Non-Insulin Anti-Diabetics

Question 1

Name the 4 groups of ORAL hypoglycemics

Answer 1

Insulin secretagogues (sulfonylurea and meglitinides)
Biguanides
Thiazolidinediones (TZDs)
Alpha- glucosidase inhibitors

Question 2

Which non-insulin anti-diabetic drugs (2) produce the biggest drop in fasting plasma glucose AND HbA1c? MOAs?

Answer 2

Sulfonylureas: Stimulate insulin release via SUR1 subunit and reduce serum glucagon levels

metformin: inhibits gluconeogenesis

Question 3

Name the two first generation sulfonylureas

Answer 3

Tolbutamide

Chlorpropamide

Question 4

Which first generation sulfonylurea has a short half life and rarely causes hypoglycemia?

Answer 4

Tolbutamide

Question 5

Which first generation sulfonylurea has a long half life and is contraindicated in patients with hepatic or renal insufficiency?

Answer 5

Chlorpropamide

Question 6

Which sulfonylurea causes jaundice in doses over 500mg?

Answer 6

Chlorpropamide

Question 7

Which sulfonylurea is contraindicated in the elderly? Why?

Answer 7

Chlorpropamide

Higher risk of prolonged hypoglycemia

Question 8

Which sulfonylurea causes a hyperemic flush if taken with alcohol?

Answer 8

Chlorpropamide

Question 9

Which non-insulin anti-diabetic drugs can be used to treat central diabetes insipidus? How?

Answer 9

Sulfonylureas esp Chlorpropamide

Can cause SIADH -> hyponatremia

Question 10

Name the three second generation sulfonylureas

Answer 10

Glyburide
Glipizide
Glimepiride

Question 11

Which sulfonylurea results in hypoglycemia in 20-30% of pts?

Answer 11

Glyburide

Question 12

How do second generation sulfonylureas differ from first?

Answer 12

100x more potent and fewer adverse effects

Question 13

Which sulfonylurea has the shortest half life? Why is this important?

Answer 13

Glipizide

Less likely to cause serious hypoglycemia

Question 14

Which sulfonylurea is approved for once-daily monotherapy or in combo with metformin or insulin?

Answer 14

Glimepiride

Question 15

How are sulfonylureas delivered?

Answer 15

Orally

Question 16

Which oral anti-diabetic agents are associated with wt gain?

Answer 16

Sulfonylureas
Meglitinides
Thiazolidinediones (TZDs)

Question 17

Which group of oral anti-diabetic drugs can lead to tachyphylaxis? (where they initially respond to treatment then regress)

Answer 17

Sulfonylureas

Question 18

Name the two meglitinides. Which is more effective? MOA?

Answer 18

Repaglinide - more effective
Nateglinide

Like sulfonylureas, stimulate insulin secretion by binding SUR1 (at different place though)

Question 19

Which group of oral anti-diabetic drugs have rapid onset, short duration and are used for postprandial glucose regulation? When are they taken?

Answer 19

Meglitinides

Taken before each meal

Question 20

Which class of oral anti-diabetic drugs can safely be given to patients with a sulfa allergy?

Answer 20

Meglitinides

Question 21

Which insulin secretagogue produces fewer incidences of hypoglycemia?

Answer 21

Nateglinide

Secretagogues are sulfonylureas and meglitinides

Question 22

Name the only biguanide. MOA?

Answer 22

Metformin

Inhibits gluconeogenesis by reducing gene expression of necessary enzymes

Question 23

Which oral anti-diabetic drug doesn’t cause hypoglycemia even at large doses?

Answer 23

Metformin

Question 24

Which oral anti-diabetic drug is associated with a LOSS of weight?

Answer 24

Metformin

Question 25

What is the only hypoglycemic drug shown to reduce macro vascular events in type II DM?

Answer 25

Metformin

Question 26

What is the first line therapy in type II DM?

Answer 26

Metformin + diet and exercise

Question 27

Which oral anti-diabetic drug is not metabolized and excreted in urine?

Answer 27

Metformin

Question 28

Which oral anti-diabetic drug used long term can interfere with B12 absorption?

Answer 28

Metformin

Question 29

What is metformin's major adverse effect in 20% of pts?

Answer 29

GIT: anorexia, nausea, vomiting, diarrhea

Question 30

Which oral anti-diabetic drug is contraindicated in pts with renal or hepatic disease due to increased risk of lactic acidosis?

Answer 30

Metformin

Question 31

What is a major off label use for metformin?

Answer 31

It lowers insulin resistance and can lead to ovulation in PCOD and possibly pregnancy

Question 32

Name the two thiazolidinediones (TZDs)

Answer 32

Pioglitazone | Rosiglitazone

Question 33

Which oral anti-diabetic drugs act by agonism of PPAR-gamma? How does this decrease insulin resistance?

Answer 33

TZDs (-glitazones) PPAR-gamma is involved in lipid and glucose metabolism and TZDs promote glucose uptake and use in adipose tissue

Question 34

Which class of oral anti-diabetic drugs has a slow onset that can take weeks to months to act? Why?

Answer 34

TZDs because they act through gene expression

Question 35

Which TZD increases HDL and decreases TAGs? How does the other affect lipids?

Answer 35

Pioglitazone | Rosiglitazone also inc HDL but has no effects on TAGs and also increases LDL

Question 36

Which class of oral anti-diabetic drugs is contraindicated in class III and class IV heart failure?

Answer 36

TZDs

Question 37

Which class of oral anti-diabetic drugs requires periodic monitoring of liver function?

Answer 37

TZDs (and Acarbose - alpha-glucosidase inhibitor)

Question 38

Name the two alpha-glucosidase inhibitors. MOA?

Answer 38

Acarbose Miglitol Reduce postprandial digestion and absorption of starch and disaccharides

Question 39

Which class of oral anti-diabetic drugs are associated with increased flatulence and contraindicated in IBD?

Answer 39

Alpha-glucosidase inhibitors

Question 40

Pt is using Acarbose and a sulfonylurea and develops hypoglycemia. How should he be treated and why

Answer 40

With glucose because breakdown of sucrose is inhibited by Acarbose

Question 41

What must be monitored in patients taking Acarbose?

Answer 41

Liver function

Question 42

Which drug is a GLP-1 analog derived from the salivary gland of the Gila monster? MOA?

Answer 42

Exenatide Incretin resistant to DPP-IV (enzyme that degrades incretins) so it enhances glucose-dependent insulin secretion, suppresses glucagon release, slows gastric emptying, and decreases appetite

Question 43

How is exenatide administered? Type of drug?

Answer 43

SC injection 2x/day | Incretin analog

Question 44

Which drug is given orally and is a selective inhibitor of DPP-IV? What is DPP-IV?

Answer 44

Sitagliptin | DPP-IV degrades incretins

Question 45

Which drug is a synthetic analog of amylin? MOA?

Answer 45

Pramlintide They both inhibit food intake, gastric emptying, and glucagon secretion Amylin is cosecreted with insulin

Question 46

Which anti-diabetic drug lowers LDL, slightly reduces HbA1c, and can cause constipation, dyspepsia and increase TAGs?

Answer 46

Colesevelam Bile-acid sequestrant

Question 47

What is the only drug approved for use in conjunction with insulin for type II diabetes?

Answer 47

Metformin

Question 48

If initial treatment with metformin does not work, what is the next step? How do you choose which drug to give?

Answer 48

Either insulin or a sulfonylurea | Give insulin if HbA1c is >8.5%

Question 49

If hypoglycemia is particularly undesirable and weight loss is a major goal, what drug would you prescribe, assuming HbA1c is <8%?

Answer 49

Exenatide

Question 50

What is the most effective diabetes medication at lowering glycemia?

Answer 50

Insulin

Question 51

When is insulin considered as a first line treatment?

Answer 51

When HbA1c is >10%

Question 52

Name two effects glucagon can have on cancers.

Answer 52

Causes release of insulin from pancreas, catecholamines from pheochromocytoma, and calcitonin from medullary carcinoma

Question 53

Which anti-diabetic drug is used in radiology of the bowel due to its ability to relax intestine?

Answer 53

Glucagon

Question 54

Which type of insulin is used in an insulin pump?

Answer 54

Rapid acting