State whether the following is rapid, short, intermediate, or long-acting: lispro; detemir; aspart; glargine; glulisine; NPH; regular insulin.
Rapid; long; rapid; long; rapid; intermediate; short
How does insulin work?
Binds to insulin receptor (tyrosine kinase activity)
T/F: Insulin is safe to use in women with gestational diabetes?
TRUE
What is the toxicity associated with insulin?
Hypoglycemia
What is metformin’s effects on gluconeogenesis, glycolysis, and peripheral glucose uptake?
Dec, inc, dec
What is the first-line therapy for type 2 DM?
Metformin
T/F: Metformin cannot be used in patients without islet function.
FALSE: CAN be used
What is the most serious adverse effect associated with metformin?
Lactic acidosis (thus contraindicated in renal failure)
Describe how sulfonylureas work.
Close K+ channel in B-cell membrane, so cell depolarizes, triggering insulin release via increased Ca influx.
T/F: Sulfonylureas require some islet function, so it is useless in type 1 DM.
TRUE
What are the toxicities associated with sulfonylureas?
First generation: disulfiram-like effects; second generation: hypoglycemia
Glitazones/thiazolidinediones bind to which regulator?
PPAR-gamma
Can glitazones/thiazolidinediones be used as monotherapy in type 2 DM?
Yes, or can be used in combination with other agents
What are the toxicities associated with glitazones/thiazolidinediones?
Weight gain, edema, hepatotoxicity, heart failure
T/F: Pramlintide is used in type 2 DM only.
FALSE: Types 1 AND 2 DM
What are some toxicities associated with GLP-1 analogs?
Nausea, vomiting, pancreatitis
Name 2 GLP-1 analogs.
Exenatide, liraglutide
Name 3 DPP-4 inhibitors.
Linagliptin, saxagliptin, sitagliptin
T/F: GLP-1 analogs and DPP-4 inhibitors are used in type 2 DM only.
TRUE
Propylthiouracil blocks _____ and _____.
Peroxidase and 5’-deiodinase
Name some toxicities associated with propylthiouracil.
Skin rash, agranulocytosis (rare), aplastic anemia, hepatotoxicity
T/F: Methimazole is safe to use in pregnancy.
FALSE: Methimazole is a possible teratogen
What are some toxicities associated with levothyroxine?
Tachycardia, heat intolerance, tremors, arrhythmias
Name 2 conditions for which GH is used.
GH deficiency, Turner syndrome
Name 5 conditions for which somatostatin (octreotide) is used.
Acromegaly, carcinoid, gastrinoma, glucagonoma, esophageal varices
Name 4 conditions for which oxytocin is used.
Stimulates labor, uterine contractions, milk-let down; controls uterine hemorrhage
Name a condition for which ADH (desmopressin) is used.
Pituitary (central, not nephrogenic) DI
Demeclocycline is a _____ antagonist used to treat _____.
ADH; SIADH
What are some toxicities associated with demeclocycline?
Nephrogenic DI, photosensitivity, abnormalities of bone and teeth
Glucocorticoids decrease the production of _____ and _____ by inhibiting _____ and expression of _____.
Leukotrienes; prostaglandins; phospholipase A2; COX-2
What is a toxicity of glucocorticoids?
Iatrogenic Cushing’s syndrome
A patient has been using glucocorticoids for several years, but abruptly stopped using it. What is the patient at risk for?
Adrenal insufficiency
