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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
Use: long duration control of blood sugar ADR: no peak - less hypoglycemia
degludec
26
alpha islets
glucagon
27
beta islets
insulin
28
delta islets
somatostatin
29
pp islets
pancreatic polypeptide
30
g islets
gastrin
31
safest treatment for pregnancy
regular insulin
32
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
metformin
33
ADR: GI distress (nausea and diarrhea), lactic acidosis (renal dysfunction), vit B12 deficiency
metformin
34
CI: renal or liver disease, cardiac failure, chronic hypoxic lung dz, pregnancy, along with contrast media - increased risk renal failure
metformin
35
first line for T2DM
metformin
36
MOA: increase insulin sensitivity of target tissues mainly adipocytes increase peripheral uptake of glucose PPAR-y activates act as ligands for PPAR- y receptors
ploglitazone | rosiglitazone
37
ADR: weight gain, water retention, heart failure - congestive, risk of stroke, bladder cancer risk, osteoporosis
ploglitazone | rosiglitazone
38
CI: px with heart disease (especially rosiglitazone), liver dysfunction, pregnancy Tx: T2DM
ploglitazone | rosiglitazone
39
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
glyburide glipizide glimepiride chlorpropamide, tolbutamide all are sulfonylureas
40
ADR: hypoglycemia, weight gain, GI distress, pruritus, agranulocytosis, aplastic anemia secondary failure
glyburide glipizide glimepiride chlorpropamide, tolbutamide
41
sulfonylureas that causes SIADH and disulfiram like action
chlorpropamide
42
CI: pregnancy, liver dysfunction, renal failure (tolbutamide, glimepride can be given), cross allergy
sulfonylureas
43
sulfonylureas that CI in elderly
chlorpropamide
44
second line tx for T2DM
sulfonylureas
45
MOA: increases insulin secretion by binding to and inactivating K ATP ch on beta cells the rest act like sulfonylureas
nateglinide | repaglinide
46
ADR: hypoglycemia, secondary failure, drug interactions with CYP inhibitors/inducers, hepatic dysfunction
nateglinide | repaglinide
47
CI: pregnancy Tx: post prandial hyperglycemia control - adjunct give before meal
nateglinide | repaglinide
48
sulfonylurea given to px with increase serum creatine and heart risk
glimepiride
49
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
sitagliptin | saxagliptin
50
ADR: debilitating joint pain, hypoglycemia with SU/insulin
sitagliptin | saxagliptin
51
CI: pregnancy Tx: adjunct T2DM
sitagliptin | saxagliptin
52
MOA: long acting incretin - GLP-1 analogue prolonged incretin action - prolongs circulating insulin in response to high blood sugar
exenatide liraglutide dulaglutide
53
ADR: nausea and vomiting, hypoglycemia with SU/insulins
exenatide liraglutide dulaglutide
54
GLP-1 agonist with ADR of immunogenicity
exenatide
55
CI: pancreatitis, pregnancy, hypertriglyceridemia, thyroid medullary cancer, gallbladder stone
exenatide liraglutide dulaglutide
56
Tx: T2DM, obesity SQ inj once daily
exenatide liraglutide dulaglutide
57
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
acarbose | miglitol
58
ADR: flatulence, bloating, diarrhea
acarbose | miglitol
59
CI: pregnancy Tx: T2DM
acarbose | miglitol
60
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
canagliflozin dapagliflozin empaglifozin
61
ADR: UTI, genital mycotic infections, ketoacidosis, acute kidney injury
canagliflozin dapagliflozin empaglifozin
62
CI: pregnancy and renal dysfunction Tx: part of 1st line for T2DM
canagliflozin dapagliflozin empaglifozin
63
binds to amylin receptor in brain delayed gastric emptying - satiety decrease in glucagon release
pramlintide
64
ADR: nausea hypoglycemia with SU/insulin
pramlintide
65
CI: pancreatitis Tx: T1DM and T2DM SQ inj peak with 20 min
pramlintide

Pharm Block 4 (18 decks)

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