Endocrine

Question 1

Which diabetes drugs are insulin sensitizers?

Answer 1

-Biguanides = Metformin
-TZDs = “-glitasone”

Question 2

Describe Metformin

Answer 2

-Magic drug, MOA not fully known
-1st line unless someone has CKD

-No risk of hypoglycemia
-Weight loss

-Diarrhea for 2 weeks with increase in dose
-Lactic acidosis, esp. with renal failure

Question 3

Describe Thiazolidinediones (TZDs)

Answer 3

-Agonist for PPAR-gamma which induces GLUT4 insertion in the membrane

-No hypoglycemia

-More glucose into adipocytes = weight gain
-Acting at the collecting duct = fluid retention (CHF exacerbation)
-Osteopenia
-Bladder cancer

Question 4

What are the drugs that result in insulin release?

Answer 4

-Sulfonylureas = Glimepiride, Glipizide, glyburide
-Meglitinides

-They close the K channel and induce depolarization for exocytosis of insulin

-Risk of hypoglycemia
-Weight gain
-Exacerbated in AKI

Question 5

Describe the Incretin drug category

Answer 5

-Stomach release of GLP-1 in response to meal to prime the pancreas
-Release of DPP4 degrades GLP-1
-Mimics/sustains incretins

-Increased satiety = weight loss
-Risk of pancreatitis & pancreatic cancer

-GLP-1 Analogs = “-anatides”
-DPP4-Inhibitors = “-gliptins”, May not work

Question 6

What are the drugs that decrease total body glucose?
(Insulin-Independent)

No hypoglycemia, no weight gain

Answer 6

-Acarbose = alpha-galactosidase inhibitor
-Prevents absorption of glucose in the intestines/ decreases digestion
-Glucose remains in the gut = diarrhea, flatulence
-Low patient adherence

-SGLT-2 Inhibitors = “-gliflozins”
-Blocks PCT resorption of glucose once filtered, remains in the tubule
-Considered a diuretic because water will follow
-Can result in euvolemic DKA (not ideal)

Question 7

What are the long-acting insulins?

Answer 7

-Glargine, Detemir, Degludec

Question 8

What are the short-acting insulins?

Answer 8

-Aspart, Lispro, Glulisine

Question 9

What is mixed insulin?

Answer 9

-Combo of NPH (Not long acting) & regular insulin (not rapid acting)

-They come in different ratios of the 2

Question 10

Describe Thioamides

Answer 10

-Ex = Propylthiouracil (PTU), Methimazole

-Blocking thyroid peroxidase = blocking coupling of iodotyrosines (formation of T3/T4 molecules stored in the colloid)
-Also block iodine organification

-Used in hyperthyroidism

Question 11

What is Sevelamer?

Answer 11

-It is used for ESRD with hyperphosphatemia (pts have impaired renal excretion due to poor function)
-They also need diet restriction of phosphorous

-The drug is a nonabsorbable anion-exchange resin that decreases intestinal absorption of phosphorous
-The resulting complex is eliminated in feces