Diabetes Non-Insu II (other)

Question 1

Name the two thiazolidinediones (TZDs)

Answer 1

Pioglitazone

Rosiglitazone

Question 2

Which oral anti-diabetic drugs act by agonism of PPAR-gamma? How does this decrease insulin resistance?

Answer 2

TZDs (-glitazones)

PPAR-gamma is involved in lipid and glucose metabolism and TZDs promote glucose uptake and use in adipose tissue

Question 3

Which class of oral anti-diabetic drugs has a slow onset that can take weeks to months to act? Why?

Answer 3

TZDs because they act through gene expression

Question 4

Which TZD increases HDL and decreases TAGs? How does the other affect lipids?

Answer 4

Pioglitazone

Rosiglitazone also inc HDL but has no effects on TAGs and also increases LDL

Question 5

Which class of oral anti-diabetic drugs is contraindicated in class III and class IV heart failure?

Answer 5

TZDs

Question 6

Which class of oral anti-diabetic drugs requires periodic monitoring of liver function?

Answer 6

TZDs (and Acarbose - alpha-glucosidase inhibitor)

Question 7

Name the two alpha-glucosidase inhibitors. MOA?

Answer 7

Acarbose
Miglitol
Reduce postprandial digestion and absorption of starch and disaccharides

Question 8

Which class of oral anti-diabetic drugs are associated with increased flatulence and contraindicated in IBD?

Answer 8

Alpha-glucosidase inhibitors

Question 9

Pt is using Acarbose and a sulfonylurea and develops hypoglycemia. How should he be treated and why

Answer 9

With glucose because breakdown of sucrose is inhibited by Acarbose

Question 10

What must be monitored in patients taking Acarbose?

Answer 10

Liver function

Question 11

Which drug is a GLP-1 analog derived from the salivary gland of the Gila monster? MOA?

Answer 11

Exenatide
Incretin resistant to DPP-IV (enzyme that degrades incretins) so it enhances glucose-dependent insulin secretion, suppresses glucagon release, slows gastric emptying, and decreases appetite

Question 12

How is exenatide administered? Type of drug?

Answer 12

SC injection 2x/dayIncretin analog

Question 13

Which drug is given orally and is a selective inhibitor of DPP-IV? What is DPP-IV?

Answer 13

Sitagliptin DPP-IV degrades incretins

Question 14

Which drug is a synthetic analog of amylin? MOA?

Answer 14

Pramlintide

They both inhibit food intake, gastric emptying, and glucagon secretionAmylin is cosecreted with insulin

Question 15

Which anti-diabetic drug lowers LDL, slightly reduces HbA1c, and can cause constipation, dyspepsia and increase TAGs?

Answer 15

Colesevelam

Bile-acid sequestrant

Question 16

If initial treatment with metformin does not work, what is the next step? How do you choose which drug to give?

Answer 16

Either insulin or a sulfonylurea

Give insulin if HbA1c is >8.5%

Question 17

If hypoglycemia is particularly undesirable and weight loss is a major goal, what drug would you prescribe, assuming HbA1c is <8%?

Answer 17

Exenatide

Question 18

What is the most effective diabetes medication at lowering glycemia?

Answer 18

Insulin

Question 19

When is insulin considered as a first line treatment?

Answer 19

When HbA1c is >10%

Question 20

Name two effects glucagon can have on cancers.

Answer 20

Causes release of insulin from pancreas, catecholamines from pheochromocytoma, and calcitonin from medullary carcinoma

Question 21

Which anti-diabetic drug is used in radiology of the bowel due to its ability to relax intestine?

Answer 21

Glucagon

Question 22

Which type of insulin is used in an insulin pump?

Answer 22

Rapid acting