lipodystrophy
Allergy
Insulin Resistance
Weight gain

Question 25

Normal RBS

Answer 25

140mg/dL

Question 26

Insulin secretagogues

Answer 26

Sulfonylureas

Question 27

Glibenclamide

Answer 27

2nd Generation Sulfonylurea * 1st Gen- amides * 2nd gen- ides

Question 28

Secretagogues MOA

Answer 28

Closing of ATP-dependent K channel, thereby depolarizing the membrane to increase insulin release

Question 29

Secretagogue with longest duration of action

Answer 29

Chlorpropamide (60 hrs)

Question 30

2nd generation secretagogues DOA

Answer 30

10-24

Question 31

Chlorpropamide ADR

Answer 31

Hypoglycemia Hyponatremia (SIADH) Disulfiram-like rxns

Question 32

Meglitinides (Repa-, Nate-)

Answer 32

Less Hypoglycemic effects | WEIGHT GAIN

Question 33

Biguanide

Answer 33

Metformin

Question 34

Metformin does not cause hypoglycemia

Answer 34

Euglycemic

Question 35

Metformin effects

Answer 35

Dec gluconeogenesis | Inc glucose uptake

Question 36

Metformin MOA

Answer 36

Activates AMP PK for insulin signaling

Question 37

First line drug for DM type 2

Answer 37

Metformin

Question 38

Other indications of metformin

Answer 38

PCOS

Question 39

Metformin ADR

Answer 39

GI disturbances B12 Deficiency Lactic acidosis CI: RENAL INSUFFICIENCY

Question 40

Oral agent that causes EDEMA and WEIGHT GAIN a. Pioglitazone b. Repaglinide c. Insulin

Answer 40

Pioglitazone * Repaglinide- weight gain only * Insulin- causes both but not oral

Question 41

Pioglitazone MOA

Answer 41

Increase peripheral glucose uptake | PPAR gamma agonists

Question 42

LDL effects of TZDs

Answer 42

Pioglitazone- Dec | Rosiglitazone- Inc

Question 43

TZDs ADR

Answer 43

Hepatotoxicity (Troglitazone) WEight gain and Edema MI risk (Rosi)

Question 44

Acarbose MOA

Answer 44

Delay CHO absorption by inhibiting glucosidase actions

Question 45

Acarbose is an

Answer 45

Alpha-glucosidase Inhibitor does not cause Weight Gain

Question 46

Acarbose ADR

Answer 46

Flatulence

Question 47

Incretins

Answer 47

Intestinal Secretion of Insulin

Question 48

Secretes incretin

Answer 48

L cells

Question 49

Incretin effect

Answer 49

Glucose-dependent- more potent release of insulin on ingested food than IV glucose

Question 50

Disease where incretin effect is greatly reduced or absent

Answer 50

DM 2

Question 51

First FDA approved Incretin mimetic

Answer 51

Exenatide

Question 52

Exenatide MOA

Answer 52

GLP-1 agonist

Question 53

Disadvantages of Exenatide

Answer 53

Injected GI disturbances Pancreatitis

Question 54

advantages of Exenatide

Answer 54

``` lack of hypoglycemia Weight Loss (Laklak na ng Exenatide) ```

Question 55

Why is GLP-1 limited thus requires continuous admnistration?

Answer 55

Rapid degradation by the ubiquitous enzyme dipeptidyl eptidase-IV (DPP IV)

Question 56

DPP-IV inhibitors

Answer 56

-gliptins

Question 57

gliptins

Answer 57

Oral | Euglycemic

Question 58

Daily GFR of 180L/day, how much glucose is reabsorbed?

Answer 58

162g

Question 59

N: plasma blood glucose concentration

Answer 59

5.6 mmol/L

Question 60

SGLT 1

Answer 60

10% | Straight (S3)

Question 61

SGLT 2

Answer 61

90% | Convoluted (S1)

Question 62

SGLT 2 inhibitors

Answer 62

inhibits renal reabsorption of glucose. Favors glucose excretion

Question 63

Advantages of SGLT 2 inhitors

Answer 63

May lower blood pressure

Question 64

Amylin analog

Answer 64

Pramlintide

Question 65

Pramlintide MOA

Answer 65

mimics amylin (secreted with insulin by B cells) and suppresses glucagon secretion, dec HGO and dec insulin demand

Question 66

Glucagon other uses

Answer 66

Treatment of Beta blocker poisoning due to its chronotropic and inotropic effects

Question 67

Hypoglycemia with reaction of two drugs

Answer 67

Glibenclamide and Repaglinide

Question 68

Optimum treatment to a patient with elevated BS and will not result to weight gain

Answer 68

METFORMIN AND DAPAGLIPLOZIN