Type2

Question 1

Biguanides

Answer 1

Metformin

Question 2

Alpha-glucosidase inhibitors

Answer 2

acarbose (precose), miglitol (glyset)

Question 3

Meglitinide agonists

Answer 3

Repaglinide (Prandin)

Question 4

D-Phenylalanine derivative

Answer 4

Nateglinide (Starlix)

Question 5

Sulfonylureas

Answer 5

Glimepride (amaryl), glyburide (diabeta, micronase, glynase), glipizide (glucotrol, gluctrol XL)

Question 6

Thiazolidinediones

Answer 6

Pilgitazone (actos), Rosiglitazone (avandia)

Question 7

GLP-1 receptor agonists (injectable)

Answer 7

exenatide (Byetta), liraglutide (victoza)

Question 8

DPP-4 inhibitors

Answer 8

Sitagliptin (Januvia), Saxagliptin (onglyza), linagliptin (tradjecta)

Question 9

Metformin C/I

Answer 9

GFR less than 30, less than 80 yrs

Question 10

Metformin mechanism

Answer 10

improves insulin action at LIVER

MUSCLE glucose uptake

Question 11

Metformin S/E

Answer 11

GI upset; metallic taste (usually transient)

Lactic acidosis = RARE

Question 12

Metformin renal dosing

Answer 12

GFR less than 30 – do NOT use
30-45 – if on metformin, decrease dose
30-45 – not on metformin, dont start

Question 13

Metformin drug interaction

Answer 13

cimetidine

Question 14

Metformin advantages

Answer 14

No hypoglycemia
Decreases microvascular and CVD events
Lack of weight gain – potential weight reduction
Improves lipid profile (decreases TG and LDL)

Question 15

Sulfonylureas (second generation preferred) MOA

Answer 15

stimulates beta cell secretion of insulin

Question 16

Sulfonylureas disadvantages

Answer 16

Higher risk of hypoglycemia; weight gain

Question 17

Avoid in early stages of typical DM2

Answer 17

sulfonylureas

Question 18

risk for lactic acidosis

Answer 18

metformin

Question 19

TZD MOA

Answer 19

more focus on glucose uptake in muscle and adipose tissue

Question 20

Slow onset (2-3 months)

Answer 20

TZD

Question 21

Advantage of Pioglitazone (actos)

Answer 21

favorable response in lipid

Question 22

Disadvantage of TZD

Answer 22

weight gain
Edema due to increased plasma volume
AVOID in CHF patients
avoid in liver dysfunction

Question 23

Moderate bone loss

Answer 23

TZD

Question 24

Alternative to metformin

Answer 24

TZD

Question 25

Usually used in combo except very early in diagnosis of DM2

Answer 25

TZD

Question 26

DPP-IV Inhibitors MOA

Answer 26

prevents breakdown of GLP-1

Question 27

Mainly lowers post-prandials

Answer 27

DPP-4 Inhibitors

Question 28

DPP-4 Inhibitors increased risk of heart failure

Answer 28

Saxaglipton | Alogliptin

Question 29

No increased risk of MACE (DPP-4)

Answer 29

Sitagliptin, Linagliptin

Question 30

GLP-1 Agonists MOA

Answer 30

mimics GLP-1 (increases insulin release, decreases glucagon release) does NOT impair normal glucagon response to hypoglycemia

Question 31

GLP-1 Agonists S/E

Answer 31

Slows gastric emptying (GI effects) Increases HR Small risk -- acute pancreatitis

Question 32

GLP-1 Agonists CI

Answer 32

Gastroporesis | severe renal impairment (Byetta, Bydureon)

Question 33

Daily (short acting) GLP-1 Agonists

Answer 33

exenatide | liraglutide

Question 34

Weekly (long acting)

Answer 34

albiglutide dulaglutide exenatide

Question 35

GLP-1 primarily targeting PPG (usually BOTH FBG and PPG)

Answer 35

exenatide (byetta) | albiglutide (tanzeum)

Question 36

GLP-1 advantages

Answer 36

no hypoglycemia weight loss decreases some CV risk factors decreases postprandial glucose excursions

Question 37

SGLT-2 Inhibitors MOA

Answer 37

upregulates SGLT-2 --> renal threshold for glucose reabsorption increased

Question 38

SGLT-2 (FBG or PPG?)

Answer 38

targets FBG primarily

Question 39

SGLT-2 Advantages

Answer 39

no hypoglycemia weight loss decreases BP slightly

Question 40

SGLT-2 Disadvantages

Answer 40

GU infections -- UTI most common increases LDL volume depletion/dizziness BONE LOSS potential