020515 diabetes pharm

Question 1

how is insulin secretion controlled?

Answer 1

stimulators:
GLUCOSE (taken up by GLUT2 receptor in beta cell)
amino acids
fatty acids
indirect (GH or cortisol)

inhibitors:
somatostatin (paracrine effect within pancreas)

Question 2

effect of glucagon

Answer 2

increases gluconeogenesis in liver

tissue release of glucose, fatty acids, ketoacids into circulation

Question 3

glucagon-like peptides (GLPs)

Answer 3

secreted from gut in response to feeding
acute-increases insulin response to glucose
chronic-increases beta cell mass

Question 4

the injectable form of insulin has what structure

Answer 4

no C peptide

Question 5

insulin formulations

Answer 5

regular insulin
NPH insulin (colloidal suspension that's intermediate acting)
pre-mixed insulin-mixtures of NPH and short acting

Question 6

advantage of insulin lispro over regular insulin

Answer 6

insulin lispro is shorter acting. regular insulin outlasts the calories of the meal, so you can get hypoglycemia

Question 7

long acting insulin analogs

Answer 7

insulin glargine (24-36 hr duration-the longest)
insulin detemir (long acting due to self association in the subcu injection site AND by binding to albumin in blood stream)

Question 8

short acting insulin analogs

Answer 8

lispro insulin
insulin aspart
insulin glulisine

Question 9

goal for diabetic fasting glucose

Answer 9

70-130

Question 10

side effects of insulin

Answer 10

hypoglycemia
insulin allergy
lipoatrophy
lipohypertrophy
insulin edema
weight gain-if you don't watch diet

Question 11

sulfonylureas

Answer 11

stimulate insulin secretion by pancreas by inactivating K channel in beta cell (this causes depolarization, which causes influx of Ca into cell, which causes insulin to be released)

glipizide
glyburide
glimepiride

Question 12

side effects of sulfonylureas

Answer 12

HYPOGLYCEMIA
rashes
GI side effects
drug interactions

Question 13

metformin’s MOA

Answer 13

makes liver more sensitive to insulin–principal result is decreasing hepatic gluconeogenesis

Question 14

side effects of metformin

Answer 14

GI
most serious: lactic acidosis (don’t prescribe metformin in pts with RENAL INSUFFICIENCY b/c can lead to lactic acidosis. also don’t use in pts with liver dysfxn)

Question 15

thiazolidinediones’ MOA

Answer 15

make peripheral tissues such as FAT and MUSCLE more sensitive to insulin (PPAR receptor agonists)

Question 16

side effects of thiazolidinediones

Answer 16

liver toxicity
weight gain
fluid retention

Question 17

MOA of alpha glucosidase inhibitors

Answer 17

inhibits enteric enzymes that break down complex carbs, resulting in partial malabsorption of carbs

Question 18

side effects of alpha glucosidase inhibitors

Answer 18

bloating, diarrhea, gas

Question 19

acarbose

Answer 19

alpha glucosidase inhibitor

Question 20

how do GLP-1 receptor agonists work?

Answer 20

acts like the GLP-1 peptide that is secreted in response to eating

augments insulin secretion, increases beta cell mass, inhibits glucagon secretion, promotes some weight loss

Question 21

side effects of GLP-1 receptor agonists

Answer 21

nausea, emesis, diarrhea, headaches

Question 22

MOA of SGTP-2 inhibitors

Answer 22

inbhits sodium-glucose transporters in the kidney, causing glycosuria

Question 23

side effects of SGTP-2 inhibitors

Answer 23

yeast infections

dehydration

Question 24

what is the relative efficacy of oral agents in decreasing hemoglobin a1c

Answer 24

better:
sulfonyulreas
metformin
thiazolidinediones

worse:
acarbose
DPP-4 inhibitors
SGTP-2 inhibitors