ANTI-DM

Question 1

insulin stimulatory or inhibitory?
glucose
glucagon
GIP
GLP-1
gastrin
secretin
cholecystokinin
somatostatin
VIP
GRP
enteroglucagon

Answer 1

glucagon & somatostatin are the only inhibitory

Question 2

transporter of glucose in beta cell

Answer 2

GLUT-2

Question 3

pathway of insulin secretion in beta cell

Answer 3

glucose enter via GLUT-2, K channel closes, cell depolarizes, Ca channel open, insulin release

Question 4

activator of K+ ATP channel, dec. insulin secretion

Answer 4

Diazoxide

Question 5

DM criteria for diagnosis

Answer 5

FBS- 7 (126)
RBS- 11 (200)
HgbA1c > 6.5%

Question 6

how many % of beta cell mass remaining to produce DM1?

Answer 6

<10%

Question 7

what regimen? regular + intermediate acting. 2x/d injections

Answer 7

regimen a

Question 8

what regimen? regular + intermediate acting (more delayed). 3x/d injections

Answer 8

regimen b

Question 9

what regimen? rapid-acting preprandial + long acting 1x/d injections

Answer 9

regmen c

Question 10

what regimen? rapid + intermediate acting

Answer 10

regimen d

Question 11

what regimen? continuous subq insulin pump

Answer 11

regimen e

Question 12

hypoglycemic drugs

Answer 12

beta antagonist, naproxen, saliylates, ethanol, ACE-ihb, lithium, theophylline, calcium, bromocriptine, mebendazole, sulfo, tetracycline, pyridoxine pentamidine

Question 13

hyperglycemic drugs

Answer 13

epi, diuretics, glucocorticoids, anti-psychotics, diazoxide, beta agonist, clonidine, phenytoin, heparin, morphine, H2-R blockers, marijuana, nicotine

Question 14

3 insulin secretagouge for DM2

Answer 14

sulfonylurea
meglitinides
Phe derivatives

Question 15

sulfonylurea 1st gen

Answer 15

(-mide)

tolbutamide, acetohexamide, talazamide, chlorpropamide

Question 16

sulfonylurea 2nd gen

Answer 16

(-r/zide)

glyburide, glipizide, gliclazide, glimepiride

Question 17

sulfonylurea MOA

Answer 17

inc. insulin release; reduce hepatic clearance of insulin

Question 18

sulfonylurea AE

Answer 18

hypoglycemia, nausea, vomiting, jaundice rare, anemia

Question 19

sulfonylurea contraind.

Answer 19

DM1, pregnancy, hep/renal insufficiency

Question 20

meglitinide (repaglinide) MOA

Answer 20

closes ATP-dependent K+ channel in b-cell; h-1hr

Question 21

Phe derivative (nateglinide) MOA

Answer 21

closes ATP-dependent K+ channel in b-cell; hepatic metab.

Question 22

2 insulin sensitizers

Answer 22

biguanides

thiazolidinediones

Question 23

biguanide drugs

Answer 23

(-formin)

metformin, buformin, phentoformin

Question 24

biguanides MOA

Answer 24

activates AMPK; reduce hepatic glucose production

Question 25

first line mgmt for DM2

Answer 25

biguanides

Question 26

metformin pharmakokinetics

Answer 26

``` SI absp.; h-2hrs; 2.5g max; red. HbA1c by 2%, plasma TGL 15-20% red. macrovascular events ```

Question 27

metformin contraind.

Answer 27

renal imp, hepatic disease, hx of LA, cardiac failure, chronic hypoxic lung disease

Question 28

metformin AE

Answer 28

GI disturbances, metallic taste, dec. absp of vit. B12 and folate, LA

Question 29

thiazolidinedione drugs

Answer 29

(-glitazone) | pioglitazone, rosiglitazone, troglitazone

Question 30

thiazolidinediones MOA

Answer 30

selective antag. of PPAR-gamma

Question 31

biguanide drug withdrawn d/t LA

Answer 31

phenformin

Question 32

thiazolidinedione drug withdrawn d/t severe hepatic toxicity

Answer 32

troglitazone

Question 33

insulin sensitizer for muscles and fat

Answer 33

biguanide

Question 34

insulin sensitizers for peripheral tissue

Answer 34

thiazolidinedione

Question 35

thiazolidinedione AE

Answer 35

edema, anemia, wt gain, hepatoxicity

Question 36

a-glucosidase inhb. drugs

Answer 36

acarbose, miglitol

Question 37

a-glucosidase inhb. MOA

Answer 37

slows absp of carbs, dec. postprandial hyperglycemia

Question 38

a-glucosidase inhb. AE

Answer 38

GI disturbances

Question 39

augment glucose-dependent insulin secretion

Answer 39

incretin

Question 40

GLP-R agonist drugs

Answer 40

``` (LEAD) -glutide liraglutide exenatide albiglutide dulaglutide ```

Question 41

GLP-R agonist drugs MOA

Answer 41

dec. hepa glucose, inc. insulin

Question 42

drugs that prolong incretin action

Answer 42

DPP-IV inh

Question 43

53% homology for GLP-1 , derived from salivary gland of Gila monster

Answer 43

exendin-4

Question 44

DPP-IV inh. drugs

Answer 44

``` (-gliptin) sitagliptin saxagliptin linagliptin vildagliptin alogliptin ```

Question 45

Amylin (pramlintide) MOA

Answer 45

glycemic control and osteogenesis

Question 46

pramlintide effects

Answer 46

dec. appetite & glucagon, inc. insulin

Question 47

reversal of BB overdose

Answer 47

glucagon

Question 48

hypoglycemia cutoff

Answer 48

<60mg/dL