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Systemic Pharmacology_Dr. McNaughton > 8. Diabetes > Flashcards

8. Diabetes Flashcards

1
Q

____% of diabetics are Type-I and the majority are diagnosed before ___ yrs of age

A

5

20

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2
Q

Type-II diabetics are typically ______ , and ______often diagnosed after ___ yrs of age

A

overweight
non-caucasian
40

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3
Q

___% 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

A

25
7.0
140/80
100

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4
Q

Over ___% of Americans are diabetes.

A

8

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5
Q

T/F A1C of 7.0 means that the plasma glucose of 150-160mg/dl

A

True

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6
Q

Who’s at greater risk for insulin resistance?

A

Latinos

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7
Q

Who’s at greater risk for beta cell dysfunction.

A

East Asians

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8
Q

What are the diabetic drug classes?

A
  1. Oral Hypoglycemics

2. Insulin

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9
Q

What are the oral therapeutic drugs classes?

A
  1. Biguanides “MOST COMMON”
  2. Sulfonylureas
  3. Thiazolinediones / Glitazones
  4. DPP-4 Inhibitors
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10
Q

Which diabetic combo drug causes weight loss?

A

Metformin with GLP-1 receptor agonist

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11
Q

Which diabetic combo drug doesn’t cause any change in the weight.

A

Metformin with DPP-4 Inhibitor

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12
Q

What is the drugs for Biguanides?

A

Metformin [Glucophage]

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13
Q

What is the indication for Metformin?

A

T2DM, Polycystic Ovary syndrome (PCOS)

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14
Q

What is the clinical pharmacology of Metformin?

A

Oral Hypoglycemic and Infertility

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15
Q

What is the mechanism of action of Metformin?

A

Biguanide-based; activates AMP-activated protein kinase (AMPK) which in turn suppresses hepatic gluconeogenesis & intestinal glucose absorption; increases insulin sensitivity

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16
Q

What is the drug interaction of Fish oils and decongestants with Metformin?

A

increase blood sugar

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17
Q

What is the drug interaction of Flaxseed with Metformin?

A

decrease blood sugar

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18
Q

What is the drug interaction of Beta-blockers with Metformin?

A

Mask hypoglycemia

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19
Q

What is the drug interaction of Aminoglycosides, Amphotericin, Ganciclovir and Acyclovir with Metformin?

A

Nephrotoxicity-induced lactic acidosis

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20
Q

What is the drug interaction of Cyclosporine with Metformin?

A

decrease metabolism, which causes hypoglycemia in the blood

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21
Q

In the liver, Beta 2 promotes _____.

In the pancreas, Beta 2 ______ insulin release and alpha 2 ______ insulin release.

A

gluconeogenesis
increases
decreases

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22
Q

What is Sulfonylureas?

A

It’s an oral therapeutic drug to treat diabetes.

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23
Q

Which generation of Slfonylureas drug is more potent?

A

2nd generation

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24
Q

Which is the most common 2nd generation Sulfonylureas?

A

Glipizide [Glucotrol] - oral hypoglycemic drug

25
Q

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.

A

islet
K+
efflux
Ca2+

26
Q

What are the common adverse effects of taking Glipizide?

A

headache, photosensitivity and hypoglycemia

27
Q

What are some serious adverse effects of taking Glipizide?

A

death fro heart failiure

28
Q

What are the drug interactions of decongestants and Steroids with Glipizide?

A

Antagonistic.

Glipizide causes hypotension, whereas decongestant and steroids cause hypertension

29
Q

What are the drug interactions of Flax seed oil with Glipizide?

A

Additive

30
Q

What are the drug interactions of Fluoroquinolones with Glipizide?

A

unpredictable

31
Q

What are the drug interactions of NSAIDs with Glipizide?

A

Prolonged effect.

32
Q

What is Thiazolidinedione/Gliltazones?

A

It’s one of the classes of oral therapeutics for treating type 2 diabetes (T2DM).

33
Q

What are the different Thiazolidinediones/Glitazones?

A
  1. Pioglitazone [Actos] “MOST COMMON”

2 Rosiglitazon [Avandia]

34
Q

A thiazolidinedione (aka glitazone) insulin sensitizer selectively stimulates _____ nuclear receptor which increases insulin sensitivity in ______, ______ and _____.

A

PPAR

liver, skeletal muscle, adipose tissue

35
Q

What is some serious adverse side effects of taking Pioglitazone?

A

Ocular: Diabetic macular edema
GU: Bladder cancer

36
Q

What is the drug interactions of Decongestants, Corticosteroids and Sympathomimetics with Pioglitazone?

A

Antagonstic

37
Q

What is the drug interactions of Flaxseed with Pioglitazone?

A

Additive

38
Q

What is the drug interactions of Beta-blockers with Pioglitazone?

A

masks hypoglycemia

39
Q

What is the drug interactions of Azoles and Trimethoprim with Pioglitazone?

A

Impaired metabolism

40
Q

What is Dipeptidly peptidase-4 inhibitors (DPP-4 inhibitors)?

A

It’s one of the classes of oral therapeutics for treating type 2 diabetes (T2DM).

41
Q

What is name of the Dipeptidly peptidase-4 inhibitors (DPP-4 inhibitors) drug?

A

Sitagliptin [Januvia]

42
Q

The mechanism of Sitagliptin is to inhibits dipeptidyl peptidase-4, slowing _____ breakdown, increasing ______synthesis/release, decreasing ______ levels.

A

incretin (a group of metabolic hormones that stimulate a decrease in blood glucose levels)
insulin
glucagon

43
Q

What are some serious adverse side effects when taking Sitagliptin?

A

Reinal failure and Steven Johnson Syndrome

44
Q

What are the insulin-based therapies?

A

Long Acting:

  • insulin Glargine [Lantus]
  • insulin Detemir [Levemir]
45
Q

What are the advantages of insulin?

A
  1. Universally effective
  2. Unlimited efficacy
  3. decreases microvascular risk
46
Q

What are the disadvantages of insulin?

A
  1. Hypoglycemia
  2. Weight gain
  3. ? Mitogenicity
  4. Injectable
  5. Training requirements
  6. “Stigma” - a mark of disgrace associated with a particular circumstance, quality, or person.
47
Q

Which insulin drugs are long acting?

a. NPH
b. Detemir
c. Regular
d. Aspart
e. Glargine

A

b and e —> Detemir and Glargine

48
Q

Which insulin drugs are intermediate acting?

a. NPH
b. Detemir
c. Regular
d. Aspart
e. Glargine

A

a. NPH

49
Q

Which insulin drugs are short acting?

a. NPH
b. Detemir
c. Regular
d. Aspart
e. Glargine

A

c. Regular

50
Q

Which insulin drugs are rapid acting?

a. NPH
b. Lispro
c. Glulisine
d. Aspart
e. Glargine

A

b, c and d —-> Lispro, Aspart, Glulisine

51
Q

T/F Insulin Glargine (long acting) is indicative only for T2DM.

A

False. It’s indicative of T1DM and T2DM

52
Q

Is insulin Glargine an oral or injection?

A

injection. 1 SC qd

53
Q

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

A

True

54
Q

Insulin stimulates peripheral ______ uptake and _____ gluconeogenesis, lipolysis and protelysis.

A

glucose

inhibits

55
Q

Common adverse effects of insulin Glargine are:

A

Hypoglycemia, local lipodystrophy, pruritus, weight gain and edema

56
Q

What are the drug interactions of decongestants, corticosteroids and sympathomimetics with Insulin Glargine?

A

Antagonistic

57
Q

What are the drug interactions of Flaxseed with Glargine?

A

Additive

58
Q

What are the drug interactions of Beta-blockers with Glargine?

A

Mask hypoglycemia

59
Q

What should you cautious about when using Insulin Glargine?

A

Infections

Systemic Pharmacology_Dr. McNaughton (12 decks)

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