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Pharmacology > Anti-Diabetes > Flashcards

Anti-Diabetes Flashcards

1
Q

Insulin of choice in emergent sitautions

A

IV regular insulin

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2
Q

Low risk of hypoglycemia insulins VRS High risk of hypoglycemia insulins. Name please

A

rapid acting (lispro, aspart, glulisine) and long acting (glargine, detremir) = low risk VRS higher risk: short acting (regular insulin) and intermediate (NPH)

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3
Q

drugs that can interefere with diabetic meds and make them more prone to hyPOglycemia

A

beta blockers - stop effects of catecholamines
EtOH - prevents gluconeogenesis
Salicylates - increases insulin secretion and acts a wee bit like insulin @ periphery

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4
Q

drugs that can interfere wtih diabetic meds and make pts more prone to hyPERglycemia

A

epinephrine, corticosteroids, atypical antipsychotics, HIV protease inhibitors = make tissue less responsive

phenyoin, clonidine, calcium channel blockers = decreased insulin secretion

diuretics = deplete K (alters ability of K to play roel in exocytosis of insulin in response to sugra SUR/KIR channel)

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5
Q

first gen sulfonylureas please

A

tobutamide - short duration of action

chlorporpamide - longer duration of action

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6
Q

a/se of chlorporpamide

A

hyperglycemia @ elderly = dont give
hyperemic flush @ OH = dont drink
SIADH = dont pee

DONT GIVE OLD, DONT DRINK LOTS, DONT PEE MUCH

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7
Q

second gen sulfonylureas, now preferred bc better a/se profile = ?

A

glyburide - hyperglycemia @ 20-30%
glupizine - hyperglycemia @ least DOC***
glimepride - hyperglycemia @ 3-4%

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8
Q

anti-diabetic drugs that cause WEIGHT GAIN

A

1) sulfonlyureas - tolbutamide, chlorpropamide, glyburide, glipizine, glimepride
2) meglinitides - repaglinide, nateglinide

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9
Q

Please name the Meglitinides

A

Repaglinide

Nateglinide

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10
Q

Describe kinetics and use of the meglitinides

A

shorter duration of action and more rapid onset than sulfonylureas –> thefeore used for post pradial (omit if you skip a meal)

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11
Q

A/se of meglitinides

A

repaglinide and natiglinide: hypoglycemia and weight gain

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12
Q

MOA of meglitinides and sulfonylureas

A

bind to SUR of ATP-K sensitive –> causes less K+ out of cell –> depolarizes –> opens vg Ca++ channels –> depolarizes –> exocytosis of insulin and increased transcription of insulin –> hurrah

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13
Q

MOA of metformin key words please

A

no insulin increase (decreases insulin levels due to improved glycemic control)
stops gluconeogen @ liver
increases insulin effects @ muscle and liver

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14
Q

Effects unique to metformin *small group too , high yeild probly

A

decreases TAG

does not cause weight gain

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15
Q

First line for DMii

A

metformin (because doesnt cause weight gain and decreases TAG)

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16
Q

When I say metformin, you think of this intracellular protein causeing all its effects

A

AMPK

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17
Q

A/se of metformin

A

a) gi messy time
b) B12 deficeincy - bc of gi messy time
c) lactic acidosis - bc liver cant use lactic acid for gluconeogenesis since metformin blocks it via AMPK

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18
Q

Dont use metformin for these 4 types of patients

A

liver dz
renal dz
OH-ics
hypoxic patients - resp dz

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19
Q

TZDs name them please

A

pioglitazide

rosiglitazone

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20
Q

MOA TZDs please

A

pioglitazide, rosiglitazone

a) decrease insulin resistance
b) agonists of PPARgamaa = alter gene expression and therefore take weeks to months to take effect

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21
Q

What does pioglitazone do better than rosiglitazone?

A

all good things

  • decreased LDL particle concentration and size
  • increase HDL
  • decreased TAG
22
Q

What blood tests MUST you order if pt is taking TZDs

A

liver function tests (also perform with alpha glucosidase inhibitors - acarbose)

23
Q

SHARK STYLE: If you have a diabetic patient with liver problems, dont give these drugs if you can

A

metformin
TZDs
acarboseo - glucosidase inhibitor

24
Q

SHARK STYLE: If you have a diabetic patient with a crapy lipid profile, these drugs will help

A

metform
TZDs (the glitta-zones)
insulin
coveleselam (decreases LDL but icnreases TAG)

25
Q

SHARK STYLE: if someone drinks alcohol + DM

A

chronic - no metformin (contraindicated)

once in a while or chronic - no first gen sulfonylureas (tolbutamide, chlorporpramide)

26
Q

MOA: exenatide

A

glucagon like polypeptide 1 - an incretin analoug = stimulates insulin secretion

27
Q

the many effects of exenatide please.

A

enhances glucose dependent insulin secretion therefore suppresses postprandial glucagon release

slows gastric emptying therefore keeps more food suppresse appetite drive = decreases appeitie

may increase beta cell proliferation

28
Q

a/se of exenatide

A

nausea, vomit, diarrhoe,
ACUTE PANCREATITIS
contraindicated in gastroparesis patients (but diabetes can cause gastropareisis :S) - bc causes gastric emptying slowing

29
Q

how come exenatide doesnt get degraded

A

resistant to dipeptidyl peptidase IV

30
Q

Sitagliptin MOA

A

DDP IV inhibitor –> increases levels of GLP-1 and insulin

31
Q

a/se of sitagliptin

A 
pancreatitis (just like exenatide - also GLP-1) 
hypersensitivity reactions (urticaria, angioedema, anaphylaxis, Steven Johnson etc)
32
Q

Pramlintide MOA

A

analogue of amyline (cosecreted from beta cells)

  • decreased glucagon secretion
  • inhibits food intake
  • slows gastric emptying
33
Q

Colesevelam

A

bile acid sequestrant used to lower LDL via MOA unknown

34
Q

SHARK STYLE: what drug to not give people with III or IV CHF?

A

TZDs - glitter-zones

35
Q

SHARK STYLE: which antidiabetic drugs do NOT cause weight gain

A

metformin
alpha-glucosidase inhibitiors
sitagliptine

36
Q

SHARK STYLE: which antidiabetic drug causes weight loss?

A

exenatide**

37
Q

SHARK STYLE: list dugs you shouldnt give if someone has issues with the following organ systems: a) heart/cvs b) pancreas c) Renal d) liver e) hyperesensivitiies f) gastroparesis

A

a) heart/chf - no TZDs
b) pancrease - no exenatide or sitagliptine
c) renal - no metformin
d) liver - no metformin, monitor TZDs and acarbose (alpha glucosidase inhibitors)
e) steven johnson - sitagliptine
f) exenatide - slows gastric emptying

38
Q

Effective treatment for people with HbA1c < 9%

A

metformin alone as monotherapy may be effective

39
Q

If monotheraphy doesnt work over three motnhs

A

metformin PLUS oral agent, exenatide or insulin

40
Q

SHARK STYLE: Which anti-diabetics do not cause weight gain

A 
metformin
alpha glucosidases
exenatide - decreases
sitaglitpine
plamlitidine
41
Q

If dual theraphy doesnt work then what would be the most ‘‘robust’’ option be

A

insuline

42
Q

~~ What level of HbA1c would favour the transition to insulin?

A

> 8,5%

43
Q

What is the most effective of diabetes medications to lower glycemia?

A

Insulin - has no ceiling

44
Q

~~~When is insulin warranted as INITIAL THERAPY

A

DM II use insuline as initial therapy when:

@ significant hyperglycemic symptoms
@ ketonuria
@ HbA1c >10% (>8.5 for tri therapy addition)
@ random glucose > 300 mg/dl

45
Q

~ If a diabetic has X treat with ? series

HYPERTENSION

A

ACEi and ARB

46
Q

~If a diabetic has X treat with ? series

albuminuria

A

If a diabetic has X treat with ? series

47
Q

~If a diabetic has X treat with ? series

distal symmetric polyneuropathy

A 
ADGOPVV
Amytriptyline
Duloxetine
Gabapentin
Opioids
Pregablin
Valproate
Venlafexin
48
Q

~If a diabetic has X treat with ? series

gastropareisis

A

CONTRAINDICATED - exenatide
metoclopramide
erythrmycin
ME

49
Q

~If a diabetic has X treat with ? series

Erectile dysfunction

A

PDE5 inhibitor

50
Q

~ DOC at pregos

A

regular insulin - short acting

IV (Emerg use of choice as well)

51
Q

Glucagon uses times four please

A

1) severe hypoglycemia @ DM pts who o/d insulin
2) radiology of bowel b/c relaxes intestion
3) beta b poisoning - O/D antidote
4) glucagon C peptide test - to assess beta cell function

52
Q

~ things i think will be super high yield and are bolded in notes
** things i think are high yield hurrah
SHARK - get these before you move on to next card.

A

15 qs on last years exam.

Pharmacology (70 decks)

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