Anti-Diabetic

Question 1

Rapid acting insulin

Answer 1

amino acid alteration preventing insulin complex formation
Onset - 10-30 min
Duration 3-5h
Insulin Lispro, Insulin Aspart, Insulin Glulisine, Inhaled Insulin
Mimic meal

Question 2

Short acting Insulin

Answer 2

Identical to human insulin - forms complex
Onset - 30-60min
Duration - 4-12h

Question 3

Intermediate acting insulin

Answer 3

protamine insulin complex
Onset - 1-2h
Duration - 4-12h
NPH

Question 4

Long Acting insulin

Answer 4

amino acid substitutions = precipitate form at neutral pH
Onset 1-4h
Duration 12-20h
Peak - none
Glargine, Detemir - mimic basal

Question 5

AE Insulin Therapy

Answer 5

Hypoglycemia - treat with glucagon
Hypersensitivity
Resistance
Lipohypertrophy, lipoatrophy

Question 6

MOA Metformin

Answer 6

Biguanide
Decrease hepatic glucose output, increase peripheral glucose utilization
Activate hepatic enzyme AMP-activated protein kinase

Question 7

AE Metformin

Answer 7

N/V/D, B12 deficiency

No hypoglycemia, not dependent on B-cell

Question 8

MOA Sulfonylureas

Answer 8

Glimepride, Glipizide, Glyburide (2nd gen)

inhibit ATP sensitive K channel of B-cell stimulating insulin release

Question 9

MOA Meglitinides

Answer 9

Repaglinide, Nateglinide

Inhibit ATP sensitive K channel of B-cell stimulating insulin release

Question 10

AE Sulfonylureas/Meglitinides

Answer 10

WG, GI, hypoglycemia

Question 11

Acarbose, Miglitol

Answer 11

Oral Glucosidase inhibitors - take with meal
inhibition of brush border glucosidase enzyme and absorption of glucose
Contraindicated in pts with GI disease; hypoglycemia

Question 12

Pioglitazone, Rosiglitazone

Answer 12

Thiazolidinediones (oral)
Decrease peripheral resistance by activating peroxisome proliferator-activated receptor-y
Affects glucose metabolism and insulin signaling

Question 13

AE Thiazolidinediones

Answer 13

Risks outweigh benefits

GI, hypoglycemia, MI

Question 14

MOA Pramlintide

Answer 14

Injected Amylinomimetic
Inhibit glucagon release, inhibit gastric emptying
Useful for Type I/II

Question 15

AE Pramlintide

Answer 15

Nausea, vomiting, anorexia, Hypoglycemia, drug absorption

Question 16

Incretins

Answer 16

Exenatide, Liraglutide
potentiate insulin secretion, inhibit glucagon release/gastrin emptying
AE - Nausea, vomiting, diarrhea, hypoglycemia*, pancreatitis, drug absorption
Injected; good for Type II

Question 17

Dipeptidyl Peptidase Inhibitors (DPP)

Answer 17

Sitagliptin*, Saxagliptin, Linagliptin
Inhibit incretin degradation
AE - nasopharyngitis, URT infection, headache, pancreatitis
Oral - good for Type II

Question 18

SGLT2 Inhibitors

Answer 18

Canagliflozin*, Dapagliflozin, Empagliflozin
Inhibit renal glucose reabsorption
AE - URT infection, hypotension, hypoglycemia, breast/bladder cancer, contraindicated for renal impairment