Anti-diabetic drugs

Question 1

Which are the rapid onset insulins?

Answer 1

Lispro, aspart, glulisine

Question 2

NPH belongs to slow onset or intermediate onset insulin?

Answer 2

Intermediate onset

Question 3

What is the relative time to peak for regular insulin?

Answer 3

2-4 hr

Question 4

What is the relative time to peak for NPH?

Answer 4

4-8 hr

Question 5

Does glargine have peak in its action?

Answer 5

No peak

Question 6

What is the best strategy to prevent microvascular complications of diabetes?

Answer 6

Tight glycemic control

Question 7

Diabetic microvascular complications includes…?

Answer 7

Retinopathy, nephropathy, neuropathy

Question 8

Does intensive glycemic control prevent coronary heart disease?

Answer 8

Yes

Question 9

What is the mechanism of insulin secretion?

Answer 9

GLUT1 allows entry of glucose inside beta cell, it is broken down and increases ATP which inhibits K efflux, depolarization occurs and insulin is released by Ca dependent exocytosis. Insulin binds cell membrane tyrosine kinase and does not enter nucleus.

Question 10

What is the mechanism of action of sulfonylurea?

Answer 10

Insulin secretagogues (K channel modulators). Bind SUR1 inhibit K efflux leading to depolarization and insulin release.

Question 11

What is the most important side effect of sulfonylurea?

Answer 11

Hypoglycemia, weight gain, not given in pregnancy.

Question 12

Which sulfonylurea causes SIADH and disulfiram-like action?

Answer 12

Chlorpropamide

Question 13

What is the mechanism of action of metformin?

Answer 13

Biguanide- insulin sensitizer. Reduces hepatic gluconeogenesis and activates GLUT4 receptors in skeletal muscles.

Question 14

What are the contraindications for metformin use?

Answer 14

Renal or liver disease, cardiac failure, chronic hypoxic lung disease and radiologic procedure using IV iodinated contrast medium.

Question 15

What is most important side effect of metformin?

Answer 15

Lactic acidosis and decreased absorption of Vit B12.

Question 16

What is the mechanism of action of repaglinide?

Answer 16

Meglitinides (K channel modulators) also nateglinide. Closes K channel similar to sulfonylurea.

Question 17

What is the MoA of pioglitazone? How about rosiglitazone?

Answer 17

Thiazolidinediones. Pioglitazone- binds and activates PPAR-y (primarily on adipocytes- increases tissue sensitivity to insulin) and PPAR-a (decreases triglycerides).
Rosiglitazone- binds PPAR-y

Question 18

What are the side effects of thiazolidinediones?

Answer 18

Pioglitazone- bladder cancer, weight gain and edema
Rosiglitazone- increased risk of heart failure
CI- HF, pregnancy and liver dysfunction

Question 19

What is the MoA of pramlintide?

Answer 19

Amylin analog, binds to its receptor in hindbrain causes decrease in glucagon release, delays gastric emptying- feeling of satiety.

Question 20

Which are the incretins? What is its function?

Answer 20

Glucagon-like polypeptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP). They increase glucose- induced insulin secretion cause less hypoglycemia.

Question 21

What is the MoA of exenatide?

Answer 21

GLP-1 agonist same as liraglutide

Question 22

What is function of DPP-4?

Answer 22

Inactivates GLP-1

Question 23

What is the MoA of Sitagliptin?

Answer 23

DPP-4 inhibitor, increases levels of GLP-1, increase insulin secretion decreases glucagon secretion less hypoglycemia.

Question 24

In the setting of diabetes + hypertension, which drug is the first choice to treat hypertension?

Answer 24

ACEI

Question 25

What disorders does glucagon treat?

Answer 25

Severe hypoglycemia and severe beta blocker poisoning

Question 26

Which drugs have hyperglycemic side effects?

Answer 26

``` β-adrenergic blockers Thiazide diuretics Diazoxide Clozapine, olanzapine Corticosteroid Cyclosporine, tacrolimus, sirolimus Protease inhibitors ```

Question 27

Sulfonylureas are cross-allergy to what drugs?

Answer 27

Sulfonamide antibiotics, thiazide diuretics, loop diuretics (except ethacrynic acid) and carbonic anhydrase inhibitors, celecoxib, diazoxide and sumatriptan.