diabetes

Question 1

metformin

Answer 1

• activates AMP-kinase
• tx: initial tx for T2DM (obese PTs)
• decreases hepatic glucose production, decreases intestinal glucose absorption, increases insulin sensitivity (can be used in PTs w/o islet function)
• • no weight gain, no hypoglycemia, low cost, reduction in cardiovascular events
• • lactic acidosis, GI distress
• **contraindications: reduced kidney function, CHF **(if you get lactic acidosis and have poor kidney function then it could be fatal)

Question 2

Glyburide, Glipizide, Gliclazide, Glimepiride

Answer 2

• Sulfonureas
• Tx: T2DM
• closes K ATP channels on beta cells–> depolarization –> insulin release (normally K efflux keeps cell hyperpolarized and insulin is only released when cell depolarizes) – require some islet fx
• SE: hypoglycemia** and weight gain (opp of metformin)
• contraindications: hepatic failure, renal failure

Question 3

Meglitinides

Answer 3

• Repaglinide, Nateglinide
• adjunctive use in T2DM - administer just before meals due to short t1/2
• closes K ATP channels on beta cell plasma membrane –> insulin secretion
• SE: hypoglycemia, weight gain
• ** -ide” = insulin secretagog –> don’t use with other -ide’s (ie: sulfonylureas)

Question 4

Pioglitazone

Answer 4

• Thiazolidinediones (glitazones)
• tx: T2DM
• activates nuclear TF PPAR-gamma
• increases peripheral insulin sensitivity
• weight gain and edema, hepatoxicity and HF
• also increases HDL and lowers TGs
• generics available
• ** Pig-litazone = pig = weight gain
• dont use in PTs with CHF due to edema

Question 5

Rosiglitazone

Answer 5

• Thiazolidinediones (glitazone)
• tx: T2DM
• activates nuclear TF PPAR-gamma –> increases peripheral insulin sensitivity
• no hypoglycemia but weight gain and edema
• increases LDL and high cost
• contraindicated in PTs with heart disease

Question 6

Acarbose and Miglitol

Answer 6

• intestinal alpha-glucosidase inhibitors –> slow intestinal carb digestion –> decreases post-prandial glucose
• • weight neutral, no hypoglycemia
• • GI SE (flatulance, diarrhea), need to take with every meal
• tx T2DM in older with ppl with constipation

Question 7

Exenatide and Liraglutide

Answer 7

• GLP-1 agonists (incretin mimetics)
• injectables T2DM
• augments glucose-dependent insulin secretion and glucagon suppression
• **weight loss **(increased satiety)
• • nausea, hypoglycemia, caute pancreatitis
• caution with renal insufficiency
• bottom line: weight loss but the most SE
• ** increase the “-tide”

Question 8

Sitagliptin, Vildagliptin, Saxagliptin, Linagliptin

Answer 8

• DPP-4 inhibitors (prevents metabolism of GLP-1)
• incretin enhancers
• tx: T2DM
• • no hypoglycemia, weight neutral, well tolerated
• expensive

Question 9

Canagliflozin

Answer 9

• SGLT2 (soduium glucose cotransporter 2) inhibitor
• reduces glucose resorption in kidney –> increased urinary glucose excretion
• • no hypoglycemia, weight loss possible (lose glucose in urine)
• • volume depletion and hyperkalemia (osmotic diuresis); genital mycotic infections, UTIs, expensive

Question 10

Colesevelam

Answer 10

• bile acid sequestrant
• unknown action
• • no hypoglycemia, lowers LDL
• • constipation, increased TGs, expensive
• tx: T2 diabetics with high LDL cholesterol

Question 11

bromocriptine

Answer 11

• DA2 agonist
• alters hypothalamic regulation of metabolism, increased insulin sensitivity
• no hypoglycemia
• not that effective, rarely used

Question 12

hypoglycemia

Answer 12

• glucose is preferred tx if indv is conscious
• glucagon emergency kit if unconscious – turn on side, call 911
• type I should have always have RX and some type 2
• hospital: IV dextrose

Question 13

Pramlintide

Answer 13

• amylin analog (amylin is secreted with insulin but is absent in T1DM and reduced in T2DM)
• inject before each meal –> reduces post-prandial glucose levels
• use with rapidly acting insulin
• significant risk of hypoglycemia
• may decrease appetite and promote weight loss
• GI SE, many injections!!
• ** think: it acts/used just like insulin bc they are secreted together

Question 14

rapid acting insulin

Answer 14

• Lispro, Aspart, Glulisine
• onset: 5-30 mins
• peak action: 0.5-3 hrs
• duration: 3-5 hrs

Question 15

short-acting insulin

Answer 15

• regular
• onset of action 30-60 mins
• peak action 1-5 hrs
• duration 6-8 hrs
• only form that can be given IV

Question 16

Intermediate acting insulins

Answer 16

NPH, NPA, NPL

• onset of action 1-4 hrs
• peak action 4-10 hrs
• duration of action 14-25 hrs

Detemir

• onset of action 3-4 hrs
• peak action 4-8 hrs
• duration 6-24 hrs

Question 17

long-acting insulin

Answer 17

• Glargine
• onset: 2-3 hrs
• no peak action
• duration of action: 24-30 hrs
• if too high, you will see hypoglycemia in the morning

Question 18

split-mixed tx program

Answer 18

• Reg and NPH given at breakfast and dinner
• can also wait to take NPH closer to bedtime so that hypoglycemia peak will occur in the am
• • easy to use, low cost
• • not very physiological, greater likelihood of nocturnal hypoglycemia with presupper NPH

Question 19

Basal/Bolus tx program

Answer 19

• std insulin preps: reg at eatch meal with NPH at bedtime
• rapid acting with each meal and long-acting at bedtime
• basal- suppresses glucose production between meals and overnight (40-50% of daily needs)
• bolus- limits hyperglycemia after meals (10-20% of total daily insulin requirement)
• preferred choice of tx in T1DM

Question 20

potency of diabetic meds in reducing HbA1C

Answer 20

insulin > metformin > thiazolidinediones > alpha-glucosidase inhibitor

Question 21

diabetic ketoacidiosis

Answer 21

not enough glucose –> metabolism of fats –> TCA cycle can’t keep up with Acetyl CoA production –> ketones

Question 22

pregnancy

Answer 22

all oral agents in contrandicated in pregnancy –> use insulin