Antidiabetic Drugs Flashcards
Insulin glargine and Insulin determir belong to which drug class?
A. Rapid Acting
B. Intermediate Acting
C. Long Acting
C. Long Acting
True or False: Regular Insulin is a rapid acting insulin
True
___ is the only intermediate acting insulin
NPH Insulin
What drug class does metformin belong to?
Biguanides
Pioglitazone belongs to what drug class?
Thiazolidinediones
What are the three sulfonyureas?
(hint: all start with G)
1) Glipizide
2) Glyburide
3) Glimepiride
Which drug class does repaglinide belong to?
Meglitinides
Exenatide, Liraglutide, and Dulaglutide (all end in tide) belong to which drug class?
Glucagon like peptide 1 agonists
All the drugs that end in -liptin (sitagliptin, saxagliptin, linagiptin) belong to what drug class?
Dipeptidyl Peptidase 4 Inhibitors
First line T2DM treatment?
What if greater reduction is needed?
Even more reduction?
Metformin
Metformin + Sulfonylureas
Metformin + Sulfonylureas + Insulin
Glucagon like peptide-1 agonists can treat T2DM with what two conditions?
CVD and atherosclerosis
A patient has T2DM with renal impairment and CKD. What drug is best to treat this and why?
SGLT2 because it reduces progression of CKD
True or False: SGLT2 inhibitors have less glycemic effect, so more meds may be needed
True
How does insulin therapy affect gluconeogenesis and conversion of AA to glucose/ketoacids?
Decreases both processed
How does insulin therapy affect glucose storage?
Increases it
True or False: Protein synthesis, transportation of amino acids, and glucose are the result of insulin therapy
True
With insulin therapy, increased storage of TG leads to increased uptake of blood ___
glucose
Three main side effects of insulin therapy?
Hypoglycemia
Weight gain
Immune insulin resistance
True or False: Regular insulin given subcutaneously works faster than native insulin secreted by pancreas
False - regular insulin given SC works SLOWER than native insulin secreted by pancreas
Which type of insulin can form non-covalent hexamers in solution, which take time to break down?
Regular Insuln
Regular insulin analogs (aspart, glulisine, and lispro) more readily form monomers in solution
True
What is the only insulin suitable for IV use and forms hexamers?
Regular insulin
Why does NPH Insulin (intermediate acting) have a delayed, longer time course compared to regular insulin?
Need to break down aggregates
Which long term insulin preparation is soluble at pH for but not at 7?
Insulin glargine
True or False: Both insulin detemir and degludec (long acting insulin preparation) bind to albumin in blood stream
True
True or False: Insulin, lispro, aspart, and glulisine act most quickly and are similar to meal ingestion
True
___ and ___ acting insulins are given to mimic 24 hr basal insulin secretion
__ acting insulins are given preprandial to mimic nutrient stimulated insulin secretion
Intermediate and long acting
Short acting
Unlike insulin, metformin does not cause ___ or ____
weight gain; hypoglycemia
True or False: Metformin is 100% excreted by kidneys
True
____ inhibits liver gluconeogenesis
Metformin
What is the black box warning for metformin? who is at higher risk?
metabolic acidosis - impaired hepatic metabolism of lactic acid
True or False: For patients with renal impairement, metformin is not eliminated as expected, leading to increased risk of met acidosis
True
Which class is considered insulin secretagogoues?
A. Sulfonylureas
B. GLP-1 agonistswo
A. Sulfonylureas
How do glyburide, glimepiride, and glipizide drugs act?
B cell depolarization and insulin secretion ; blocks K+ channel
True or False: Glipizides can cause hypoglycemia and weight gain
True
Repaglinide (sulfonylureas) requires ____ and is considered a insulin ____
functioning pancreatic b cells (ok for T2DM) ; secretagogue
Which sulfonylureas inhibits K gated channels in pancreatic beta cells, leading to depolarization?
Repaglinide
True or False: Repaglinide can be used in patient with sulfur allergy
True
How is pioglitazone similar to metformin?
Effects peripheral tissues
Which sulfonylurea drug increases expression of GLUT1/4 in muscle, adipose, and liver tissues and acts on PPAR?
Pioglitazone
True or False: GLP-1 produces feeling of hunger
False - satiety
How are all GLP-1 agonists given?
How are DPP-4’s administered?
GLP1: SC injection
DPP-4: Oral
Endogenous ___ is released from intestinal L cells in response to nutrient ingestion, acts to “wake up” body in preparation of eventual elevation in glucose
GLP-1
True or False: GLP-1 agonists belong to the sulfonylureas
True
____ receptor activation in pancreatic b-cells enhance or augment glucose stimulated insulin secretion
GLP-1
Exenatide belongs to what class of drugs?
GLP1 Receptor Agonists (dosed 60 min before meal)
What is the only DPP-4 inhibitor that requires NO dose adjustment for RENAL DYSFUNCTIOn or CKD?
Linagliptin
_____ inhibits DEGRADATION of GLP-1, therefore extending actions of GLP-1 on pancreatic B cells
DPP-4 Inhibitors
SGLT2 Inhibitors are not as effective as __
GLP-1 agonists
SGLT2 inhibitors has less effective in what patients?
Pts with CDK
Drugs that end in -fozin?
SGLT2
GLP1 agonists and SGLT2 inhibitors share what beneficial side effect?
Reduced weight
True or False: Canaglifozin (SGLT-2 inhibitor) increases risk of bone fractures
True
True or False: All SGLT-2 drugs increase UTI risk
True
What H2 agent has anti-androgen effect?
Cimetidine
PPI are administered as ____and activated by ___/___cells
inactive prodrugs; protonation/parietal cells
PPI irreversibly inactivates ____
H/K ATPase
What class of drugs can lead to microbial overgrowth of upper GI tract with chronic use?
Omeprazole (PPI)
What drug can prevent stress and NSAID-induced ulcers?
Omeprazole/PPI’s
Three primary uses of PPI’s?
1) GERD
2) Peptic ulcer disease
3) Zollinger Ellison Syndrome
First line drug for treating excess acid production?
PPI’s!
___ and ___ are strongest inhibitors of CYP2C19 while ___ has least effect on CYP2C19
Omeprazole/esomeprazole
Pantoprazole
___ polymerizes to make a viscious material that binds to proteins on ulcer crater and forms protective barrier
Sucralfate
- facilitates ulcer healing
____ is a PGE1 analog that prevents NSAID induced ulcers
Misoprostol
- should not be given to pregnant women
True or False: Colloid Bismuth exerts a coating action to protect stomach; may inhibit pepsin; and has antibacterial activity against H. pylorii
True
______ contains salicylates and has been associated with Reye’s Syndrome in kids
Colloid Bismuth
Triple therapy treats H. pylori and includes ___ ; either ___or____; and ___/___
1) Bismuth salt
2) Metronidazole/Amoxicillin
3) Tetracycline/Clarithomycin
___ are agents that mimic effects of well balanced diet
Bulk Forming Laxatives
Dietary fiber, methylcellulose, psyllium, and polycarbophil belong to _____
bulk forming laxatives
Which laxatives act on intestinal mucosa to either enhance secretion, inhibit absorption of water/induce peristalsis?
Contact/Stimulus Cathartic
Senna/Bisacodyl are ____ laxatives
contact/stimulant
Active agent of castor oil is ____, which acts on mucosa of ____ to inhibit absorption of fluid and stimulate peristaltic movements
ricinoleic acid; small intestine
