Diabetes

Question 1

What are the rapid-acting insulins?

Answer 1

Insulin lispro (Humalog)
Insulin aspart (NovoLog)
Insulin glulisine (Apidra)

Question 2

What is the short-acting insulin?

Answer 2

Regular insulin

Question 3

What is the intermediate acting insulin?

Answer 3

NPH/Isophane Insulin

Question 4

What are the long acting insulins?

Answer 4

Insulin glargine

Insulin detemire

Question 5

Which groups of insulin can be given IV?

Answer 5

Rapid-acting and short-acting

Question 6

What are normal responses to insulin?

Answer 6

Blood glucose level decreases
Blood pyruvate and lactate increase
Inorganic phosphate decreases
Plasma potassium decreases

Question 7

Who should you never give insulin to?

Answer 7

hypokalemia

Question 8

What are some causes of hypoglycemia? How do you treat in an emergency situation?

Answer 8

Vigorous exercise
Failure to eat
Over indulgence in alcohol; Give 50-100 ml of 50% glucose solution IV and 0.5-1 mg glucagon injection

Question 9

What drugs are sulfonylureas? What is their MOA?

Answer 9

Glyburide (Micronase)
Glipizide (Glucotrol)
Glimepriride (Amaryl)
Tolbutamine (Orinase)
Tolazamide (Tolinase)
Chlorpropamide (Diabinese)
They stimulate insulin release from pancreatic beta cells by blocking the K+ channel and causing depolarization, potentiate action at target cells

Question 10

What are the first gen sulfonylureas? Second gen?

Answer 10

TCT, GGG

Question 11

What is the safest sulfonylurea for use in elderly patients?

Answer 11

Tolbutamine (Orinase)

Question 12

What are the primary adverse side effects of sulfonylureas?

Answer 12

•All sulfonylureas can cause hypoglycemia
-More in long-lasting agents
–2nd gen. agents typically better
–Can be caused by drug interactions
•Some GI side effects (2nd gen better)
•Weight gain

Question 13

What are in the class of meglitinides that are secretagogues but can be used with a sulfa allergy and with better likelihood of euglycemia?

Answer 13

RegaGLINIDE (Prandin) and NateGLINIDE (Starlix)

Question 14

What are the two Thiazolidinediones? What is their MOA?

Answer 14

Pioglitazone
Rosiglitazone
Ligands of the nuclear PPARg receptor which can cause post-receptor insulin-mimetic action, upregulates GLUT4 receptors and insulin uptake enzymes

Question 15

What is the one biguanide?

Answer 15

Metformin

Question 16

What are the indications for TCDs?

Answer 16

Decreases HbA1c, MAY BE USEFUL FOR PROPHYLAXIS OF TYPE 2 DM (Pio only)

Question 17

What are CI to TCD?

Answer 17

LIVER DZ
CHF
ROSIGLITAZONE BLACK BOX MI/ANGINA!

Question 18

What is the MOA for Acarbose and Miglitol?

Answer 18

Inhibit alpha-glucosidases in small intestine  delayed carbohydrate digestion and absorption

Question 19

What are two indications for using alpha glucosidase inhibs?

Answer 19

decreases post prandial serum glucose

WEIGHT NEUTRAL

Question 20

Which two drugs are synthetic GLP1 that are resistant to degradation by DPPIV? What are two potential benefits to using these drugs?

Answer 20

Exenetide and liraglutide; may increase B cell number and function, slows gastric emptying so it leads to weight loss

Question 21

What is one absolute contraindication for liraglutide use?

Answer 21

THYROID CANCER-Black box

Question 22

What is one rare but serious side effect of incretin mimetics?

Answer 22

Pancreatitis

Question 23

What is the MOA for DPP-IV inhibs? What are they?

Answer 23

Potentiates effects of incretins by acting as a direct inhibitor of DPP-IV; 
SitaGLIPTIN
SaxaGLIPTIN
LinaGLIPTIN
AloGLIPTIN

Question 24

What are some compelling indications for DPPIV use?

Answer 24

to decrease HbA1c and weight neutral

Question 25

What is the MOA for amylin-like peptide Pramlintide?

Answer 25

Works with insulin to regulate postprandial glucose by ↓ Gastric emptying without altering the overall absorption of nutrients, suppression of postprandial glucagon secretion centrally-mediated modulation of appetite ↓ caloric intake

Question 26

What are two compelling uses for pramlintide?

Answer 26

As adjunct to insulin therapy in TYPE 1 and 2 | WEIGHT LOSS

Question 27

How is pramlintide administered?

Answer 27

SQ injection TID, similar to insulin. post prandial only!

Question 28

What is the MOA of Bromocriptine? What are two benefits to its use?

Answer 28

Dopamine agonist; prevents somogyi reaction (MORNING SURGE and ↓ postmeal plasma glucose levels due to enhanced suppression of hepatic glucose production THIS MEANS IT POTENTIALLY REDUCES THE CARDIOVASCULAR END POINT PROBLEMS IN DIABETICS

Question 29

What are contraindications to bromocriptine use?

Answer 29

Pgn and lactation

Question 30

What is the only drug FDA approved for Type 1 DM? What is one FDA drug used off label for Type 1?

Answer 30

Pramlintide; acarbose or miglitol