Diabetes

Question 1

what drugs are insulin secretogogues?

Answer 1

sulfonylureas

meglitinides

Question 2

name the 6 sulfonylureas

Answer 2

1. Chlorpropramine
2. Tolbutamide
3. Tolazamide
4. Glipizide
5. Glyburide
6. Glimepiride

Question 3

what are the 2 Meglitinides?

Answer 3

1. Repaglinide
2. Nateglinide

Question 4

how do all sulfonylureas work?

Answer 4

Block ATP sensitive K+ channels in pancreatic beta cells.

Inhibits efflux of K+ and opening Ca channels (influx) causing release of pre-formed insulin

Question 5

which sulfonylureas are 1st generation?

Answer 5

1. Chlorpropramide
2. Tolbutamide
3. Tolazamide

Question 6

which sulfonylureas are 2nd generation?

Answer 6

1. Glipizide
2. Glyburide
3. Glimepiride

Question 7

which sulfonylurea has the longest half life?

how long does it last?

Answer 7

chlorpropramide

32 hours

Question 8

when is chlorpropramide contraindicated?

Answer 8

patients with hepatic disease (slowly metabolized in liver)

Question 9

which sulfonylurea has the shortest half life?

which is why it is perfect to use in which patient?

Answer 9

tolbutamide

elderly patients

Question 10

sulfonylureas, all of them, are used for what condition?

Answer 10

diabetes mellitus type 2

Question 11

what are signs of sulfonylurea toxicity?

Answer 11

hypoglycemia

disulfiram like reaction with alcohol

(nausea, palpitation, sweating)

Question 12

all sulfonylureas are contraindicated when?

Answer 12

pregnancy

Question 13

when is Glipizide contraindicated?

Answer 13

In patients with hepatic disease (can cause hypoglycemia)

Question 14

which sulfonylurea has the highest potency?

Answer 14

Glimepiride

Question 15

how do Meglitinides work?

Answer 15

sames as sulfonylureas:

block ATP sensitive K+ channels in pancreatic beta cells. Inhibits the efflux of K+, resulting in depolarization. Opening of voltage gated Ca influx. Release of preformed insulin and increase insulin receptors

Question 16

Repaglinide and Nateglinide have what type of onset?

and how long do they last?

Answer 16

rapid onset

have a short duration

Question 17

Repaglinide, Nateglinide are used for what?

Answer 17

**good for controlling Postprandial hyperglycemia

Question 18

too much Repaglinide, Nateglinide may lead to what?

Answer 18

hypoglycemia

Question 19

Name a Biguanide drug

Answer 19

Metformin

Question 20

how does biguinides work?

Answer 20

it is a Antihyperglycemic by Increasing peripheral insulin sensitivity by increasing insulin receptors and Inhibits hepatic gluconeogenesis.

Question 21

will metformin give you hypoglycemia?

is metformin euglycemic?

Answer 21

no

yes

Question 22

what is a secondary benefitial effect from metformin?

Answer 22

reduced triglycerides, reduced total cholesterol, reduced LDL, increased HDL.

Question 23

when is metformin used?

Answer 23

1. Obese Type 2 DM
2. Polycystic Ovarian Syndrome: lowers the serum androgens and restores normal menstrual cycles

Question 24

metformin toxicity will affect what organ only?

toxicity will elicit what effects?

Answer 24

GI

1. Lactic acidosis
2. Vitamin B12 deficiency.
3. metabolic acidosis (extreme dehydration, hyperventialtion, high anion gap, acidic blood pH)

Question 25

metformin causes lactic acidosis, especially in which patients?

Answer 25

in alcoholics and patients with hepatic impairment

Question 26

what happens if you give metformin to an alcoholic?

Answer 26

he develops lactic acidosis

Question 27

what is the category name for Insulin Sensitizers?

Answer 27

Thiazolidinediones

Question 28

name the 2 Thiazolidinediones

Answer 28

1. Pioglitazone 2. Rosiglitazone

Question 29

how does Pioglitazone and Rosiglitazone work?

Answer 29

Activate peroxisome proliferator-activating receptors (PPAR’s) these are involved in the **transcription** of **insulin** responsive genes. **Increase** the **glucose** **uptake** in **muscle** and **adipose** tissue and **decreases** **hepatic** **gluconeogenesis**.

Question 30

Insulin Sensitizers will have what effects?

Answer 30

Reduce plasma glucose and triglycerides.

Question 31

will you develop hypoglycemia with insulin sensitizers?

Answer 31

\*\*\***No** **hypoglycemia** because they are **euglycemic**

Question 32

toxicity with Thiazolidinediones will lead to what?

Answer 32

\*\*\*\*\*Hepatic enzyme inducers: hepatotoxicity (monitor)

Question 33

name the 2 Alpha Glucosidase Inhibitors

Answer 33

1. Acarbose 2. Miglitol

Question 34

how do Acarbose, Miglitol work?

Answer 34

they are competitive and reversible inhibitors of α-glucosidase in the small intestine.

Question 35

will you develop hypoglycemia with alpha glucosidase inhibitors? how about lactic acidosis? what about weight gain?

Answer 35

\*\*No hypoglycemia, lactic acidosis, or weight gain.

Question 36

when are alpha glucosidase inhibitors used?

Answer 36

In **significant** postprandial hyperglycemia.

Question 37

Pramlintide (new drug) is used when? how is it administered? how does it work?

Answer 37

postprandial hyperglycemia subcutaneous Synthetic analogue of amylin, and suppresses glucagon release. (GLP-1)

Question 38

Exenatide (Incretin) (new drug) is used for what? how does it work? how is it adminstered? toxicity may lead to what? exenatide should never be given with what other drug? Why?

Answer 38

* only type 2 diabetes * Synthetic analogue of glucagon-like-peptide (GLP-1). * subcutaneously * loss of apetite because it slows gastric emptying * NEVER give with INSULIN because it can cause fatal necrotizing pancreatitis or hemorrhagic pancreatitis

Question 39

how does Sitaglyptin work?

Answer 39

**Inhibitor of dipeptidyl peptidase-4 enzyme** that degrades GLP-1.

Question 40

name a Hyperglycemic Agents

Answer 40

glucagon

Question 41

when is glucagon used?

Answer 41

in severe hypoglycemia

Question 42

what are the Rapid and Short-Acting Insulin (onset: 5-15 min, duration: 3-5 hrs.)?

Answer 42

1. Insulin lispro 2. aspart 3. glulisine 4. inhaled human insulin

Question 43

rapid and short acting insulin can be used in what other condition?

Answer 43

Can be used in diabetic ketoacidosis.

Question 44

What is the Short-Acting Insulin (duration: 5-8 hrs.) drug? when is it used?

Answer 44

insulin **diabetic** **ketoacidosis** and other **emergency** situations.

Question 45

what are the Intermediate-Acting Insulin (onset: 2-5 hrs, duration: 4-12 hrs.)?

Answer 45

1. Lente insulin 2. NPH insulin

Question 46

What are the Ultra Long-Acting Insulin (slow onset, duration: 20-24 hrs.)? when is it used?

Answer 46

1. Ultra lene 2. Insulin glargine 3. Insulin detemir to control basal glucose

Question 47

identify the insulin preparations

Answer 47