Diabetes Mellitus Pharmacology (Endocrine Pancreas) Flashcards
Peptide hormone analog used as adjunct therapy to facilitate pancreatic insulin secretion: A) Metformin B) Insulin C) Acarbose D) Rosiglitazone E) Glyburide F) Exenatide G) Sulfonylureas
F
Primary mechanism of action is to decrease carbohydrate absorption by the gut: A) Metformin B) Insulin C) Acarbose D) Rosiglitazone E) Glyburide F) Exenatide G) Sulfonylureas
C
Insulin “sensitizer” with adipose tissue as its primary site of action: A) Metformin B) Insulin C) Acarbose D) Rosiglitazone E) Glyburide F) Exenatide G) Sulfonylureas
D
Insulin “sensitizer” that acts by activation of AMP-stimulated protein kinase (AMPPK): A) Metformin B) Insulin C) Acarbose D) Rosiglitazone E) Glyburide F) Exenatide G) Sulfonylureas
A
Insulin “sensitizer” that acts by activation of PPARγ A) Metformin B) Insulin C) Acarbose D) Rosiglitazone E) Glyburide F) Exenatide G) Sulfonylureas
D
Primarily targets liver to decrease gluconeogenesis and glycogenolysis: A) Metformin B) Insulin C) Acarbose D) Rosiglitazone E) Glyburide F) Exenatide G) Sulfonylureas
A
Class of oral antihyperglycemic drugs that depolarize pancreatic beta cells to enhance insulin release:
A) Metformin B) Insulin C) Acarbose D) Rosiglitazone E) Glyburide F) Exenatide G) Sulfonylureas
G
Primary therapy for type 1 diabetes mellitus: A) Metformin B) Insulin C) Acarbose D) Rosiglitazone E) Glyburide F) Exenatide G) Sulfonylureas
B
T or F: Insulin resistance is a key feature of type 1 diabetes mellitus
F
The primary pathology in type 1 diabetes is lack or absence of insulin; target tissue insulin resistance is a cardinal feature of type 2 diabetes
T or F: If the proper preparation and dose are used, it is possible to maintain reasonably good glycemic control in type 1 diabetes mellitus with a single daily injection of insulin.
F
Healthy glycemic control requires multiple administrations of insulin per day, by injection and/or pump in order to adapt to exercise, dietary intake, stress, and other aspects of daily life that affect energy needs.
T or F: The primary difference between different insulin preparations involves their potency at insulin receptors.
F
All insulin preparations are equipotent at the insulin receptor. Modifications to make different preparations are targeted at providing different options for rate of onset and duration of action of a single dose. The rates of onset and duration of action are primarily functions of how quickly the insulin is released from its depot administration site. These parameters may be altered by the chemical composition of the preparation in which natural insulin is suspended or dissolved (e.g. pH and/or Zn), or by amino acid modifications of insulin (insulin analogs).
A 32-year-old man with type 1 diabetes mellitus uses an insulin therapy designed to maintain tight control of his blood glucose levels. Which of the following adverse effects is this patient likely to experience with his therapy? A) Hypoglycemia B) Diabetes insipidus C) Ketoacidosis D) Adrenal crisis
A
In a patient with type 1 DM who is trying to maintain tight control of blood glucose with their insulin therapy, hypoglycemia can occur as an adverse effect due to mismatching of insulin dose and amount of glucose intake and/or utilization. The chances of developing hypoglycemia are greater in a patient who is on an insulin regimen designed to maintain tight control of blood glucose levels. A patient usually learns how to recognize the symptoms of hypoglycemia and can take immediate steps to increase glucose with an appropriate beverage or snack. In patients who are unable to detect the early symptoms of hypoglycemia, it may not be a good idea to attempt tight control, as hypoglycemia can rapidly escalate to a mental state in which the person is unable to understand or explain their situation, and is at risk of becoming unconscious or even dying.
Ketoacidosis can occur with insulin deficiency and not with insulin therapy. Diabetes insipidus occurs due to either vasopressin deficiency or unresponsive vasopressin receptors in the kidney. Adrenal crisis occurs due to sudden glucocorticoid deficiency.
A 52-year-old woman has been managing her type 2 diabetes with diet and exercise for the past 5 years. Recently, her HbA1c levels have been consistently elevated. Her physician recommends that she begin drug therapy to help manage her diabetes. Which of the following drugs is most likely to be recommended to the patient at this time? A) Acarbose B) Insulin C) Exenatide D) Metformin E) Rosiglitazone
D
Metformin is usually the first drug to be prescribed for treatment of type 2 diabetes. It is taken orally and decreases hepatic gluconeogenesis and glycogenolysis, both of which effects decrease blood glucose. It is a relative safe drug with few adverse effects.
Review why the other drug choices would be less beneficial for first-line therapy. Note: as GLP-1 agonists that can be injected on a weekly, rather than daily basis become more common, it is possible that they may compete with metformin for being an initial therapy for type 2 diabetes, but this is not yet the case.
A 65-year-old man with type 1 diabetes uses two different insulin preparations to maintain daily control of his blood glucose levels. Before each meal, he injects a rapid-acting insulin at a dose calculated to match his planned meal. At bedtime he takes a consistent dose of a different insulin preparation. Which of the following is most likely the insulin preparation he takes at bedtime? A) Regular insulin B) Insulin NPH C) Insulin glargine D) Insulin lispro
C
Insulin glargine maintains a steady baseline level of insulin within 2 hrs of injection. There is no peak blood level. If administered at the same time every day, insulin glargine will maintain a relatively steady background level of insulin. Each of the other answer choices has more dynamic pharmacokinetics. You should be able to explain the relative rates of onset, peak, and disappearance of effects of each of the insulin preparations in the drug list.
