Diabetes

Question 1

Severe Hypoglycemia tx

Answer 1

Diazoxide: glucagon agonist which opens potassium channels, inhibiting insulin from being released. IV.
Reversal with beta blockers
Affects: nausea vomiting, hypokalemia, no pheochromocytoma pts

Question 2

Type I Tx

Answer 2

Insulins, rapid, intermediate, or slow acting, also ultra long acting
Need to ingest carbs prior each pump.

Question 3

Humalog/insulin lispro

Answer 3

rapid: proline and lysine 3-4h, insulin pumps Aa: hypoglycemia, rxns at injection site, allergies, swelling, itching/rash

Question 4

NPH:

Answer 4

intermediate: 4-12 h.Can be mixed with rapid acting analogs, needs proteolytic enzyme digestion to absorb insulin

Question 5

Glargine and detemir: arg

Answer 5

long: Arg broad plasm plateau, slow depo of release at injection site, splubel at acidic pH. Cannot be mixed with other analogs

Question 6

Insulin degludec(Tresiba)

Answer 6

ultra long:42h, sub q 1x/day, can be mixed with short acting

Question 7

Inhalational insulin

Answer 7

Technosphere insulin(afrezza): big ass surface area for absorption, fast onset, 3h only
Can cause coughing, no smokies

Question 8

Adjuvant Tx to type i

Answer 8

Amylin analog to assist insulin lower glucose
Pramlintide: type i or type ii dbs. Aa: anorexia, feeding carsb can b an issue due to delayed gastric emptying

Question 9

Sulfonylureas:

Answer 9

blocks atp sensitive k channel, membrane depol, calcium channels open, insulin release. 1st gen have lower affinity, 2nd gen higher affinity and preferred drugs nowadays

Question 10

Tolbutamide:

Answer 10

Sulfonylurea, not as high affinity, excreted via kidneys, AA weight gain, sun and skin rxns, GI distress, dark urine. No type i diabetics, renal insuff, hepatic disease

Question 11

Glimepiride and Glipizide:

Answer 11

Sulfonylureas,when metformin is contraindicated, again no renal insuff, hepatic issue, caution with elderly bc of hypoglycemia

Question 12

Meglitinide analogs:glinides

Answer 12

block k channel on islet cells. Taking 30 min before meals, causes hypoglycemia. Similar to binding of sulfonylureas but has an extra binding site. AA: Hypoglycemia

Question 13

Reaglinide

Answer 13

metabolized by cyp2C90 and 3A4

Question 14

Nateglinide:

Answer 14

metabolized by cyp2C90 and 3A4, adjunctive to metformin

Question 15

AMPK activators

Answer 15

activates AMPK and reduces glucose production. MOA slightly unknown. Hypoglycemia is rare.
Metformin: not metabolized by liver, but don’t take CKD or renal failure. Increased risk of arctic acidosis. Interferes with cobalamin absorption. Halter also before imaging is done

Question 16

TZDs Glitazones:

Answer 16

Increase GLUT1 and GLUT4 to increase insulins sensitivity, decreases resistance. Godo for also fatty liver disease. Can increase MI or angina. Activates PPAR-Y
Pioglitazone : 2C8/3A4
Rosiglitazone : 2C8/2C9

Question 17

Incretin agonists GLP-1 and GIP aka Tides:

Answer 17

increases insulin release to lower plasma glucose, amplification due to GLP and GIPs, orla gives a bigger effect because of these two peptides interacting thru the gut for insulin secretion.
AA: pancreatitis

Question 18

Exenatide and Dulaglutide:

Answer 18

incretin. adjunctive tx with metformin or metformin + sulfonylureas that need more glycemic control.

Question 19

gliptins

Answer 19

helps incretins stay in the system longer to keep amplifying effect. JOIN PAIN aa
Sitagliptin
Saxagliptin

Question 20

SGLT-2 Inhibitors Flozins:

Answer 20

block reabsorption in proximal tubule. Can cause hypotension bc of intravascular volume contraction
Contraindications for pts with CKD or renal insufficiency, can’t give to patients with beta cell failure or insulin deficiency
Canagliflozin
Dapagliflozin