27: Drugs for DM

Question 1

fasting glucose levels diagnostic for DM

Answer 1

125+

Question 2

insulin vs non-insulin dependent DM

Answer 2

insulin dependent = type 1

non-insulin dependent = type 2

Question 3

what is type 4 DM

Answer 3

gestational DM

Question 4

three anabolic effects of insulin on carb metabolism

Answer 4

1. GLUT4 translocation to membrane in skeletal muscle, cardiac myocytes, adipocytes
2. activates glycolysis
3. activates glycogen synthesis

Question 5

two ways insulin opposes catabolism

Answer 5

1. inhibits gluconeogenesis

2. inhibits glycogenolysis

Question 6

treatmnt for severe hyperkalemia involving insulin

Answer 6

Insulin, glucose, furosemide

Question 7

signs of hypoglycemia

Answer 7

1. CNS: confusion, weird behavior, szrs, coma
2. symps: tachy, palpitations, sweating, tremor
3. parasymps: hunger, nausea

Question 8

two drug types that promote insulin secretion (GPCR-Gs ligands) vs two that inhibit insulin secretion (GPCR-Gi)

Answer 8

1. promote: B2-adrenergics, GLP-1 receptor agonists

2. inhibit: somatostatin, a2-adrenergics

Question 9

incretins

Answer 9

group of GI hormones that cause a decrease in blood glucose levels

Question 10

a major incretin

Answer 10

GLP-1 (glucagon-like peptide1)

Question 11

what cell type makes GLP-1

Answer 11

intestinal L cells

Question 12

why are GLP-1 analogs not great on their own as drugs?

Answer 12

they are destroyed quickly by DPP-4

Question 13

how to calculate anion gap

Answer 13

Na - (Cl + bicarb)

Question 14

how does rapid-acting insulin work so fast?

Answer 14

blocks assembly of dimers for rapid absorption

Question 15

how does short-acting insulin work?

Answer 15

activates phosphoinositide3 kinase

Question 16

how does long-actingin insulin last so long?

Answer 16

binds strongly to albumin for a slow release

Question 17

pramlintide MOA

Answer 17

inhibits glucagon, decreases gastric emptying

Question 18

drug intx for amylin analogs

Answer 18

anticholingerics -> increase constipation

Question 19

MOA of sulfonylurea and Meglitinides

Answer 19

K/ATP channel blockres by binding SUR1

Question 20

drugs that increase hypoglycemia and decrease efficiency of sulfonylureas

Answer 20

1. increase effects: sulfonamides, clofibrate, salicylates, NSAIDs, alcohol, CYP inhibitors (azoles, gemfibrozil, cimetidine)
2. decrease effects: BBs, CCBs, CYP inducers (phenytoin, rifampin)

Question 21

MOA of: Biguanides, thiazolidinediones, SGLT2 inhibitors, a-glycosidase inhibitors

Answer 21

1. Biguanides: active AMP-activated PKs
2. Thiazolidinediones: PPARy ligand
3. SGLT2 inhibitors: inhibit Na/glu co-transport in kidney -> increased glucose excretion
4. a-glycosidase inhibitors: inhibit absoprtion of monosaccharides

Question 22

drug that decreases CV risks

Answer 22

Metformin

Question 23

metformin MC AE

Answer 23

GI complaints

Question 24

which drug causes edema, HF exacerbation

Answer 24

thiazolidinediones

Question 25

which drug has a delayed onset of 1-3 months?

Answer 25

thiazolidinediones