treatment of diabetes

Question 1

what is the first line therapy in newly diagnosed T2DM ?

Answer 1

lifestyle modification - 3-6 month trial

Question 2

what are the biguanides ?

Answer 2

metformin

Question 3

what is the primary effect of metformin ?

Answer 3

lower hepatic glucose production
increases glycolysis
decreases glucogenesis

Question 4

what is the most common adverse effect of metformin ?

Answer 4

GI upset
lactic acidosis
vitamin B12 deficiency

Question 5

when does lactic acidosis happen when given with metformin ?

Answer 5

in patients with renal insufficiency
liver disease

Question 6

when is metformin held or avoided ?

Answer 6

patients with renal insufficiency
patients with lactic acidosis (bicarb is low)
p[patients with liver disease
patient undergoing IV contrast

Question 7

what is the MOA of sulfonylurea ?

Answer 7

close potassium channels
so they increase insulin release

Question 8

what is the major side effect of sulfonylurea ?

Answer 8

hypoglycemia
weight gain

Question 9

what are common examples of sulfonylureas ?

Answer 9

glipizide
glyburide

Question 10

what is the side effect associated with first generation sulphonylureas ?

Answer 10

disulfram like reaction
hyponatremia

Question 11

close cousin to sulfonylurea ?

Answer 11

meglitinides

Question 12

when can meglitinides be used ?

Answer 12

used in patients with sulfa allergies

Question 13

what is the MOA of TZD ?

Answer 13

decreases insulin resistance
all of them end in glitazone

Question 14

what are the receptors associated with TZDs?

Answer 14

PPAR gamma receptors

Question 15

where are TZD receptors highest in concentration ?

Answer 15

PPAR gamma receptors are highest in adipose tissue

Question 16

after TZD bind to PPAR gamma receptors , what does this complex bind to ?

Answer 16

RXR retinoid X receptors

Question 17

what are the major side effects of TZDs ?

Answer 17

may case weight gain
risk of hepatotoxicity

Question 18

what type of patients should avoid TZDs ?

Answer 18

patients with heart failure due to increased risk of pulmonary edema

Question 19

what are the alpha glucosidase inhibitors ?

Answer 19

acarbose
miglitol
voglibose

Question 20

what is the MOA of alpha glucosidae inhibitors ?

Answer 20

decrease absorption of glucose in the small intestine

Question 21

what is the main side effect of alpha glucosidase inhibitos ?

Answer 21

diarrhea
flatulence

Question 22

what are the amylin analogs ?

Answer 22

pramlintide

Question 23

what is the MOA of amylin ?

Answer 23

hormone that is co secreted with insulin
that suppresses glucagon release
always given with insulin

Question 24

what are the main side effects of amylin ?

Answer 24

hypoglycemia
nausea

Question 25

what are incretins ?

Answer 25

hormones that increase insulin secretion including GIP GLP-1

Question 26

oral glucose or IV glucose metabolized faster ?

Answer 26

oral glucose

Question 27

what are the GLP 1 analogues ?

Answer 27

exenatide liraglutide

Question 28

what are the side effects of GLP. ?

Answer 28

nause and diarrhea

Question 29

what are the DPP 4 inhibitors ?

Answer 29

sitagliptin linagliptin

Question 30

what is the MOA of DPP4 inhibitors ?

Answer 30

DPP4 normally breaks down the incretins with its inhibiton the effects of GLP1 and GIP last longer

Question 31

what are the side effects associated with DPP-4 inhibitors ?

Answer 31

infections due to glycosuria urinary infections, vulvovaginitis respiratory infections weight gain

Question 32

what are the SGLT2 inhibitors ?

Answer 32

canagliflozin dapagliflozin

Question 33

what is the MOA of SGLT 2 inhibitors ?

Answer 33

block the reabsorption of glucose in proximal convulated tubules

Question 34

what are the side effects of SGLT 2 inhibitors ?

Answer 34

glucosuria vulvovaginal candidiasis UTI weight loss

Question 35

renal failure avoid ?

Answer 35

metformin

Question 36

advanced heart failure avoid ?

Answer 36

TZDs Metformin