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Pharm Exam 5 > 67: Antidiabetic Agents > Flashcards

67: Antidiabetic Agents Flashcards

1
Q

alpha cell –>

beta cell –>

A

glucagon
insulin and amylin

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

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2
Q

+ regulation of insulin release

A 
glucose
amino acids
incretins
epi/B2 adrenergic stimulation
vagus stimulation
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3
Q
  • regulation of insulin release
A

NE/a2 adrenergic stimulation

amylin

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4
Q

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

A

glut 4

found in muscle and adipose tissue

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5
Q 
\+ or - with insulin:
gluconeogenesis
glycogenolysis
glcogenesis
glycolysis
A

+
+

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6
Q

s/s type I DM

A 
polyuria/nocturnal enuresis
thirst
blurred vision
WL/polyphagia
weakness/dizziness
paresthesia
level of consciousness
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7
Q

s/s type II DM

A 
asymptomatic initially
infections
neurpathy
severe insulin deficiency signs
obesity and metabolic syndrome
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8
Q

FPG – DM range

A

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

CPG greater than 200
oral glucose tolerance test greater than 200

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9
Q

insulin is absolutely required for…

A

type I DM

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10
Q

therapeutic goal with insulin

A

FPG between 90-120

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11
Q

28 U equals =

A

1 mg

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12
Q

rapid acting insulins

A

lispro
aspart
glulisine
inhaled insulin

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13
Q

short acting insulin

A

regular insulin (pump type)

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14
Q

intermediate acting insulin

A

NPH

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15
Q

long acting insulin

A

glargine

determir

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16
Q

key feature rapid acting insulins

A

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

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17
Q

key feature short acting insulins

A

identical to human insulin, forms complexes

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18
Q

key feature intermediate acting insulin

A

protamine-insulin complex

19
Q

key feature long acting insulin

A

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

20
Q 
duration of insulins:
rapid
short
intermediate
long
A

3-5 hr

4-12 hr

10-20 hr

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

21
Q

most common adverse effect to insulin therapy

A

hypoglycemia

tx: give glucose or give glucagon

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

22
Q

adverse effects of insulin therapy

A

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)

23
Q

MOA glucagon and use

A

treat hypoglycemia

injected peptide

catabolism of stored glycogen to increase blood glucose levels

24
Q

key points metformin

A
  • first line agent
  • doesn’t produce hypoglycemia
  • not dependent upon B cell function
25
Q

MOA metformin

A

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

26
Q

adverse effects metformin

A

GI disturbances

vit B12 deficiency

27
Q

sulfonylureas

A

glimepiride
glipizide
glyburide

28
Q

meglitinides

A

repaglinide

nateglinide

29
Q

MOA sulfonylureas and meglitinides

A

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

30
Q

adverse effects sulfonylureas and meglitinides

A

weight gain

hypoglycemia

31
Q

glucosidase inhibitors

A

acarbose

miglitol

32
Q

key points glucosidase inhibitors

A
  • taken with a meal
  • contraindicated for pts with GI diseases
  • hypoglycemia can occur if in combo with other drugs
  • treat hypoglycemia with oral glucose
33
Q

MOA glucosidase inhibitors

A

inhibition of brush border glucosidase enzyme and subsequent absorption of glucose

34
Q

adverse effects glucosidase inhibitors

A

abdominal pain
diarrhea
flatulence

due to unabsorbed carbs

35
Q

MOA TZD thiazolidinediones

A

increase transcription of GLUT 4

  • decrease peripheral resistance by activation peroxisome proliferator activated receptor gamma
  • effect on glucose metabolism, insulin signaling
36
Q

adverse effects TZDs

A

**cardiovascular

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

37
Q

TZD thiazolidinediones (2)

A

pioglitazone

rosiglitazone

38
Q

amylinomimetic drug =

MOA?

A

pramlintide

inhibits glucagon release
inhibits gastric emptying
anoretic effect

39
Q

adverse effects pramlintide

A 
anorexia
nausea
vomiting
hypoglycemia
delayed drug absorption
40
Q

incretin example; MOA

A

exenatide

  • potentiate insulin secretion
  • inhibit glucagon release
  • inhibit gastric emptying
  • anorectic effect
41
Q

adverse effects exenatide

A 
*acute pancreatitis
nausea/vomiting
diarrhea
hypoglycemia
delayed drug absorption
42
Q

dipeptidy peptidase inhibitor example; MOA

A

sitagliptin

inhibit incretin degradation

43
Q

adverse effects sitagliptin

A
  • pancreatitis

Pharm Exam 5 (11 decks)

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