Question 1

The first line treatment for type 2 diabetes is _____________.

Accepted Answer

metformin

Question 2

What is the mechanism of metformin?

Accepted Answer

It decreases hepatic gluconeogenesis by inhibiting the mitochondrial enzyme glycerophosphate dehydrogenase (think of the girl – whom the METaphOR-wielding boy is trying to woo – who is biting a mitochondria-shaped candy). Also, it activates AMPK, an enzyme that also works to inhibit gluconeogenesis. (Think of the AMPKandy bag.) Lastly, it increases peripheral insulin sensitivity (like the open Valentine's mailbox on the bench by the metformin metaphor boy).

Question 3

What side effects can metformin cause?

Accepted Answer

Lactic acidosis from impaired gluconeogenesis (think of the spilled, spoiled milk). This needs to be thought of in patients with renal failure, because metformin is just excreted unmodified by the kidneys (think of the cracked, kidney-shaped tray that the lactic acid is on). Also, GI upset can be caused (like the green-faced girl about to barf at the metformin boy).

Question 4

What are the thiazolidinedione drugs?

Accepted Answer

Rosiglitazone and pioglitazone (think of the girl reading ROSes are red on the GLITter-covered card)

Question 5

What is the mechanism of thiazolidinediones?

Accepted Answer

They act on peroxisome proliferator-activated receptor gamma (PPAR-gamma), an intracellular nuclear receptor that increases glucose uptake and decreases glucose production (like the life of the PPARy shirt that the thiazolidinedione boy is wearing). One of the proteins expressed is adiponectin (like his turtleneck). Another protein is GLUT4 (like the GLUT4 mailbox).

Question 6

Explain the unique relationship between the thiazolidinediones and weight gain.

Accepted Answer

Thiazolidinediones lead to increased fatty-acid storage in adipocytes differentiation of adipocytes, leading to decreased triglyceride levels and weight gain. (Think of the boy eating doughnuts to represent fat storage.)

Question 7

True or false: thiazolidinediones take days to weeks to become effective.

Accepted Answer

True. Because it works by increasing gene expression, it takes time.

Question 8

Which non-insulin-raising diabetic meds increases weight gain?

Accepted Answer

The thiazolidinediones – "they put extra GLIT in your ZONE"

Question 9

What big side effect do you need to worry about with the thiazolidinediones (not related to weight gain)?

Accepted Answer

Peripheral edema due to increased fluid retention (like the thiazolidinedione boy's baggy pants) – do not give to patients with CHF (like the baggy heart being crushed by the boy's chair)

Question 10

The non-insulin-raising drug that acts on the peroxisome proliferator-activator receptor gamma can cause which side effect that is especially common in older women?

Accepted Answer

Osteoporosis (think of the boy's chair, which has a femur-shaped leg that is breaking)

Question 11

What cells normally secrete amylin?

Accepted Answer

The pancreatic islet cells that also secrete insulin! Amylin is secreted with insulin and acts to decrease glucagon and delay gastric emptying (just like the full, stomach-shaped water cooler and torn glucagon packets next to the furious AMY and LyNn who were asked out by the same boy). The analogue is pramlintide.

Question 12

Pramlintide can be used to treat the _______________ in both types of diabetes.

Accepted Answer

postprandial glucose spike

Question 13

The two main side effects with pramlintide are _____________.

Accepted Answer

hypoglycemia (the falling candy jar that AMY is kicking) and nausea (Brayden getting sick at the embarassment)

Question 14

These two drugs work by inhibiting intestinal-brush-border alpha glucosidase: _________________.

Accepted Answer

acarbose (A-Carb candies) and miglitol (wIgGLer candies)

Question 15

The alpha glucosidase work to ____________.

Accepted Answer

delay glucose absorption (just like the frustrated boy is delayed in eating his Wiggler gummy worms)

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Sketchy Pharm: Metformin, Thiazolidinediones, Pramlintide, SGLT2 Inhibitors Flashcards

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