Diabetes

Question 1

Four factors that increase insulin release

Answer 1

Glucose, sulfonylureas, M-agonists, B2-agonist

Question 2

IV forms of insulin

Answer 2

Lispro and regular

Question 3

Long-acting insulin with no peak

Answer 3

Glargine

Question 4

Mechanism of action: Insulin

Answer 4

binds transmembrane receptors–>tyrosine kinase–> phosphorylate tissue-specific substrates

Question 5

Does a-2 agonist cause hyper- or hypoglycemia

Answer 5

↓ insulin resistance–>hyperglycemia

Question 6

Symptoms of DKA

Answer 6

polyuria, polydipsia, nausea, fatigue, dehydration, Kussmaul breathing, fruity breath

Question 7

Symptoms of hypoglycemia

Answer 7

lip/tongue tingling, lethargy, confusion, sweats, tremors, tachycardia, coma, seizures

Question 8

Mechanism of action: Glucose

Answer 8

Enters Beta cell via GLUT2–> glycolysis produces ATP–> ATP closes K channels–> cell depolarizes–> Ca channels open–> insulin release

Question 9

Mechanism of action: Sulfonylureas

Answer 9

Blocks K channels–> depolarization–> insulin release, ↓glucagon release and ↑insulin receptor sensitivity

Question 10

First generation oral sulfonylureas (OSU)

Answer 10

Acetohexamide, Tolbutamide, Chlorpropamide

Question 11

Acetohexamide: Class and unique properties

Answer 11

FG OSU; active metabolite (long duration), need to ↓ dose in renal dysfxn

Question 12

Tolbutamide: Class and unique properties

Answer 12

FG OSU; appropriate in renal dysfxn

Question 13

Chlorpropamide: Class and unique properties

Answer 13

long-acting, SIADH/disulfiram reactions

Question 14

Second generation OSU

Answer 14

Glipizide and Glyburide

Question 15

Glipizide: Class and unique properties

Answer 15

need to ↓ dose in hepatic dysfuntion

Question 16

Glyburide: Class and unique properties

Answer 16

active metabolite, need to ↓ dose in renal dysfunction

Question 17

SE’s of OSU’s

Answer 17

hypoglycemia, weight gain, drug interactions w/cimetidine, insulin, salicylates and sulfonamides

Question 18

Mechanism of action: Metformin

Answer 18

bypasses insulin receptor–> directly into cell–> stim PPAR and inhibits mitochondrial glycerophosphate dehydrogenase–> ↑ tissue sensitivity to insulin and ↓ liver gluconeogensis

Question 19

SE’s of Metformin

Answer 19

possible lactic acidosis, GI distress; CI in CHF. NO weight or hypoglycemia

Question 20

Mechanism of action: Acarbose & Miglitol

Answer 20

inhibits a-glucosidase in SI–>↓ breakdown of glucose to absorbable carb–>↓ postprandial glucose–> ↓insulin demand. NO HYPOGLYCEMIA

Question 21

SE’s of Acarbose & Miglitol

Answer 21

GI discomfort, flatulence, diarrhea, hepatotoxicity

Question 22

Thiazolidinediones

Answer 22

Pioglitazone and Rosiglitazone

Question 23

Mechanism of action: Thiazolidinediones

Answer 23

bind to nuclear PPARy–> transcription of insulin-responsive genes–> sensitization of tissues to insulin, ↓hepatic gluconeogenesis and TGs, and ↑insulin receptor numbers

Question 24

SE’s of Thiazolidinediones

Answer 24

GOOD: less hypoglycemia than sulfonylureas, ↓TG ↑HDL

BAD: weight gain, bone fractures, increased bladder cancer and edema; CI in CHF; Rosiglitazone ↑ LDL

Question 25

Mechanism of action: Exenatide

Answer 25

GLP-1 receptor agonist; GLP-1 ↑glucose-dependent insulin secretion, ↓glucagon secretion, slows gastric emptying, ↑satiety; used in type 2 diabetes in combo w/other

Question 26

SE's of Exenatide

Answer 26

nausea, hypoglycemia w/sulfonylureas, acute pancreatitis, caution w/renal insufficiency

Question 27

Mechanism of action: Sitagliptin

Answer 27

inhibits DPP-4 (which normally inactivates GLP-1)

Question 28

Mechanism of action: Repaglinide and Nateglinide

Answer 28

Closes K channels-->stimulates insulin release; T2DM

Question 29

Mechanism of action: Pramlintide

Answer 29

slows rate of food absorption--> ↓glucose production and ↓appetite; T1DM and T2DM

Question 30

Meglitinides: Drug types and SE's

Answer 30

Repaglinide and Nateglinide; weight gain, hypoglycemia, very short acting

Question 31

Other GLP-1 Receptors agonists

Answer 31

Liraglutide, Albiglutide, Dulaglutide

Question 32

Other DPP-4 inhibitors

Answer 32

Alogliptin, Saxagliptin, Linagliptin

Question 33

SE's of DPP-4 inhibitors

Answer 33

Some urticaria/angioedema; URIs, headace; some pancreatitis; weight neutral, no hypoglycemia

Question 34

Sodium glucose cotransporter 2 (SGLT2) inhibitors

Answer 34

Canagliflozin, Dapaglifozin, Empagliflozin

Question 35

Mechanism of action: SGLT2 inhibitors

Answer 35

↓ glucose resorption in kidney-->↑ urinary glucose excretion

Question 36

SE's of SGLT2 inhibitors

Answer 36

Volume depletion, hyperkalemia; UTI's, genital infections; ↑LDL; no weight gain or hypoglycemia

Question 37

Bile acid sequestrant

Answer 37

Colesevelam

Question 38

Mechanism of action: Colesevelam

Answer 38

binds bile acid/cholesterol--> ↓hepatic glucose production; NO hypoglycemia, ↓LDL

Question 39

SE's of Colesevelam

Answer 39

Constipation, ↑TGs

Question 40

Rapidly acting insulins (3)

Answer 40

Lispro, Aspart, Glulisine

Question 41

Short acting insulin

Answer 41

Regular insulin

Question 42

Intermediate acting insulins (4)

Answer 42

NPH, NPL, NPA and Detemir

Question 43

SE's of GLP-1 agonists

Answer 43

GOOD: weight reduction BAD: hypoglycemia, NVD, acute pancreatitis, C-cell hyperplasia/medullary thyroid CA