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Pharm Block 4 > anti diabetic > Flashcards

anti diabetic Flashcards

1
Q

what receptor does insulin bind to on the cell membrane

A

tyrosine kinase

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2
Q

no C peptide with?

C peptide is in

A

exogenous insulin

endogenous insulin

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3
Q

can prevent microvascular complications (retinopathy, neuropathy, nephropathy)
control of diabetic dyslipidemia prevents macrovascular dz

A

tight glycemic control

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4
Q

dawn hyperglycemia

A

somogyi phenomenon

differentiate between waning of insulin or dawn phenomenon - check glucose at 3 AM

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5
Q

Drugs causing hyperglycemia

A

1) B adrenergic blockers
2) thiazides
3) diazoxide
4) clozapine, olanzapine
5) corticosteroid
6) cyclosporine, tacrolimus, sirolimus
7) protease inhibitors

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6
Q

increases blood glucose
stimulates adenyl cyclase and increases cAMP levels

Used: severe hypoglycemia in DM, antidote for B blocker OD

A

glucagon

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7
Q

SX: sweating. palpitation, confusion, loss of concentration, nightmares, loss of consciousness, seizures, coma

A

Hypoglycemia

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8
Q

Causes of hypoglycemia

A

1) exercise
2) renal failure
3) exogenous insulin
4) insulinoma
5) sulfonylurea
6) missed meals, starvation

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9
Q

rapid acting insulins

onset 15-30 min
DOA 3-4 hrs
Peak 1-2 hrs

A

lispro
aspart
glulisine

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10
Q

monomers on sub Q - fast absorption
rapid breakdown to monomers - can give IV

given just prior to meals

A

lispro
aspart
glulisine

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11
Q

Use: post prandial hyperglycemia, emergency - lispro

ADR: hypoglycemia is missed meal

A

lispro
aspart
glulisine

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12
Q

short acting insulins

onset 30-60 min
DOA 5-7 hrs
Peak 2-4 hrs

A

regular insulin (crystalline zinc)

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13
Q

hexamers with zinc (zinc slows absorption)
breaks down to monomers - fast absorption

given 15-30 min before meal
combo with NPH - 2x day

A

regular insulin (crystalline zinc)

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14
Q

Used: post prandial blood sugar control and emergency!

ADR: hypoglycemia if missed meal

A

regular insulin (crystalline zinc)

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15
Q

intermediate insulin

onset 1-2 hrs
DOA 4-8 hrs
peak 10 -20 hrs

A

isophane/NPH (neutral protamine hagedorn)

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16
Q

complexed with zinc and protamine in phosphate buffer - low absorption

given with food before bedtime
combo with regular insulin 2x day

A

isophane/NPH (neutral protamine hagedorn)

cloudy suspension - no IV, SQ only

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17
Q

Use: to prevent night time blood sugar excursions, blood sugar control during day with regular insulin

ADR: hypoglycemia with fasting/ strenuous exercise

A

isophane/NPH (neutral protamine hagedorn)

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18
Q

long acting

onset 1-2 hrs
DOA -24 hrs
peak none

A

glargine

determir

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19
Q

low pH 4.0 stabilizes insulin

more weight gain

A

glargine

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20
Q

in neutral sub cut space, breaks down slowly - absorb slowly
cannot be combined with other insulins

once daily injections

A

glargine

determir

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21
Q

myristoylated and bound to albumin: slow release

A

determir

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22
Q

Uses: basal insulins and sustained action - long duration control blood sugar, night time control

ADR: no peak - less hypoglycemia

A

glargine

determir

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23
Q

ultra long acting

onset 1-2 hrs
DOA > 24 hrs
peak none

A

degludec

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24
Q

forms polymers when injected subcut
dissociates to hexamers then monomers - slow absorption
alternate day injections

A

degludec

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25
Q

Use: long duration control of blood sugar

ADR: no peak - less hypoglycemia

A

degludec

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26
Q

alpha islets

A

glucagon

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27
Q

beta islets

A

insulin

28
Q

delta islets

A

somatostatin

29
Q

pp islets

A

pancreatic polypeptide

30
Q

g islets

A

gastrin

31
Q

safest treatment for pregnancy

A

regular insulin

32
Q

MOA: decrease hepatic gluconeogenesis

increase insulin sensitivity of target tissues - activation of GLUT4 receptors on skeletal muscle and adipocytes

increase peripheral tissue uptake of glucose

A

metformin

33
Q

ADR: GI distress (nausea and diarrhea), lactic acidosis (renal dysfunction), vit B12 deficiency

A

metformin

34
Q

CI: renal or liver disease, cardiac failure, chronic hypoxic lung dz, pregnancy, along with contrast media - increased risk renal failure

A

metformin

35
Q

first line for T2DM

A

metformin

36
Q

MOA: increase insulin sensitivity of target tissues mainly adipocytes

increase peripheral uptake of glucose

PPAR-y activates act as ligands for PPAR- y receptors

A

ploglitazone

rosiglitazone

37
Q

ADR: weight gain, water retention, heart failure - congestive, risk of stroke, bladder cancer risk, osteoporosis

A

ploglitazone

rosiglitazone

38
Q

CI: px with heart disease (especially rosiglitazone), liver dysfunction, pregnancy

Tx: T2DM

A

ploglitazone

rosiglitazone

39
Q

MOA:
increases secretion of insulin by binding to SUR1 receptor on the K ATP ch on beta cells

inhibiting the K efflux
depolarization- more Ca2+ entry - fusion of insulin vesicles with cell membrane and release insulin decreased hepatic clearance of insulin

A

glyburide
glipizide
glimepiride
chlorpropamide, tolbutamide

all are sulfonylureas

40
Q

ADR: hypoglycemia, weight gain, GI distress, pruritus, agranulocytosis, aplastic anemia
secondary failure

A

glyburide
glipizide
glimepiride
chlorpropamide, tolbutamide

41
Q

sulfonylureas that causes SIADH and disulfiram like action

A

chlorpropamide

42
Q

CI: pregnancy, liver dysfunction, renal failure (tolbutamide, glimepride can be given), cross allergy

A

sulfonylureas

43
Q

sulfonylureas that CI in elderly

A

chlorpropamide

44
Q

second line tx for T2DM

A

sulfonylureas

45
Q

MOA: increases insulin secretion by binding to and inactivating K ATP ch on beta cells the rest act like sulfonylureas

A

nateglinide

repaglinide

46
Q

ADR: hypoglycemia, secondary failure, drug interactions with CYP inhibitors/inducers, hepatic dysfunction

A

nateglinide

repaglinide

47
Q

CI: pregnancy

Tx: post prandial hyperglycemia control - adjunct
give before meal

A

nateglinide

repaglinide

48
Q

sulfonylurea given to px with increase serum creatine and heart risk

A

glimepiride

49
Q

MOA: dipeptidyl peptidase-4 enzyme inactivates incretins

incretins stimulate release of insulin in response to elevated blood sugar levels and inhibit glucagon

inhibition of DPP4 - prolongs incretin action more circulating insulin

A

sitagliptin

saxagliptin

50
Q

ADR: debilitating joint pain, hypoglycemia with SU/insulin

A

sitagliptin

saxagliptin

51
Q

CI: pregnancy

Tx: adjunct T2DM

A

sitagliptin

saxagliptin

52
Q

MOA: long acting incretin - GLP-1 analogue

prolonged incretin action - prolongs circulating insulin in response to high blood sugar

A

exenatide
liraglutide
dulaglutide

53
Q

ADR: nausea and vomiting, hypoglycemia with SU/insulins

A

exenatide
liraglutide
dulaglutide

54
Q

GLP-1 agonist with ADR of immunogenicity

A

exenatide

55
Q

CI: pancreatitis, pregnancy, hypertriglyceridemia, thyroid medullary cancer, gallbladder stone

A

exenatide
liraglutide
dulaglutide

56
Q

Tx: T2DM, obesity

SQ inj once daily

A

exenatide
liraglutide
dulaglutide

57
Q

MOA: alpha glucosidase enzyme on brush border of apical cells in intestine

breaks down starch to simple sugars, helps absorption of sugar

inhibition of enzyme - less absorption of sugar, reduced blood sugar levels

A

acarbose

miglitol

58
Q

ADR: flatulence, bloating, diarrhea

A

acarbose

miglitol

59
Q

CI: pregnancy

Tx: T2DM

A

acarbose

miglitol

60
Q

MOA: SGLT 2 on proximal renal tubules

decrease reabsorption of filtered glucose

block SGLT 2 increased excretion of glucose, decreased reabsorption of filtered glucose, low blood sugar levels

A

canagliflozin
dapagliflozin
empaglifozin

61
Q

ADR: UTI, genital mycotic infections, ketoacidosis, acute kidney injury

A

canagliflozin
dapagliflozin
empaglifozin

62
Q

CI: pregnancy and renal dysfunction

Tx: part of 1st line for T2DM

A

canagliflozin
dapagliflozin
empaglifozin

63
Q

binds to amylin receptor in brain
delayed gastric emptying - satiety
decrease in glucagon release

A

pramlintide

64
Q

ADR: nausea hypoglycemia with SU/insulin

A

pramlintide

65
Q

CI: pancreatitis

Tx: T1DM and T2DM

SQ inj
peak with 20 min

A

pramlintide

Pharm Block 4 (18 decks)

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