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CAS 3 > Drugs Used in Diabetes Mellitus > Flashcards

Drugs Used in Diabetes Mellitus Flashcards

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1
Q

what is Type 3 Diabetes Mellitus

A

Refers to multiple other specific causes of an elevated blood glucose.

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2
Q

what is Type 4 Diabetes Mellitus

A

Gestational diabetes (GDM)
- During pregnancy, the placenta and placental hormone create an insulin resistance at 3rd trimester

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3
Q

what is the treatment for Type 3 Diabetes Mellitus.

A

insulin

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4
Q

what is the treatment for Type 4 Diabetes Mellitus.

A

insulin

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5
Q

MOA of insulin

A

tyrosine kinase phosphorylation promotes entry
of glucose into the cell

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6
Q

The standard mode of insulin therapy is ________injection

A

subcutaneous (SC)

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7
Q

which drugs is categorized as rapid acting insulin

A

Lispro
Aspart
Glulisine

tallest curve

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8
Q

which drugs is categorized as short acting insulin

A

Regular (SC/IV)

subcutaneous (SC)injection.
IV: Intravenous; NPH: Neutral Protamine Hegedorn.

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9
Q

which drugs is categorized as intermediate acting insulin

A

NPH

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10
Q

which drugs is categorized as LONG acting insulin

A

Glargine
Detemir
Degludec

flatest curve

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11
Q

Afrezza is an ____ form of insulin

A

inhaled -Powdered human insulin
Insulin powder is aerosolized and delivered to the lungs .

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12
Q

what do you give to treat fruity breath odor of acetone

A

give insulin drip until acetone goes away

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13
Q

how do you treat DKA

A

IV insulin (regular)
IV fluids, Dextrose
Correct electrolytes, K+

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14
Q

symptoms of hypoglycemia (<70 mg/dL)

A

“TIREDD”
T- tachy
-i - irritability
r- restless
E- excessive hunger
d- depressed
d- diaphoresis

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15
Q

Insulin allergy is mediated via

A

anti insulin IgE-mediated
local cutaneous reactions, angioedema, urticaria

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16
Q

Immune insulin resistance is mediated via

A

IgG antibodies
neutralize the action of insulin

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17
Q

Neuroglycopenic symptoms: Difficulty in
concentrating, confusion, weakness, drowsiness, a feeling
of warmth, dizziness, blurred vision, and loss of
consciousness
is seen in what glucose levels

A

:(<40 mg/dL)

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18
Q

lipoatrophy is due to

A

Atrophy of
subcutaneous fat at the site of insulin injection

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19
Q

what is lipohypertrophy

A

lipohypertrophy (enlargement of subcutaneous fat
depots)

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20
Q

if glucose is low counter regulatory hormones kicks in to raise it . those are :

A

glucagon
growth hormone
cortisol
epnephrine

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21
Q

what is the MOA of glucagon

A

lucagon molecule bind to specific Gs protein-coupled
receptors on liver and heart → increase in cAMP → hyperglycemia & inotropic and chronotropic effect on the heart without requiring functioning beta-adrenergic receptors.

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22
Q

what are the adverse effects of glucagon

A

Nausea

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23
Q

what are the uses for glucagon

A

Severe hypoglycemia
- glucagon injection
Endocrine diagnosis
Beta adrenergic receptor blocker overdose
- Ability to increase cAMP production in the heart
Radiology of bowel
- Relaxes the intestine
- Used in radiology as an aid to X-ray visualization

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24
Q

what type of category are: sulfonylureas & Glitinides

A

Insulin secretagogues

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25
what type of category are: Biguanides & Thiazolidinediones
insulin sensitizers
26
what type of category are: Acarbose & Miglitol
alpha- glucosidase inhibitors
27
what type of category are: Sitagliptin & saxagliptin
DPP-4 inhbitors
28
what type of category are: Exenatide & Liraglutide
GLP-1 analogs
29
what type of category are: Pramlintide
Amlyin analogs
30
what type of category are: Canagliflozin
SGLTT inhbitors
31
what type of category are: Canagliflozin
SGLTT inhbitors
32
what are Sulfonylureas first generations?
FirsT-generation Tolbutamide Tolazamide Chlorpropramide
33
what are Sulfonylureas second generations?
second Generation ↓ Glipizide Glyburide Glimepiride
34
what are some use for Second Generation Sulfonylureas
* To control hyperglycemia in type 2 DM patients who cannot achieve appropriate control with changes in diet alone * Most effective when pancreatic ß cells are functioning * Most appropriate in non-obese
35
what are some Adverse effects of Sulfonylureas
Hypoglycemia Severe hypoglycemia  - Overdose  - Most common with glyburide Weight gain, Rashes, hypersensitivity
36
how can you tell if someone is taking Glipizide
- making more iinsulin - c-peptide is increased - antibodies are absent
37
how do you test if someone is ingesting sulphonyurea
perform urine sulphonylurea
38
MOA of Repaglinide, Nateglinide (D-phenylalanine) (no sulfur)
- Meglitinides Binds to 2 common sites of SUR, one unique site of meglitinides on beta cells of pancreas – Closure of ATP-sensitive K+ channels – Restoration of more normal insulin secretion – Glucagon secretion & hepatic glucose production  Rapid onset and short duration of action  Taken just before meals
39
what are some use for Repaglinide, Nateglinide (D-phenylalanine) (no sulfur)
Alone or with biguanides in type 2 diabetes & pts with S or SU allergy
40
which drug is safe in renal insufficency
Nateglinide is safe in renal insufficiency & lower incidence of hypoglycemia
41
MOA of metformin (biguanides)
**Inhibits hepatic glucose production **(through the activation of enzyme AMP-activated protein kinase (AMPK).  Inhibits mitochondrial Glycerol-3-phosphate dehydrogenase  Decreases renal gluconeogenisis ***Direct stimulation of glycolysis*** in tissues,  Converts glucose to lactate by enterocytes  Increases removal of glucose form blood ** Increases the hepatic sensitivity **to insulin  Reduction of plasma glucagon levels  Slowing the glucose absorption from GIT dec. Triglycerides
42
what are some uses for metformin
Appropriate for obese Type 2 diabetics Decreases Insulin resistance
43
what are the side effects for metformin
-Anorexia, nausea, vomiting, diarrhoea -Lactic acidosis ( inc. Blood lactate & anion gap, dec. pH, dec. HCO3) (Anion gap= [Na+ ] – ([Cl- ] + [HCO3]) -Vitamin B 12 deficiency
44
what are the contraindication in metformin
 Alcoholism  Renal and hepatic disease  Chronic cardiopulmonary dysfunction  Radiographic contrast studies, seriously ill patients,  Metabolic acidosis
45
what are the contraindication in metformin
 Alcoholism  Renal and hepatic disease  Chronic cardiopulmonary dysfunction  Radiographic contrast studies, seriously ill patients,  Metabolic acidosis
46
what is the MOA of Thiazolidinediones: Pioglitazone & Rosiglitazone
 Pioglitazone activates PPAR-γ & PPAR-α → Upregulation of adiponectin & fatty acid uptake → Triglyceride lowering activity (PPAR-α)  Decreases hepatic gluconeogenesis  Decreases insulin resistance [increases insulin sensitivity]
47
what are the adverse effects of Thiazolidinediones
* Fluid retention, edema, increased risk of heart failure. * Weight gain, loss of bone mineral density - atypical extremity bone fractures in women * Rosiglitazone carry more risk of Cardiovascular than Pio * Hepatotoxicity (Troglitazone discontinued to use by FDA
48
what are the contraindications of Thiazolidinediones
* Patients with a history of heart failure * Active liver disease (or elevated transaminase levels) - due to increased risk of hepatic injury
49
what is the MOA for Acarbose, Miglitol
* Inhibitor of α-glucosidase in the brush borders of small intestine & inhibits amylase * Delay carbohydrate digestion and absorption * Decreased demand for insulin
50
what is the clinical uses for Acarbose, Miglitol
control postprandial hyperglycemia
51
what is the adverse effects for Acarbose, Miglitol
GI discomfort, Flatulence, Diarrhea, & hepatotoxicity
52
what is the adverse effects for Pramlintide
hypoglycemia
53
what is the MOA for Pramlintide
Suppresses glucagon release, delays gastric emptying, and has central nervous system-mediated anorectic effects
54
what are the uses for Pramlintide
Modulates postprandial glucose levels → Preprandial use in individuals with type 1 and type 2 diabetes.
55
A synthetic analog of amylin given by injection is
pramlintide
56
what is the MOA of EXENATIDE, Liraglutide
A synthetic analog of glucagon-like-polypeptide 1 (GLP-1)  Adjunctive therapy with metformin or sulfonylureas  Potentiation of glucose-mediated insulin secretion,  Decreases glucagon release  Slowed gastric emptying, increase satiety, loss of appetite  Increased beta cell mass result from decreased beta cell apoptosis
57
what are the side effects of EXENATIDE, Liraglutide
 Nausea, hypoglycemia with sulfonylureas  Necrotizing & hemorrhagic pancreatitis
58
what is the MOA of SITAGLIPTIN, Saxagliptin
Inhibitor of dipeptidyl peptidase-4 (DPP-4)  Inhibiting the inactivation of GLP-1  Increase levels of GLP-1, GIP – increasing glucose mediated insulin secretion and decreasing glucagon levels
59
what are the adverse effects of SITAGLIPTIN, Saxagliptin
Naso-pharyngitis, upper respiratory infections, head aches, hypoglycemia, acute pancreatitis, joint pain.
60
what are the MOA of Canagliflozin, Dapagliflozin, Empagliflozin
SGLT2- inhibitors-inhibits glucose reabsorption in PCT → decrease blood glucose
61
what are the side effects of Canagliflozin, Dapagliflozin, Empagliflozin
hypotension/dehydration, & genital mycotic infections, hyperkalemia, weight loss
62
what are the contraindications of Canagliflozin, Dapagliflozin, Empagliflozin
severe renal impairment
63
what is the MOA of Colesevelam
decreased Farnesoid X receptor (FXR) activation -FXR is a nuclear receptor with multiple effects on cholesterol, glucose & bile acid metabolism. -Decrease glucose absorption dec. HbA1c by 0.5%, LDL by 15%
64
what is the side effects of Colesevelam
Constipation, Indigestion & flatulance
65
what is the C/I of Colesevelam
Hypertriglyceridemia, pacreatitis, esophagial, gastric & duodenal disorders
66
list the anti-obesity drug names
Orlistat, Lercaserin, Phenteramine/topiramate, Bupropionnaltrexone
67
what is the MOA of Orlistat
Alters fat digestion by inhibiting pancreatic lipases.  In hypertensive patients, orlistat improves blood pressure (likely due to weight loss)
68
what is the adverse effects of Orlistat
GI upset; cramps, flatus, fecal incontinence, oily spotting, and flatus with discharge Renal – Oxalate-induced acute kidney injury has also been reported in orlistat users
69
what is the contraindications of Orlistat
not be used during pregnancy or in patients with chronic malabsorption, cholestasis, or a history of calcium oxalate stones.
70
what is the MOA of Phentermine, diethylpropion, benzphetamine, phendimetrazine
Stimulate the release of norepinephrine or inhibit its reuptake into nerve terminals, and sympathomimetic drugs reduce food intake by causing early satiety.
71
what is the adverse effects of Phentermine, diethylpropion, benzphetamine, phendimetrazine
All sympathomimetic drugs can increase heart rate and blood pressure and cause insomnia, dry mouth, constipation, and nervousness.
72
what is the MOA of Lorcaserin
is a selective agonist of the serotonin 2C receptor. It reduces appetite and thereby reduces body weight in men and women
73
what is the adverse effects of Lorcaserin
Headache, upper respiratory infections, nasopharyngitis, dizziness, and nausea
74
what is the contraindications of Lorcaserin
should not be used in individuals with CrCl <30 mL/min. It is contraindicated during pregnancy
75
what are the drug interactions for Lorcaserin
**lorcaserin should not be used with other serotonergic drugs *** (ex :SSRI'S, SNRI'S, bupropion, TCA's, and monamine oxidase inhibitors), because of the theoretical potential for *****serotonin syndrome****

CAS 3 (10 decks)

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