Drugs

Question 0

Rapid acting insulin

Answer 0

Lispro (Humalog)
Aspart (NovoLog)
Glulisine (Apidra)
Human insulin, inhaled (Afrezza)
Onset: 15 minutes
Peak: 1 hr
DOA: 4 hrs
Bolus insulin target postprandial sugars

Question 1

Short acting (Regular) insulin

Answer 1

Humulin R
Novolin R
Onset: 0.5-1 hr
Peak: 2-4 hr
DOA: 6-8 hr
Bolus/mealtime insulins

Question 2

Intermediate acting (NPH) insulin

Answer 2

NPH: cloudy-->suspension
Humulin N
Novolin N
Onset: 1-2 hrs
Peak: 4-8 hrs
DOA: 12-18 hrs. 
Basal insulin BID dosing
Target fasting sugars

Question 3

Long acting insulin

Answer 3

Glargine (Lantus)–>precipitates in body
Detemir (Levemir): dose dependent. At 1.6 u/kg/day you start to get 24hr coverage. Myristic acid fatty acids side chain
Onset: 2 hrs
Peak: NONE less incidence of hypoglycemia
DOA: 24 hrs (detemir 12-24)
Basal insulin. Detemir BID initially. Lantus is a true 24 hour
Target fasting sugars

Question 4

Amylin agonist

Answer 4

Pramlintide (Symlin)

Slows gastric emptying, satiety, decrease glucagon release, weight loss, NV

Question 5

GLP-1 agonist (incretin)

Answer 5

Exenatide (Byetta), Byuredon (XR): Gila monster
Liraglutide (Victoza): fatty acid
Albiglutide (Tanzeum): dimer fused to albumin
Dulaglutide (Trulicity)
Binds to g-coupled protein receptor, inreasing cAMP and insulin release in Glucose dependent manner
Slows gastric emptying, increased satiety, NV, weight neutral, increase risk of pancreatitis and thyroid cancers

Question 6

Exenatide

Answer 6

Byetta
Byuredon (extended release)

Question 7

Liralglutide

Answer 7

Victoza

Question 8

Albiglutide

Answer 8

Tanzeum

Question 9

Sulfonylureas

Answer 9

1st generation: chlorpropamide(diabinase), tolbutamide (orinase), tolazamide (tolinase)
2nd generation: glyburide (DiaBeta), glimepiride (Amaryl), glipizide (Glucotrol)
Close ATP sensitive channels. Secretegogues. Increase insulin release
Independent of blood glucose

Question 10

Glimepiride

Answer 10

Amaryl

Question 11

Glipizide

Answer 11

Glucotrol

Question 12

Glyburide

Answer 12

DiaBeta

Question 13

Megletinides (non sulfonylureas)

Answer 13

Repaglinide (Prandin)
Nateglinide (Starlix)
Act on ATP dependent k+ channels (similar MOA but different site than sulfonylureas) on beta cells to increase insulin release. Secretegogues.
Hypoglycemia, weight gain
Independent of blood glucose

Question 14

Repaglinide

Answer 14

Prandin

Question 15

Nateglinide

Answer 15

Starlix

Question 16

Metformin

biguanide

Answer 16

Glucophage
Increase insulin sensitivity in liver and muscle cells!
Independent of functioning beta cells
NVD: take with food, euglycemic, lactic acidosis, dependent onkidney fxn

Question 17

Thiozolidinediones

Answer 17

Rosaglitazone (Avandia)
Pioglitazone (Actos)
P-PAR Agonists (acts primarily in adipose) to redirect fat production/differentiation to periphery
Glucose/Insulin dependent –> decreased risk of hypoglycemia since insulin is required
Weight gain, CV risks, bone fractures, decreased hematocrit

Question 18

Rosiglitazone

Answer 18

Avandia

Question 19

Pioglitazone

Answer 19

Actos

Question 20

DPP-IV inhibitors

Answer 20

Sitagliptin (januvia)
Sexagliptin (onglyza)
Linagliptin (tradjenta)
Alogliptin (nesina)
Inhibit breakdown of GLP-1 and GIP (incretins). Increases insulin release and synthesis in glucose dependent manner. Type 2 diabetics have decreased incretin levels so this drug is less efficacious than GLP-1agonists. No satiety or gastric emptying effects. Possible pancreatitis

Question 21

Sitagliptin

Answer 21

Januvia

Question 22

Sexagliptin

Answer 22

Onglyza

Question 23

Alogliptin

Answer 23

Nesina

Question 24

Linagliptin

Answer 24

Tradjenta

Question 25

Alpha glucosidase inhibitors

Answer 25

Miglitol (glyset) Acarbose (precose) Inhibit breakdown of carbs to monosaccharides in the gut. Delays digestion and absorption of starches and disaccharides Flatulence, diarrhea, abdominal pain and cramping Glucose dependent

Question 26

Acarbose

Answer 26

Precose

Question 27

Miglitol

Answer 27

Glyset

Question 28

SGLT2 inhibitors

Answer 28

Canagliflozin (invokana) Dapagliflozin (farxiga) Empagliflozin (jardiance) Inhibit Na/glucose 2 transporter in proximal renal tubule Insulin independent Prevents glucose reabsorption Increased risk of UTI, some weight loss possible

Question 29

Canagliflozin

Answer 29

Invokana

Question 30

Dapagliflozin

Answer 30

Farxiga

Question 31

Empagliflozin

Answer 31

Jardiance

Question 32

Afrezza

Answer 32

Insulin human

Question 33

Dulaglutide

Answer 33

Trulicity

Question 34

Estimated average glucose and A1C formula

Answer 34

28.7 x A1C - 46.7= eAG