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Pharm Block 4 > Anti-diabetics > Flashcards

Anti-diabetics Flashcards

1
Q

Which are the rapid onset insulins?

A

Glulisine, Aspart, Lispro

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2
Q

Neutral Protamine Hagedorn (NPH)/isophane insulin belongs to slow onset or intermediate onset insulin?

A

Intermediate

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3
Q

What is the relative time to peak for regular insulin?

A

2-4 h

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4
Q

What is the relative time to peak for NPH?

A

4-8 h

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5
Q

Does glargine have peak in its action?

A

No peak (neither does detemir and degludec)

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6
Q

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

A

Tight glycemic control (HBA1c <7%)

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7
Q

Diabetic microvascular complications includes…?

A

Retinopathy, nephropathy, and neuropathy

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8
Q

Does intensive glycemic control prevent coronary heart disease?

A

No, control of diabetic dyslipidemia prevents macrovascular disease.

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9
Q

What is the most common side effect of intensive glycemic control?

A

Severe hypoglycemia

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10
Q

What is the mechanism of insulin secretion?

A

The pancreatic β cell in a resting state (fasting blood glucose) is hyperpolarized. Glucose, entering via GLUT 1 transporters is metabolized and elevates cellular ATP, which inhibits. K+ efflux through the KATP channel; the decreased K+ conductance (decreased efflux) results in depolarization, leading to Ca2+- dependent exocytosis of stored insulin.

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11
Q

What is the mechanism of action of sulfonylurea?

A

Bind to the sulfonylurea receptor (SUR1)→ Inhibit ATP-sensitive potassium channel → Inhibition of potassium efflux → depolarization → opening of calcium channels → release of stored insulin via calcium mediated exocytosis

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12
Q

What is the most important side effects of sulfonylurea?

A

Hypoglycemia and weight gain

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13
Q

Which sulfonylurea causes SIADH and disulfiram-like action?

A

Chlorpropamide (first generation)

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14
Q

What is the mechanism of action of metformin?

A
  1. Inhibits mitochondrial synthesis of ATP required for energy- intensive gluconeogenesis process in liver resulting in the main glucose lowering effect of reduced hepatic gluconeogenesis.
  2. Activates GLUT4 receptor in skeletal muscle which increases the basal glucose uptake in skeletal muscle cells. This is known as peripheral insulin sensitizing action.
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15
Q

What are the contraindications for metformin use?

A

Renal or liver disease, Cardiac failure, Chronic hypoxic lung disease (precipitates acidosis), Pregnancy, Radiologic procedure using IV iodinated contrast medium (due to potential for acute renal failure induced by contrast medium)

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16
Q

What are the most important side effects of metformin?

A

Lactic acidosis- if serum creatin high DO NOT GIVE and decreased absorption of Vit B12

17
Q

What is the mechanism of action of repaglinide?

A

Close K+ ATP channel

18
Q

What is the MoA of pioglitazone and rosiglitazone?

A

PPAR-γ activators act as ligands for PPAR-γ receptor in adipose tissue. Receptor activation leads to adipocyte differentiation, uptake of circulating fatty acids into the adipocyte and increased tissue sensitivity to insulin. The result is insulin sensitizing effect of glucose uptake in adipocytes and skeletal muscle plus a reduction in hepatic glucose production.

19
Q

What are the side effects of thiazolinediones?

A

Bladder cancer, weight gain, and edema

20
Q

What is the MoA of pramlintide?

A

Amylin analogue that binds to amylin receptor in hindbrain and causes reduction in glucagon release, delayed gastric emptying, and produces a feeling of satiety.

21
Q

Which are the incretins and what is its function?

A

Glucagon-Like Polypeptide-1 (GLP-1)
and glucose-dependent insulinotropic polypeptide (GIP); secreted by duodenum and increase / enhance glucose-induced insulin secretion and inhibits glucagon secretion therefore causing less hypoglycemia.

22
Q

What is the MoA of exenatide?

A

GLP-1 analog so stimulates insulin release to lower blood sugar

23
Q

What is function of DPP-4?

A

Protease enzyme that inactivates GLP-1 and degrades incretins

24
Q

What is the MoA of Sitagliptin?

A

DPP-4 inhibitor so increases circulating GLP-1 levels. This increases insulin secretion and reduction in glucagon levels.
Drug action is dependent on glucose levels –less risk of hypoglycemia.

25
Q

What disorders does glucagon treat?

A

Severe hypoglycemia in DM and in severe beta blocker poisoning bc useful in reversing cardiac effects

26
Q

Which drugs have hyperglycemic side effects?

A

β-adrenergic blockers, Thiazide diuretics, Diazoxide (highlighted in red), Clozapine, olanzapine, Corticosteroid, Cyclosporine, tacrolimus, sirolimus, and Protease inhibitors

27
Q

Sulfonylureas are cross-allergy to what drugs?

A

Sulfonamides (antibiotics and non-antibiotics) and diuretics except Etacrynic acid (loop diuretic)

28
Q

Which type of diabetes runs in the family..Type I or II?

A

Type II

29
Q

***** What do you give a patient when treating Diabetes + proteinuria?

A

ACEI

30
Q

***** What do you give a patient when treating Diabetes + HTN?

A

ACEI

31
Q

Why do you give ACEI to diabetics with proteinuria or HTN (MOA)?

A

ATII constricts efferent artery more potently than afferent artery of glomerulus, decreases filling pressure

32
Q

What is given for Insulinoma?

A

Streptozotocin or diazoxide (K+ channel opener)

33
Q

Which tumor can be found in Zollinger-Ellison syndrome?

A

Gastrinoma

34
Q

What are the symptoms for glucagonoma?

A

Hyperglycemia, diarrhea, necrolytic migratory erythema

35
Q

What are the longer acting insulins (basal insulins)?

A

Detemir and glargine

36
Q

Ultra-long-acting insulin is _____ .

A

Degludec

37
Q

What are the contraindications of thiazolinediones?

A

Heart failure, pregnancy, and liver dysfunction

Pharm Block 4 (21 decks)

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