67: Antidiabetic Agents

Question 1

alpha cell –>

beta cell –>

Answer 1

glucagon
insulin and amylin

d cell - somatostatin
g cell - gastrin
F cell - pancreatic polypeptide

Question 2

+ regulation of insulin release

Answer 2

glucose
amino acids
incretins
epi/B2 adrenergic stimulation
vagus stimulation

Question 3

• regulation of insulin release

Answer 3

NE/a2 adrenergic stimulation

amylin

Question 4

which glucose transported is associated with insulin mediated uptake of glucose?

Answer 4

glut 4

found in muscle and adipose tissue

Question 5

\+ or - with insulin:
gluconeogenesis
glycogenolysis
glcogenesis
glycolysis

Answer 5

+
+

Question 6

s/s type I DM

Answer 6

polyuria/nocturnal enuresis
thirst
blurred vision
WL/polyphagia
weakness/dizziness
paresthesia
level of consciousness

Question 7

s/s type II DM

Answer 7

asymptomatic initially
infections
neurpathy
severe insulin deficiency signs
obesity and metabolic syndrome

Question 8

FPG – DM range

Answer 8

greater than 126 mg/dL
pre-diabetes is 110-125

CPG greater than 200
oral glucose tolerance test greater than 200

Question 9

insulin is absolutely required for…

Answer 9

type I DM

Question 10

therapeutic goal with insulin

Answer 10

FPG between 90-120

Question 11

28 U equals =

Answer 11

1 mg

Question 12

rapid acting insulins

Answer 12

lispro
aspart
glulisine
inhaled insulin

Question 13

short acting insulin

Answer 13

regular insulin (pump type)

Question 14

intermediate acting insulin

Answer 14

NPH

Question 15

long acting insulin

Answer 15

glargine

determir

Question 16

key feature rapid acting insulins

Answer 16

aa alteration in c-terminal tail of B peptide preventing insulin complex formation

Question 17

key feature short acting insulins

Answer 17

identical to human insulin, forms complexes

Question 18

key feature intermediate acting insulin

Answer 18

protamine-insulin complex

Question 19

key feature long acting insulin

Answer 19

aa substitiutions that result in precipitate formation at more neutral pH in the body

Question 20

duration of insulins:
rapid
short
intermediate
long

Answer 20

3-5 hr

4-12 hr

10-20 hr

12-20 h (glargine) r or 22-24 hr (detemir)

Question 21

most common adverse effect to insulin therapy

Answer 21

hypoglycemia

tx: give glucose or give glucagon

s/s tahcycardia, sweating, tremors, nausea, hunge, coma, loss of consciousness

Question 22

adverse effects of insulin therapy

Answer 22

hypoglycemia (insulin therapy too effective)

hypersensitivity (immune response to noninsulin prtn contaminants)

resistance (anti-insulin antibodies)

lipohypertrophy (fat deposition at injection site)

lipoatrophy (fat loss at injection site)

Question 23

MOA glucagon and use

Answer 23

treat hypoglycemia

injected peptide

catabolism of stored glycogen to increase blood glucose levels

Question 24

key points metformin

Answer 24

• first line agent
• doesn’t produce hypoglycemia
• not dependent upon B cell function

Question 25

MOA metformin

Answer 25

decreases hepatic glucose output [via activation of AMPK] and increases peripheral glucose utilization

Question 26

adverse effects metformin

Answer 26

GI disturbances | vit B12 deficiency

Question 27

sulfonylureas

Answer 27

glimepiride glipizide glyburide

Question 28

meglitinides

Answer 28

repaglinide | nateglinide

Question 29

MOA sulfonylureas and meglitinides

Answer 29

inhibition of ATP sensitive K channel of B cell --> insulin release

Question 30

adverse effects sulfonylureas and meglitinides

Answer 30

weight gain | hypoglycemia

Question 31

glucosidase inhibitors

Answer 31

acarbose | miglitol

Question 32

key points glucosidase inhibitors

Answer 32

- taken with a meal - contraindicated for pts with GI diseases - hypoglycemia can occur if in combo with other drugs - treat hypoglycemia with oral glucose

Question 33

MOA glucosidase inhibitors

Answer 33

inhibition of brush border glucosidase enzyme and subsequent absorption of glucose

Question 34

adverse effects glucosidase inhibitors

Answer 34

abdominal pain diarrhea flatulence due to unabsorbed carbs

Question 35

MOA TZD thiazolidinediones

Answer 35

increase transcription of GLUT 4 - decrease peripheral resistance by activation peroxisome proliferator activated receptor gamma - effect on glucose metabolism, insulin signaling

Question 36

adverse effects TZDs

Answer 36

**cardiovascular also peripheral edema, WG, hepatotoxicity, bone fractures, hypoglycemia

Question 37

TZD thiazolidinediones (2)

Answer 37

pioglitazone | rosiglitazone

Question 38

amylinomimetic drug = | MOA?

Answer 38

pramlintide inhibits glucagon release inhibits gastric emptying anoretic effect

Question 39

adverse effects pramlintide

Answer 39

``` anorexia nausea vomiting hypoglycemia delayed drug absorption ```

Question 40

incretin example; MOA

Answer 40

exenatide - potentiate insulin secretion - inhibit glucagon release - inhibit gastric emptying - anorectic effect

Question 41

adverse effects exenatide

Answer 41

``` *acute pancreatitis nausea/vomiting diarrhea hypoglycemia delayed drug absorption ```

Question 42

dipeptidy peptidase inhibitor example; MOA

Answer 42

sitagliptin inhibit incretin degradation

Question 43

adverse effects sitagliptin

Answer 43

* pancreatitis