Diabetes

Question 1

Insulin Lispro

Answer 1

instant rapid acting

subcutaneous injection, continuous s.c. infusion

ADV. relative insuline overdose in renal failure (compare healthy people insulin degraded by liver)

Question 2

Insulin Aspart

Answer 2

instant rapid acting

ADV. relative insuline overdose in renal failure (compare healthy people insulin degraded by liver)

Question 3

Regular Insulin

Answer 3

short acting - delayed onset of actions

subcutaneous injection, continuous s.c. infusion, combo pen with NPH, emergency IV in ICU.

ADV. forms hexamers leading to lipodystrophic changes in areas of injection, requires post prandial snack (hypoglycemia), relative insuline overdose in renal failure (compare healthy people insulin degraded by liver)

Question 4

Lente Insulin

Answer 4

intermediate acting

ADV. relative insuline overdose in renal failure (compare healthy people insulin degraded by liver)

Question 5

NPH insulin (neutral protamin hagedorn)

Answer 5

intermediate acting

subcutaneous injection, combo pen with regular

ADV. relative insuline overdose in renal failure (compare healthy people insulin degraded by liver)

Question 6

Ultralente Insulin

Answer 6

long acting

ADV. relative insuline overdose in renal failure (compare healthy people insulin degraded by liver)

Question 7

Insuline Glargine

Answer 7

long acting, slow onset (plateau) - injected as polymers

provides constant inculin level, combine with rapid acting insulin at meals

TX. diabetes

ADV. relative insuline overdose in renal failure (compare healthy people insulin degraded by liver)

Question 8

Insuline Detemir

Answer 8

long acting, slow onset (plateau)

provides constant inculin level, combine with rapid acting insulin at meals

TX. diabetes

ADV. relative insuline overdose in renal failure (compare healthy people insulin degraded by liver)

Question 9

Sulfonylureas

Answer 9

• acetohexamide, chlorpropamide, tolazamide, tolbutamide
• glyburide, glibenclamide, glibizide, glimepiride

hypoglycemic. block K+ channel to depolarize beta pancrease secreting cells. reduce glucagon levels, potentiate insuline effect on target tissues??

oral. DoA ~24hrs. hepatic met and biliary/renal elimination

TX. uncomplicated type II diabetes (combo insulin/metformin)

ADV. weight gain, GI nausea, vomiting, cholestasis, alergy, hematologic leukopenia, thrombopenia, anemia, disulfiram effect with alcohol.

CI; hepatic or renal disease. drug interactions with ACE. inhibitors, sulfonamides.

Question 10

Repaglinide

Answer 10

(meglitinide)
hypoglycemic. block K+ channel to depolarize beta pancrease secreting cells.

oral. fast onset with short DoA ~1hr for meals

TX. type II Diabetes, combo metformin (but not other antidiabetics)

ADV. headache, nausea, joint pain, (no sulfa for alergy)

Question 11

Metformin

Answer 11

antihyperglycemic. biguanide. decrease hepatic output and GI absorption glucose, increase insulin sensitivity muscle/adipose, favourable effects on plasma lipids and body weight. [does not stimulate insulin secretion]

oral. renal excretion.

TX. first line drug type II diabetes and hyperlipidemia. may be combo with sulfonylureas

ADV. GI disturbacnes, nausea, diarrhea (rare, dangerous lactic acidosis). no hypoglycemia

CI. renal or hepatic disease, alcoholism, pregnancy

Question 12

Pioglitazone

Answer 12

thiazolidinediones (TZD, glitazones)

antihyperglycemic. enhance insulin action at target tissue (increase glut 4), agonist for PPAR-gamma nuclear receptor. improve adipose function, lower blood glucose and lower circulating insulin levels.

oral once daily, 99% plasma protein bound, hepatic cyp450 metabolism and excretion.

TX. type II diabetes and hyperinsulinema/resistnace (PCOS)

NO weight gain, no hypoglycemia.

ADV. mild anemia, edema, hypoglycemia when combined with insuline, p450 interactions (do not use in liver disease)

Question 13

Rosiglitazone

Answer 13

thiazolidinediones (TZD, glitazones)

antihyperglycemic. enhance insulin action at target tissue (increase glut 4), agonist for PPAR-gamma nuclear receptor. improve adipose function, lower blood glucose and lower circulating insulin levels.

oral once daily, 99% plasma protein bound, hepatic cyp450 metabolism and excretion.

TX. type II diabetes and hyperinsulinema/resistnace (PCOS)

NO weight gain, no hypoglycemia.

ADV. mild anemia, edema, hypoglycemia when combined with insuline, p450 interactions (do not use in liver disease)

Question 14

Acarbose

Answer 14

antihyperglycemic. competitive inhibitors of (extrasystemic) intestinal alpha-glucosidase.

oral. start low dose and titrate up

TX. uncomplicated type II diabetes

ADV. Winds, abdominal pain, oily spotting, elevated liver enzymes. prevents live saving oral glucose in hypoglycemia (risk when used in drug combination)

CI. liver, kidney, bowel disease

Question 15

Miglitol

Answer 15

antihyperglycemic. competitive inhibitors of (extrasystemic) intestinal alpha-glucosidase.

oral. start low dose and titrate up

TX. uncomplicated type II diabetes

ADV. Winds, abdominal pain, oily spotting, elevated liver enzymes. prevents live saving oral glucose in hypoglycemia (risk when used in drug combination)

CI. liver, kidney, bowel disease

Question 16

Exenatide

Answer 16

full agonist analogue to glucagon-like polypeptide (GLP-1) derived from salivary gland of the gila monster

• enhances glucose-dependant insuline secretion
• supresses postprandial glucagon release
• slows gastric emptying
• decrease appetite
• may stimulate b-cell proliferation
• moderate effects on HbA1C

bid injections. resistant to dieptityl peptidase IV (DPP-IV)

TX. adjunct tx in type II diabetes

Question 17

Sitaglyptin

Answer 17

selective inhibitor of dieptityl peptidase IV (DPP-IV) which degrades incretins.

increase circulating levels of GLP-1 and therefor, insulin

oral

TX. type II diabetes