diabetes

Question 1

what percent of diabetes are type 1 and majority are diagnosed before 20 yo?

Answer 1

5%

Question 2

insulin dependent diabetes

Answer 2

type 1

Question 3

diabetics who are overweight, non white and diagnosed after 40

Answer 3

type 2 diabetes

Question 4

what percent of people with type 2 diabetes are undiagnosed

Answer 4

25%

Question 5

Therapy is aimed at keeping A1-C below ____?

Answer 5

7

Question 6

blood pressure below ______; and LDL cholesterol below _____

Answer 6

140/180 AND 100

Question 7

does arcus ever go away?

Answer 7

no there for life

Question 8

whats the lowest a1c level?

Answer 8

6

Question 9

whats the highest a1c level?

Answer 9

10

Question 10

2 diabetic drug classes

Answer 10

oral hypoglycemics

insulin

Question 11

4 oral therapy drug classes

Answer 11

• Biguanides
  • Sulfonylureas
  • Thiazolinediones / Glitazones
  • DPP-4 Inhibitors

Question 12

fuel for brain

Answer 12

only glucose

Question 13

why is hypoglycemia dangerous?

Answer 13

life threatening –> due to loss of sugar for brain

Question 14

when metformin is combined with dpp4 inhibitor what do we see?

Answer 14

neutral weight loss

Question 15

MODY

Answer 15

maturity onset diabetes of the young; MONOGENIC (unlike the others); autosomal dominant disorder (only requires one gene to be affected)

Question 16

polygenic and influenced by environment

Answer 16

type 1 and type 2 diabetes

Question 17

INDICATION
DM-II, Polycystic Ovary Syndrome (PCOS)
DOSING [500-1000mg]
1 tab bid

Answer 17

metformin indication

Question 18

reason why metformin is used for polycystic ovary syndrome

Answer 18

similar manifestations to diabetes

Question 19

what organ fails towards end of diabetes

Answer 19

renal

Question 20

CLINICAL PHARMACOLOGY
Oral Hypoglycemic, Infertility
Mechanism of Action
Biguanide-based; activates AMP-activated protein kinase (AMPK) which in turn suppresses hepatic gluconeogenesis & intestinal glucose absorption; increases insulin sensitivity

Answer 20

metformin moa

Question 21

biguanides are found in diabetic drugs and what else?

Answer 21

preservative for cls

Question 22

lactic acidosis from metformin –> mechanism

Answer 22

lactic acidosis from metformin –> if m. is in fight and flight –> under hypoxia it produces lactic acid –> liver must spew out more glucose for m. –> but liver refuses to uptake lactate –> therefore no stimulus to produce glucose

Question 23

why do beta blockers mask hypoglycemia?

Answer 23

heart slows down –> they dont feel hyperglycemic

blood sugar levels rapidly decrease, if decreased too far brain needs sugar and they could shut down –> diabetic coma

Question 24

metfomin plus what drug makes a pt suffer from hypoglycemic crisis?

Answer 24

cyclosporine

Question 25

sympathetic ns role for beta 2 receptor on hepatic

Answer 25

glycogenolysis; gluconeogenesis

Question 26

developed as an extension with work done on sulfomide antibiotics

Answer 26

sulfonylureas

Question 27

``` 2nd Generation (succeed 1st gen) • Glipizide [Glucotrol®] • Glibenclamide / Glyburide [Micronase®, Diabeta®] 1st Generation • Tolbutamide [Orinase®] • Chlorpropamide [Diabinese®] (discontinued in usa) ```

Answer 27

types of sulfonylureas

Question 28

INDICATION DM-II DOSING [5, 10 mg] 2.5 – 20 mg PO qd - bid

Answer 28

glipzide

Question 29

CLINICAL PHARMACOLOGY Oral Hypoglycemic Mechanism of Action Stimulates pancreatic islet beta cell insulin release Actions involve binding to an ATP-dependent K+ channel: blocked efflux leads to depolarization, Ca++ release and insulin vesicle effusion

Answer 29

glipzide moa

Question 30

INDICATION DM-2 DOSING [15/30/45mg] 1 tab qd

Answer 30

pioglitazone

Question 31

2 types of glitazones

Answer 31

* Pioglitazone [Actos®] | * Rosiglitazone [Avandia®]

Question 32

CLINICAL PHARMACOLOGY Hypoglycemic/Anti-Diabetic Mechanism of Action A thiazolidinedione (aka glitazone) insulin sensitizer selectively stimulates nuclear receptor PPAR which increases insulin sensitivity in liver, skeletal muscle and adipose tissue

Answer 32

pioglitazone moa

Question 33

regluates amount of glucose released

Answer 33

liver