Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm II Final (Lauren) > Antidiabetics > Flashcards

Antidiabetics Flashcards

1
Q

What are the 2 agents that are used to INCREASE blood sugar?

A

Glucagon

Diazoxide (Proglycem)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which cell types do NOT need insulin to get glucose?

A

Brain

Liver

RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens to levels when you inject insulin (in anyone)

Blood glucose:

Pyruvate and lactate:

Inorganic phosphate:

Plasma potassium:

A

Glucose decreases

Pyruvate and Lactate: increase (metabolism)

Phosphate: decrease (metabolism)

Potassium- decreases. Glucose in cells makes Na-K pumps work more

(PROBABLY not on test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which GLUT receptors are on the B-cells in the pancreas?

A

GLUT-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which GLUT transporter is in muscle and adipose?

A

GLUT 4 (needs insulin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Do we use insulin for Type 1 or Type 2

A

Both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the adverse reactions of insulin?

A

HYPOGLYCEMIA**

Weight gain***

Cough (inhaled only)

Local reactions (allergy)

Lipodystrophy and lipohypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some symptoms of hypoglycemia

A

Tachycardia

Confusion

Vertigo

Sweating

Cognitive dysfunction/ death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What kinds of things can cause hypoglycemia in a patient who uses insulin?

A

Taking too much insulin

Change in insulin type preparation

Too many insulin secreting drugs

Spontaneous decreases in insulin requirements (no longer pregnant or stressed out)

Vigorous exercise ⛹️‍♂️

Failure to eat

Overindulgence in alchol🍻🍸🥃🍾🍷🥂🍺🍹

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you treat hypoglycemia in someone who is unconscious?

A

Give 50% glucose solution IV until they wake up

Could also theoretically give glucagon but no one does that

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Do we give oral glucose to unconscious patients

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why do patients get local allergic reactions to insulin?

A

Because they get lazy with their injection technique. Reusing needles, injecting through clothes etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What kinds of things increase insulin requirement?

A

ANYTHING that increases stress**
….Like SURGERY, preganncy, thyrotoxicosis, infection

Acromegaly and Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If your patient is having surgery, what do you need to do to their insulin dose?

A

Increase it! (Surgery is stressful)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 4 preparation types of insulin?

A

Rapid

Short (Regular)

Intermediate

Long acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 4 types of rapid acting insulin available

A

Lispro

Aspart

Glulisine

Inhaled*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which insulins are clear solutions and can be given in an IV (like you would do for an unconscious patient)

A

Rapid acting

Short acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What kind of insulin is used in insulin pumps?

A

Rapid acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which insulin’s have been modified to provide prolonged action?

A

NPH (Turbid)

Glargine (low pH)

Detemir (myristoylated)

I DONT KNOW WHAT THIS MEANS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What kind of insulin is used first in type II DM?

A

Long-acting (basal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do you need to do if you’re going to inject your insulin yourself (instead of have a pump)

A

Create an insulin profile and eat to fill it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you take insulin if you use a pump?

A

Adjust insulin blouses according to what you eat

More similar to a natural insulin release pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is necessary for glucagon to work to increase blood glucose?

A

You must have glycogen stores!**

NOT EVERYONE DOES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are two uses for glucagon that are not to increase blood sugar

A

Beta blocker overdose- will increase heart rate and contractility

Radiology- relaxes the intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Diazoxide (Proglycem)?

A

It is a thiazide (no diuretic effect though) that vasodilators and RAISES blood sugar by inhibiting insulin secretion, decreasing peripheral glucose utilization, and stimulating hepatic glucose production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Who do we give Diazoxide (Proglycem) to?

A

Patients with insulinoma (insulin secreting tumor)

Diazoxide inhibits insulin secreting and raises blood sugar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are some of the things you need to consider before giving a patient an anti diabetic agent?

A

Effect on cardiovascular disease (CVD is the #1 killer of diabetics!)

Hypoglycemia risk

Impact on weight

Glucose reduction efficacy

Side effects, cost, patient preferences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the 4 rapid acting insulins?

A

Insulin lispro (Humalog)

Insulin aspart (NovoLog)

Insulin glulisine (Apidra)

Insulin, inhaled (Afrezza)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the short acting insulin’s

A

Regular Insulin (Novolin R, Humulin R)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the intermediate acting insulins?

A

NPH or Isophane Insulin (Humulin N, Novolin N)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the long acting insulins?

A

Insulin glargine (Lantus)

Insulin detemir (Levemir)

Insulin degludec (Tresiba)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the #1 killer of diabetics

A

cardiovascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the initial drug of choice for Type 2 diabetics, as long as their A1C is under 10%?

A

Metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the MOA of Metformin?

A

Decreases glucose in an insulin-INDEPENDENT matter:

Removes glucose from blood (AMPK)

Secretion of GLP-1

Decrease glucose absorption from GI

Decrease glucagon levels

Decreased gluconeogenesis (mitochondrial enzyme inhibition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What glycemic effects does metformin have?

A

Decreases A1C a LOT! (1-1.5%)

Promotes a euglycemic state *!!! (as opposed to hypoglycemic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Why is it ok to give metformin to women with PCOS that DONT have diabetes?

A

Because metformin promotes a euglycemic state and NOT a hypoglycemic state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the cardiovascular effects of metformin?

A

Lower triglycerides by 15-20%

Decrease Macrovascular events (aka heart attacks)*******

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are some “other” effects of metformin?

A

Weight neutral (does NOT increase insulin release, so it has no effect on weight!)***

Decrease all-cause mortality events

BEST pharmacologic therapy for diabetes prevention in prediabetics**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What drug should prediabetics take to prevent diabetes?

A

Metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Will metformin cause weight gain

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is metformin excreted?

A

Through the kidneys

Remember the whole contrast and holding metformin thing?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the adverse effects of metformin?

A

Lactic Acidosis** LETHAL

Diarrhea*** (53% of patients!)

Hypoglycemia rarely

43
Q

What are the contraindications/precautions for metformin?

A

Anything that can cause lactic acidosis:

Kidney disease (contraindicated in renal failure or GFR <30)

Liver disease

Alcoholism

Diseases that predispose to tissue hypoxia: COPD, CHF

44
Q

What are incretins?

A

GLP-1 and GIP that get released when you take glucose ORALLY

They increase insulin release and inhibit glucagon release (decreased hepatic gluconeogenesis)

45
Q

What is the MOA of GLP-1 agonists?

A

They are GLP-1 agonists that are ~resistant~ to DPP-4 degradation

46
Q

What are the 5 GLP-1 agonists?

A

Exenatide (Byetta, Bydureon)

Liraglultide (Victoza)

Dulaglutide (Trulicity)

Albiglutide (Tanzeum)

Lixisenatide (Adlyxin)

47
Q

How are GLP-1 agonists administered?

A

SC injections 2x/day or 1x/week

48
Q

What are the effects of GLP-1 agonists?

A

Large A1C decrease (1-1.5%)

Liraglutide (Victoza) will decrease macrovascular events**

Lower BP (maybe)

Slows gastric emptying= eating less

Weight loss**

Increased B cell number and function**

49
Q

Which GLP-1 agonist is only approved for weight loss?

A

Liraglutide (Sandexa)

🏝👙 (take it before you hit the SAND)

50
Q

What are the adverse effects of GLP-1 agonists?

A

ACUTE PANCREATITIS* ON TEST***!!

Hypoglycemia (low risk)

GI

Hypersensitivity

51
Q

What are the contraindications/precautions of GLP-1 agonists?

A

Pancreatitis (now or ever)***

Thyroid Cancer BLACK BOX WARNING it is thought that it exacerbates thyroid cancer when it increases the # of B cells

52
Q

What are the 4 DPP-4 inhibitors?

A

Sitagliptin (Januvia)

Saxagliptin (Onglyza)

Linagliptin (Tradjenta)

Alogliptin (Nesina)

the gliptins

53
Q

What is the MOA of DPP-4 inhibitors?

A

Potentiates the effects of endogenous incretins by inhibiting their breakdown by DPP-4

54
Q

How are DPP-4 inhibitors administered?

A

Oral

55
Q

What are the therapeutic effects of DPP-4 inhibitors?

A

Decrease A1C a medium amount (0.5-1%)

Weight neutral

Neutral CV effects (at least its not bad)

56
Q

What are the adverse effects of DPP-4 inhibitors?

A

Hypoglycemia*

Acute pancreatitis*

Severe joint pain*

57
Q

What are the contraindications/precautions of DPP-4 inhibitors?

A

Pancreatitis now or ever*

Slow GI

Renal impairment

58
Q

What are the 4 SGLT-2 inhibitors?

A

Canagliflozin (Invokana)

Dapagliflozin (Farxiga)

Empagliflozin (Jardiance)

Ertugliflozin (Steglatro)

“Gli” -> glucose

“Flozin” -> flowing (kidney)

59
Q

What is the MOA of SGLT-2 inhibitors?

A

Inhibits the sodium-glucose cotransporter (SGLT-2) in the kidney= makes you pee out a lot of glucose

60
Q

What are the 2 antidiabetic drugs that are FDA approved too treat Cardiovascular Disease’?

A

Liraglutide (Victoza)

Empagliflozin (Jardiance)

This is probably due to their weight loss effect

61
Q

Do SGLT-2 inhibitors do anything to address the insulin resistance problem

A

No

62
Q

What are the therapeutic effects of SGLT-2 inhibitors?

A

Medium A1C decrease (0.5-1%)

Empagliflozin decreases CV events****

Lower BP*

Weight Loss** (you’re pissing out glucose)

63
Q

What are the adverse effects of SGLT-2 inhibitos?

A

Vaginal yeast infections, UTIs and increased urinary frequency**** You’re pissing out glucose 🧁🚽

Hypoglycemia rarely

Hyponatremia***Increased urinary Na+ excretion due to increased H2O in proximal tubule

Osmotic diuresis**

Hypotension, dizziness, syncope, dehydration due to diuresis

Increased LDL (not addressing insulin problem)

Increased bone fractures

Renal impairment

64
Q

What are the contraindications/precautions for SGLT-2 inhibitos?

A

Contraindicated in severe kidney disease or on dialysis (these drugs wont work if your kidneys are shitty)

Prone to UTIs or other GU infections

65
Q

How would an SGLT-2 inhibitor affect someone with an overactive bladder?

A

It would be made WORSE due to the osmotic diuresis and increased need to pee

66
Q

What are the 2 thiazolidinediones (TZDs)?

A

Pioglitazone (Actos)

Rosiglitazone (Avandia)

the glitazones

67
Q

What is the MOA of thiazolidinediones (TZDs)?

A

Bind to PPARγ receptor which causes post-receptor insulin-mimetic action:

Increased GLUT4

Decreased hepatic gluconegenesis

68
Q

What antilipid drug class are Thiazolidinediones (TZDs) similar to?

A

Fibrates (PPAα ligands)

69
Q

Do thiazolidinediones (TZDs) specifically target insulin resistance?

A

YES. They are “Insulin sensitizers”**

70
Q

How long does it take for thiazolidinediones to work?

A

Weeks to months

Half life is 100-150 hours

71
Q

What are the therapeutic effects of thiazolidinediones?

A

High A1C decrease (1-1.5%)

Lower triglycerides in long-term use (insulin is getting glucose into cells, so there’s less FFA’s)

Increase HDL

Lower insulin resistance**

May help prediabetics prevent development of DM

72
Q

What are the adverse effects of thiazolidinediones?

A

Edema (can cause HF in patients with CHF!!**)

Weight gain **

Bone fracture risk** (no one knows why)

Back pain, fatigue, headache

Rosiglitazone had a troubled history CV issues, but it’s all made up

73
Q

What are the contraindications/precautions for thiazolidinediones?

A

Hepatic disease (1st TZD was taken off the market for this!*)

Contraindicated in heart failure ** due to edema

74
Q

What are the 2 α-glucosidase inhibitors?

A

Acarbose (Precose)

Miglitol (Glyset)

75
Q

What is the only Class of antidiabetic agent that is used in type 1 diabetes?

A

α-glucosidase inhibitors

Used off-label in type 1 becasue if they eat too many carbs than the amount of insulin they took for their insulin profile, they can take this to prevent the absorption of the carbs)

76
Q

What is the MOA of α-glucosidase inhibitors?

A

Inhibit α-glucosideases in small intestine= delayed carb digestion and absorption

77
Q

How do you take α-glucosidase inhibitors?

A

Orally, pre-prandially

78
Q

What are the therapeutic effects of α-glucosidase inhibitors?

A

Decrease postprandial glucose (can lower A1C)

No effect on weight (?!?!)

79
Q

What are the adverse effects of α-glucosidase inhibitors?

A

GI effects- diarrhea and flatulence**** (all those undigested carbs make your gut bacteria very happy!)💩💨

High liver enzymes, jaundice

80
Q

What are the contraindications to α-glucosidase inhibitors?

A

Contraindicated in: GI disease, GI obstruction, lieu’s, IBD, hiatal hernia

Be careful with Liver/kidney probs

81
Q

Left off on slide 51

A

Saiodfghjlidfsuhv

82
Q

How do Sulfonylureas work?

A

They float over to the β-cells and bind to a K+ channel, which depolarizes the membrane and increases Calcium influx into the cells= big fat insulin release

83
Q

What are the therapeutic effects of sulfonylureas?

A

Lower A1C a lot (1-1.5%)

Decrease risk of MI and microvascular disease

Decrease mortality

Decrease glucagon= lower hepatic glucose production

Potentiate action of insulin on target tissues

84
Q

What are the adverse effects of sulfonylureas?

A

HYPOGLYCEMIA** the worst drug for this

Weight gain

85
Q

What are the contraindications of sulfonylureas?

A

SULFA ALLERGY!!!!!*****

86
Q

Which diabetic drug class has the highest risk of causing hypoglycemia (other than insulin)

A

Sulfonylureas

87
Q

Why dont we use sulfonylureas very much anymore?

A

They have the highest risk of hypoglycemia

88
Q

A guy went on a trip to the Himalayan Mountains, and he got Acute mountain sickness. The doctor there gave him a drug to treat this and he had an allergy! What drug class can we not use to treat his Type II diabetes

A

Sulfonylureas, because they are SULFAS

He was treated with acetzolamide- a sulfa

89
Q

What are the 1st generation sulfonylureas, and what are the points you need to know about them?

A

Tolbutamide- short acting (less hypoglycemia)

Chlorpropamide- long acting, disulfiram-like effect, WORST hypoglycemia

Tolazamide

90
Q

What are the 3 second generation sulfonylureas, and which ones has the highest risk of hypoglycemia?

A

Glyburide- most hypoglycemia

Glipizide-worst hypoglycemia

Glimepiride

91
Q

Which sulfonylureas generation is the most potent: 1st or 2nd?

A

2nd

92
Q

What are meglitinides?

A

Almost the same thing as sulfonylureas, but they are NOT sulfonamides= can be used in a sulfa allergy

93
Q

What are the 2 Meglitinides?

A

Repaglinide (Prandin)

Nateglinide (Starlix)

94
Q

What are the adverse effects of meglitinides?

A

Nateglinide: a little bit of hypoglycemia

Repaglinide: hypoglycemia

95
Q

What is Colesevelam (WelChol)?

A

A bile acid binding resin that will lower A1C in combo with other antidiabetic drugs

96
Q

What is Bromocriptine (Cycloset)?

A

It is a dopamine agonist that suppresses hepatic glucose production

97
Q

What are the therapeutic effects of Bromocriptine (Cycloset)?

A

Lowers FFA and TG’s

Lowers CV end point problems

98
Q

What is Pramlintide (Symlin)?

A

A synthetic analog of amylin (a hormone cosecreted with insulin)

99
Q

Can we give Pramlintide (Symlin) alone?

A

No, it is only an adjunct to insulin therapy in Type 1 AND Type 2 diabetes!!!!!***!!

100
Q

What is the MOA of Pramlintide (Symlin)?

A

It works with insulin to Lower post-prandial glucose by:

Slowing gastric emptying

Suppressing glucagon

Centrally-mediated appetite suppression

101
Q

What are the only two classes of diabetes drugs that can cause hypoglycemia?

A

Sulfonylureas

Meglitinides

(+ insulin of course)

102
Q

What are the only two classes of drugs that can cause hyperinsulinemia?

A

Sulfonylureas

Meglitinides

103
Q

Some guy rolls into the ER and you can tell right away he has way too much insulin flowing through his system. How can you tell if it’s from taking too much insulin or if he took too much of a sulfonylurea or Meglitinide?

A

C-peptide.

Sulfonylureas and Meglitinides will increase endogenous insulin production

Pharm II Final (Lauren) (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions