DM pharm

Question 1

rapidly acting insulins

Answer 1

lispro
aspart
glulisine

Question 2

short acting insulins

Answer 2

regular insulin

Question 3

intermediate acting insulins

Answer 3

NPH and NPL

Question 4

ultra-long actin insulins

Answer 4

glargine

detemir

Question 5

sulfonylureas

Answer 5

glipizide
glyburide
glimepiride

Question 6

non-sulfonylurea insulin releasers

Answer 6

repaglinide

nateglinide

Question 7

alpha glucosidase inhibitors

Answer 7

acarbose

miglitol

Question 8

TZDs

Answer 8

rosiglitazone

pioglitazone

Question 9

adjuncts

Answer 9

exenatide
sitagliptin
saxagliptin

Question 10

regulation of insuline secretion

Answer 10

glut 2 transports glucose into beta cells -> high ATP -> opens ATP sensitive KCh -> depolarizes membrane -> opens CaChs -> insulin release

Question 11

degradation of insuline

Answer 11

primarily liver
kidney
t1/2= 5-15min

Question 12

recommended hA1C

Answer 12

6.5-7%

Question 13

Dx of DM

Answer 13

classic signs and symptoms
FBG >126
random glucose >200
failure of oral glucose tolerance test

Question 14

typical insulin regimen

Answer 14

30 U/day
2/3 before breakfast (2/3 NPH 1/3 regular)
1/3in evening (1/3 regular before dinner, 2/3 NPH at bed)

Question 15

metformin

Answer 15

first line
antihyperglycemic
does not cause hypoglycemia

Question 16

metformin affects

Answer 16

• increases action of insulin
• increases glycolysis
• increases glucose uptake and utilization by mm
• decreases gluconeogenesis and hepatic glucose output
• decreases GI absorption of glucose

Question 17

advantages of metformin

Answer 17

no hypoglycemia
no weight gain
favorable lipid profile

Question 18

adverse effects of metformin

Answer 18

GI: anorexia, nausea, diarrhea, abdominal discomfort

lactic acidosis

Question 19

complications of metformin induced lactic acidosis

Answer 19

renal or hepatic insufficiency

CV disease

Question 20

second generation sulfonylureas

Answer 20

glipizide

glyburide

Question 21

third generation sulfonylureas

Answer 21

glimeperide

Question 22

MOA sulfonylureas

Answer 22

bind ATP sensitive KCh -> continuously open -> Ca influx -> insulin secretion

indirectly increase insulin sensitivity

Question 23

adverse effects of sulfonylureas

Answer 23

weight gain and hypoglycemia

Question 24

glimerperide advantages

Answer 24

less weight gain then 2nd gen

doses once daily PO

Question 25

glimerperide CI

Answer 25

``` sulfa allergy pregnancy type I DM ketoacidosis renal failure hepatic failure major surgery ```

Question 26

glipizide

Answer 26

dose 1-2x/day PO inactive metabolites no CIs

Question 27

glyburide

Answer 27

freater incidence of hypoglycemia | use with caution

Question 28

non-sulfonylurea secretagogues

Answer 28

same MOA as sulfonylureas, but have different binding site short half-life rapid action can be taken right before meal

Question 29

alpha-glucosidase inhibitors

Answer 29

not very popular b/c block glucose absorption -> more gut bacteria digestion -> serious gas can also cause hypoglycemia

Question 30

GLP-1 agonists

Answer 30

peptide hormone cleaved from pro-glucagon precursor secreted by intestinal L cells highly resistant to DPP-4 degredation

Question 31

actions of GLP-1 agonists

Answer 31

glucose dependent enhancement of insulin secretion inhibition of glucagon secretion appetite suppression and satiety induction reduce gastric emptying possible stimulation of islet cell growth Decrease HbA1c decrease postprandial glucose weight loss little hypoglycemia

Question 32

GLP-1 combos

Answer 32

with metformin, TZDs, and/or sulfonylurea NOT with insulin must be injected

Question 33

DDP-4 inhibitors

Answer 33

prevents break down of GLP-1 and GIP oral cannot be combined with insulin

Question 34

actions of DDP-4 inhibiots

Answer 34

``` increase insulin secretion decrease glucagon decrease hepatic glucose production increase peripheral glucose uptake and utilization little hypoglycemia ```

Question 35

pramlintide

Answer 35

synthetic analog of amylin 4th line drug used with DMI or II when already on insulin cannot be dosed with insulin and must be injected

Question 36

TZDs MOA

Answer 36

``` insulin sensitizers act as steroid hormone -> PPAR-gamma RXR R complex decrease insulin resistance decrease hepatic glucose output increase glucose uptake ```

Question 37

risks of TZDs

Answer 37

very controversial risk of MI with rosiglitazone risk of bladder CA with pioglitazone

Question 38

SGLT2 inhibitors

Answer 38

-flozin PO 1/day for DMII used in combo

Question 39

SGLT2 inhibitors MOA

Answer 39

SGLT2 is membrane protein expressed in kidney and inhibition of this protein blocks glucose reabsorption