8. Diabetes Flashcards
____% of diabetics are Type-I and the majority are diagnosed before ___ yrs of age
5
20
Type-II diabetics are typically ______ , and ______often diagnosed after ___ yrs of age
overweight
non-caucasian
40
___% of those with DM-II are undiagnosed
Therapy is aimed at keeping A1-C below ____; blood pressure below ____ ; and LDL cholesterol below ____
Lifestyle changes focus on BMI (target 18.5-24.9), exercise, and smoking cessation
25
7.0
140/80
100
Over ___% of Americans are diabetes.
8
T/F A1C of 7.0 means that the plasma glucose of 150-160mg/dl
True
Who’s at greater risk for insulin resistance?
Latinos
Who’s at greater risk for beta cell dysfunction.
East Asians
What are the diabetic drug classes?
- Oral Hypoglycemics
2. Insulin
What are the oral therapeutic drugs classes?
- Biguanides “MOST COMMON”
- Sulfonylureas
- Thiazolinediones / Glitazones
- DPP-4 Inhibitors
Which diabetic combo drug causes weight loss?
Metformin with GLP-1 receptor agonist
Which diabetic combo drug doesn’t cause any change in the weight.
Metformin with DPP-4 Inhibitor
What is the drugs for Biguanides?
Metformin [Glucophage]
What is the indication for Metformin?
T2DM, Polycystic Ovary syndrome (PCOS)
What is the clinical pharmacology of Metformin?
Oral Hypoglycemic and Infertility
What is the mechanism of action of Metformin?
Biguanide-based; activates AMP-activated protein kinase (AMPK) which in turn suppresses hepatic gluconeogenesis & intestinal glucose absorption; increases insulin sensitivity
What is the drug interaction of Fish oils and decongestants with Metformin?
increase blood sugar
What is the drug interaction of Flaxseed with Metformin?
decrease blood sugar
What is the drug interaction of Beta-blockers with Metformin?
Mask hypoglycemia
What is the drug interaction of Aminoglycosides, Amphotericin, Ganciclovir and Acyclovir with Metformin?
Nephrotoxicity-induced lactic acidosis
What is the drug interaction of Cyclosporine with Metformin?
decrease metabolism, which causes hypoglycemia in the blood
In the liver, Beta 2 promotes _____.
In the pancreas, Beta 2 ______ insulin release and alpha 2 ______ insulin release.
gluconeogenesis
increases
decreases
What is Sulfonylureas?
It’s an oral therapeutic drug to treat diabetes.
Which generation of Slfonylureas drug is more potent?
2nd generation
Which is the most common 2nd generation Sulfonylureas?
Glipizide [Glucotrol] - oral hypoglycemic drug
The mechanism of action is to stimulates pancreatic ____ beta cell insulin release
- Actions involve binding to an ATP-dependent ___ channel: blocked ____ leads to depolarization, ____ release and insulin vesicle effusion.
islet
K+
efflux
Ca2+
What are the common adverse effects of taking Glipizide?
headache, photosensitivity and hypoglycemia
What are some serious adverse effects of taking Glipizide?
death fro heart failiure
What are the drug interactions of decongestants and Steroids with Glipizide?
Antagonistic.
Glipizide causes hypotension, whereas decongestant and steroids cause hypertension
What are the drug interactions of Flax seed oil with Glipizide?
Additive
What are the drug interactions of Fluoroquinolones with Glipizide?
unpredictable
What are the drug interactions of NSAIDs with Glipizide?
Prolonged effect.
What is Thiazolidinedione/Gliltazones?
It’s one of the classes of oral therapeutics for treating type 2 diabetes (T2DM).
What are the different Thiazolidinediones/Glitazones?
- Pioglitazone [Actos] “MOST COMMON”
2 Rosiglitazon [Avandia]
A thiazolidinedione (aka glitazone) insulin sensitizer selectively stimulates _____ nuclear receptor which increases insulin sensitivity in ______, ______ and _____.
PPAR
liver, skeletal muscle, adipose tissue
What is some serious adverse side effects of taking Pioglitazone?
Ocular: Diabetic macular edema
GU: Bladder cancer
What is the drug interactions of Decongestants, Corticosteroids and Sympathomimetics with Pioglitazone?
Antagonstic
What is the drug interactions of Flaxseed with Pioglitazone?
Additive
What is the drug interactions of Beta-blockers with Pioglitazone?
masks hypoglycemia
What is the drug interactions of Azoles and Trimethoprim with Pioglitazone?
Impaired metabolism
What is Dipeptidly peptidase-4 inhibitors (DPP-4 inhibitors)?
It’s one of the classes of oral therapeutics for treating type 2 diabetes (T2DM).
What is name of the Dipeptidly peptidase-4 inhibitors (DPP-4 inhibitors) drug?
Sitagliptin [Januvia]
The mechanism of Sitagliptin is to inhibits dipeptidyl peptidase-4, slowing _____ breakdown, increasing ______synthesis/release, decreasing ______ levels.
incretin (a group of metabolic hormones that stimulate a decrease in blood glucose levels)
insulin
glucagon
What are some serious adverse side effects when taking Sitagliptin?
Reinal failure and Steven Johnson Syndrome
What are the insulin-based therapies?
Long Acting:
- insulin Glargine [Lantus]
- insulin Detemir [Levemir]
What are the advantages of insulin?
- Universally effective
- Unlimited efficacy
- decreases microvascular risk
What are the disadvantages of insulin?
- Hypoglycemia
- Weight gain
- ? Mitogenicity
- Injectable
- Training requirements
- “Stigma” - a mark of disgrace associated with a particular circumstance, quality, or person.
Which insulin drugs are long acting?
a. NPH
b. Detemir
c. Regular
d. Aspart
e. Glargine
b and e —> Detemir and Glargine
Which insulin drugs are intermediate acting?
a. NPH
b. Detemir
c. Regular
d. Aspart
e. Glargine
a. NPH
Which insulin drugs are short acting?
a. NPH
b. Detemir
c. Regular
d. Aspart
e. Glargine
c. Regular
Which insulin drugs are rapid acting?
a. NPH
b. Lispro
c. Glulisine
d. Aspart
e. Glargine
b, c and d —-> Lispro, Aspart, Glulisine
T/F Insulin Glargine (long acting) is indicative only for T2DM.
False. It’s indicative of T1DM and T2DM
Is insulin Glargine an oral or injection?
injection. 1 SC qd
T/F The mechanism of action of Insulin Glargine is slow release, micro-crystalized rDNA insulin analog for stable day-long blood sugar regulation to be used in post-prandial combination with fast acting insulin
True
Insulin stimulates peripheral ______ uptake and _____ gluconeogenesis, lipolysis and protelysis.
glucose
inhibits
Common adverse effects of insulin Glargine are:
Hypoglycemia, local lipodystrophy, pruritus, weight gain and edema
What are the drug interactions of decongestants, corticosteroids and sympathomimetics with Insulin Glargine?
Antagonistic
What are the drug interactions of Flaxseed with Glargine?
Additive
What are the drug interactions of Beta-blockers with Glargine?
Mask hypoglycemia
What should you cautious about when using Insulin Glargine?
Infections
