Drugs for Diabetes

Question 1

Rapid-acting Insulins

Answer 1

Aspart
Lispro
Glulisine

Question 2

Short-acting Insulin

Answer 2

Regular Insulin

Question 3

Intermediate-acting Insulin

Answer 3

Neutral Protamine Hagerdorn (NPH)

Question 4

Long-acting Insulin

Answer 4

Detemir

Glargine

Question 5

Amylin Analog name

Answer 5

Pramlintide

Question 6

GLP-1 agonists

Answer 6

Exantide

Liraglutide

Question 7

DPP-4 Inhibitors

Answer 7

-liptins 
Sitagliptin
Linagliptin
Saxagliptin
Alogliptin

Question 8

First gen K-channel blockers (Sulfonylureas)

Answer 8

-amides
Chlorpropamide
Tolbutamide
Tolazamide

Question 9

Second-gen K channel blockers

Answer 9

Glipizide
Glyburide
Glimepiride

Question 10

Meglitinides (Non-sulfonylurea K channel blocker)

Answer 10

-inide
Nateglinide
Repaglinide

Question 11

Thiazolidinediones

Answer 11

-azones
Pioglitazone
Rosiglitazone

Question 12

SGLT2 inhibitors

Answer 12

-flozin
Canagliflozin
Dapagliflozin
Empagliflozin

Question 13

a-glycosidase inhibitors

Answer 13

Acarbose

Miglitol

Question 14

What is the diagnostic criteria for Diabetes Mellitus?

Answer 14

Fasting plasma glucose over 125 mg/dl

Question 15

Is insulin anabolic or catabolic?

Answer 15

only anabolic hormone that lowers blood glucose

Question 16

2 pathways that insulin activates to increase glucose transport into cell and promote growth

Answer 16

PI3K-Akt- GLUT4 insertion into membrane

MAP kinase- proliferation

Question 17

How does Insulin act as a antihyperglycemic?

Answer 17

Activation of glycolysis and glycogen synthesis

Inhibition of gluconeogenesis and glycogenolysis

Question 18

How do the short acting insulins increase pharmacokinetics?

Answer 18

mutated to block formation of dimers and hexamers which allows faster absorption

Question 19

When are short acting insulins used?

Answer 19

Postprandial hyperglycemia

Question 20

When is regular insulin used?

Answer 20

Basal insulin maintenance
Overnight maintenance
Can be given IV in emergencies

Question 21

A patient wants to stabilize their blood sugar throughout the day with 1-2 injections. What can be prescribed?

Answer 21

Long acting insulins Detemir or Glargine

Question 22

Can insulins be used for TIDM and TIIDM?

Answer 22

Yes, compared to regulators of insulin secretion which works only on TIIDM

Question 23

What BMP abnormality can be corrected with insulin?

Answer 23

Hyperkalemia- Insulin drives K+ into cells via activation of Na/K ATPase

Question 24

Adverse effects of Insulin

Answer 24

Hypoglycemia if over-dosed (most common)
Lipodistrophy at injection site
Insulin resistance
Type I hypersensitivity reaction
Hypokalemia

Question 25

What hormone released by B-cells of the pancreas enhances insulin action?

Answer 25

Amylin

Question 26

When is Pramlintide indicated?

Answer 26

Adjunct to Post prandial insulin

Question 27

What endogenous factors increase insulin release?

Answer 27

``` B2 agonists (Terbutaline, Albuterol) Incretins (GLP-1 agonists) ```

Question 28

What endogenous factors decrease insulin release?

Answer 28

Somatostatin | a2-agonists (Clonidine)

Question 29

4 targets to regulate insulin secretion

Answer 29

1. Gs (stimulate insulin) 2. Gi (decrease) 3. K+ channel (block to decrease) 4. Ca2+ channel

Question 30

What are incretins?

Answer 30

GI hormones that decrease blood glucose

Question 31

Glucagon-Like Peptide-1 (GLP-1) MOA

Answer 31

Promotes B-cell proliferation Insulin gene expression Increases glucose-dependent insulin secretion Promotes satiety

Question 32

What is the action of Dipeptidyl Peptidase-4?

Answer 32

Breaks down GLP-1

Question 33

How do the Sulfonylureas work to increase insulin release?

Answer 33

Blocks K+ channel by binding to SUR1 which depolarizes the cell

Question 34

Adverse affects of Sulfonylureas

Answer 34

Hypoglycemia Weight gain CYP inhibitor

Question 35

What other drugs increase the efficacy of sulfonylureas leading to hypoglycemia risk?

Answer 35

NSAIDS!!

Question 36

When are the meglitinides recommended to take?

Answer 36

Orally before a meal

Question 37

What are advantages of Metformin?

Answer 37

Doesn't cause hypoglycemia No weight gain Not metabolized (excreted unchanged)

Question 38

Side effects of Metformin

Answer 38

GI issues | Lactic Acidosis under hypoxic conditions

Question 39

Thiazolidinediones MOA

Answer 39

PPARy ligand that increases Glut4

Question 40

Use of Thiazolidinediones

Answer 40

T2DM and is a euglycemic drug (will not cause hypoglycemia)

Question 41

Adverse effects of Thiazolidinediones

Answer 41

Increased vascular permeability Increased ENaC expression leading to edema Osteoporosis risk

Question 42

How do the SGLT2 inhibitors work?

Answer 42

Block reabsorption of Glucose in the PCT

Question 43

If you're patient is hypotensive/hypovolemic, should you use SGLT2 inhibitors

Answer 43

Only after correcting volume due to the osmotic diuresis effect the -flozins

Question 44

a-glycosidade inhibitor MOA

Answer 44

Blocks breakdown of polysaccharides into mono's, which inhibits their absorption.