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Flashcards in Endo Pharm Deck (58):
0

What is the treatment strategy for a type I diabetic?

Low sugar diet and insulin replacement

1

What is the tx strategy for type II diabetic patients?

Diet modification
Exercise/ weight loss
Oral hypoglycemics
Insulin replacement (end-stage)

2

What is the MOA of insulin?

Bind insulin receptor - tyrosine kinase activity
Causes increased glucose storage as glycogen in liver, muscle
Increased protein synthesis
Potassium uptake (forces potassium into the cells)
Aids in TG storage

3

What are the rapid acting insulins?

Lispro
Aspart
Glulisine

4

What is the intermediate acting insulin?

NPH

5

What are the long acting insulins?

Glargine
Detemir

6

What are the toxicities of insulin?

Hypoglycemia
Hypersensitivity

7

What is the action of biguanides?

Decrease gluconeogenesis
Increase glycolysis
Increase peripheral glucose uptake

8

What are biguanides used for?

First line for Type II

9

What is the tox of biguanides?

GI upset
Lactic acidosis (CI in renal failure)

10

What is the MOA of sulfonylureas?

Close K channel in beta cell membrane so cell depolarizes and insulin is released via calcium influx

11

What are sulfonylureas used for?

Stimulate release of insulin in Type II
Requires some islet fxn

12

What are the side effects of first gen sulfonylureas?

Disulfiram-like effects

13

What are the first gen sulfonylureas?

Tolbutamide
Chlorpropamide

14

What are the second gen sulfonylureas?

Glyburide
Glimepiride
Glipizide

15

What is the tox in second gen sulfonylureas?

Hypoglycemia

16

What is the MOA of glitazones?

Increase insulin sensitivity in peripheral tissue
Binds PPAR-gamma nuclear transcription regulator

17

What are glitazones used for?

Used as monotherapy in type II

18

What is the tox in glitazones?

Weight gain
Edema
Hepatotoxicity
Heart failure

19

What is the MOA of alpha glucosidase inhibitors?

Inhibit intestinal brush border alpha glucosidase
Delay sugar hydrolysis and glucose absorption so it decreases postprandial hyperglycemia.

20

What are the alpha glucosidases?

Acarbose
Miglitol

21

What are alpha glycosidase inhibitors used for?

Monotherapy type II

22

What is the tox of alpha glucosidase inhibitors?

GI disturbances

23

What is the MOA of amylin analog (pramlintide)?

Decreases glucagon

24

What is pramlintide used for?

Type I and type II DM

25

What are the side effects of pramlintides?

Hypoglycemia
Nausea
Diarrhea

26

What is the MOA of GLP-1 analogs?

Increase insulin
Decrease glucagon release

27

What are the GLP-1 analogs?

Exenatide
Liraglutide

28

What are GLP-1 analogs used for?

Type II DM

29

What are the side effects of GLP1 analogs?

Nausea
Vomiting
Pancreatitis

30

What is the MOA of Dpp-4 inhibitors?

Increase insulin
Decrease glucagon release

31

What are the Dpp 4 inhibitors?

The gliptins
Linagliptin
Saxagliptin
Sitagliptin

32

What are Dpp 4 inhibitors used for?

Type II DM

33

What are the side effects of Dpp 4 inhibitors?

Mild urinary or respiratory infections

34

What does activation of PPAR- gamma cause?

Increase insulin sensitivity
Increased levels of adiponectin

35

What is the MOA of propylthiouracil?

Blocks peroxidase thereby inhibiting organification of iodide and coupling of thyroid hormone synthesis
Blocks 5'-deiodinase blocking conversion of T4 to T3

36

What is the MOA of methimazole?

Blocks peroxidase thereby inhibiting organification of iodide and coupling of thyroid hormone synthesis

37

What are methimazole and propylthiouracil used for?

Hyperthyroid

38

What are the toxicities of propylthiouracil and methimazole?

Skin rash
Agranulocytosis
Aplastic anemia
Hepatotoxicity (propylthiouracil)
Teratogen (methimazole)
Edema

39

What is GH given for?

Turner syndrome and GH deficiency

40

What is octreotide given for?

Acromegaly
Carcinoid
Gastrinoma
Glucagonoma
Esophageal varices

41

What is oxytocin given for?

To stimulate labor, uterine contractions, milk-let down
Controls uterine hemorrhage

42

What is desmopressin given for?

Central diabetes insipidus

43

What is the MOA of demeclocycline?

ADH antagonist

44

What is the demeclocycline used for?

SIADH

45

What is the tox of demeclocycline?

Nephrogenic DI
Photosensitivity
Abnormalities of bone and teeth

46

What are the glucocorticoids?

Hydrocortisone
Prednisone
Triamcinolone
Dexamethasone
Beclomethasone

47

What is the MOA of glucocorticoids?

Decreased production of leukotrienes and prostaglandins by inhibiting phospholipase A2 and expression of COX2

48

What is the tox of glucocorticoids?

Iatrogenic Cushing's

49

How do the glitazones work?

They increase insulin sensitivity in target tissues by increasing the expression of GLUT4 in target tissues and causes differentiation of pre-adipocytes to adipocytes by up regulating transcription of insulin responsive genes

50

What is repaglinide?

A meglinitide derivative, short-acting insulins tropic agent used in type II with diet and exercise. MOA is similar to sulfonylureas but doesn't cause insulin release when extra cellular glucose is low

51

When should executive be used?

For type II diabetics with suboptimal glucose control despite adequate levels of metformin and sulfonylureas

52

Which drugs are known to cause SLE-like syndrome?

Hydralazine
Procainamide
Isoniazid
Minocycline
Quinidine

53

Which insulin is best to decrease postprandial glucose level?

Lispro
Aspart
Glulisine
Peak at 45-75 minutes

54

Which insulin is best for IV use DKA?

Regular insulin - peak 2-4 hours

55

What is the duration of NPH and why?

It is a crystalline suspension of protamine and zinc which prolongs the duration of action. It starts working within 2 hours, peaks at 12 and ends at 18

56

What is the duration of glargine and why?

It last 24 hours because it precipitates in the subcutaneous tissue allowing for slow absorption

57

What is the duration of action of detemir and how does it work?

It has a fatty acid bound to a losing residue that allows it to bind to albumin and slowly dissociate from there.
It lasts 24 hours and peaks between 3-9