Diabetes

Question 1

Features of regular insulin

Answer 1

physiologic levels of zinc, no protein
readily soluble and rapidly absorbed
onset 1/2 to 1 hour, peak in 2-4h duration of 5-8h
Can be given IV

Question 2

Features of isophane insulin

Answer 2

insulin complexed with the protein protamine at neutral pH (NPH)
Onset 1-2h peak 6-12h duration 18-24h
Cannot be used IV

Question 3

Therapeutic use of regular insulin

Answer 3

for pre-meal use, short duration

Question 4

Therapeutic use of isophane insulin

Answer 4

between meal use, often combined with regular insulin at meal times

Question 5

Rapid and short acting insulin analog

Answer 5

Insulin Lispro

Question 6

What are the therapeutic considerations for insulin lispro

Answer 6

does not dimerize so acts more quickly and has shorter duration. This means that timing for meals is less important and there is less chance of hypoglycemia after meals/missed meals

Question 7

Slow and short acting insulin analog

Answer 7

Insulin glargine

Question 8

Features that reduce solubility of insulin glargine

Answer 8

formulated with zinc and at acidic pH slows absorption

Question 9

Dosing of insulin glargine

Answer 9

sub cutaneous once daily

Question 10

Considerations for injecting rapid and slow insulin analogs

Answer 10

can be used together, but not mixed before injection

Question 11

Inhaled insulin

Answer 11

Afrezza

Question 12

What is the treatment for severe hypoglycemia where the patient is unconscious

Answer 12

glucagon

Question 13

What is the only novel diabetes drug on the market

Answer 13

Pramlintidine

Question 14

MOA of pramlintidine

Answer 14

analog of amylin, peptide hormone release from beta cells along with insulin, which decreases liver glucose production

Question 15

What is the advantage with pramlintidine

Answer 15

decreases gastric emptying and reduces weight gain

Question 16

Therapeutic use/dosing of pramlintidine

Answer 16

only given in combination with normal insulin injected sub

Question 17

What is the prototype sulfonylureas (SUs)

Answer 17

Glimepiride

Question 18

What is the MOA of glimepiride

Answer 18

block the ATP sensitive channel in islet cells, which leads to calcium dependent release of insulin. Increases insulin release

Question 19

Dosing for glimepiride

Answer 19

once daily

Question 20

Metabolism of glimepiride

Answer 20

metabolized by liver and excreted by kidney, contraindicated in liver and kidney disease

Question 21

What is the MOA of meglitinides

Answer 21

similar to SUs, not very effective

Question 22

What is the prototype for biguanides

Answer 22

metformin

Question 23

What is the MOA of metformin

Answer 23

activates AMP-K, increases glucose uptake in liver, does not alter insulin level, so no risk of hypoglycemia

Question 24

Pharmacokinetics of metformin

Answer 24

2-4 times per day orally, excreted unmetabolized by kidneys, contraindicated in patients with kidney disease

Question 25

Advantages of metformin

Answer 25

does not cause hypoglycemia or weight gain

Question 26

Adverse effects of metformin

Answer 26

Inhibits lactate metabolism, can cause lactic acidosis, especially in patients with impaired liver function Unpleasant GI effects

Question 27

Prototype drugs of Reducers of GI glucose

Answer 27

Acarbose

Question 28

MOA of acarbose

Answer 28

microbial sugars that inhibit sugar metabolism in the gut

Question 29

dosing of acarbose

Answer 29

immediately before meals, always used with other agents

Question 30

Side effects of acarbose

Answer 30

can caused hypoglycemia when in combination with other agents, not on its own Adverse GI effects (farts), especially in combination with metformin

Question 31

Prototype thiazolidinediones

Answer 31

Pioglitazone

Question 32

MOA of Pioglitazone

Answer 32

increases PPAR-gamma activity, increases transcription of insulin responsive genes - decreases gluconeogenesis - increase glucose uptake in muscle and adipocytes

Question 33

Pharmokinetics of pioglitazone

Answer 33

orally effective, taken with food | metabolized by liver, excreted in feces

Question 34

Adverse effects of piogliatazone

Answer 34

hepatotoxicity, cardiovascular