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pharmacology II > diabetes 2 > Flashcards

diabetes 2 Flashcards

1
Q

Diagnoses of DM from fasting

A

fasting glucose over 126mg/dl

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2
Q

diagnosis non fasting glucose

A

non fasting over 200mg/dl

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3
Q

diagnosis with glucose tolerance test

A

glucose tolerance over 200 at 2-3 hours after bolus

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4
Q

Onset of type !

A

less than 20 years

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5
Q

cause of DM I

A

autoimmunity against pancreatic beta cells and to insulin , familial

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6
Q

cause of DM II

A

Insulin resistance, then insulin deficiency and excess hepatic glucose production

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7
Q

diffenrence in body habitis of DM I and DM II

A

DM I often underweight onset prior to 20, DM II overweight and onset often after 30

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8
Q

is DM II familial

A

yes, 90-100 percent in twins, in DM I is 50% with twins

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9
Q

what is LADA

A

Latent onset adult diabets 1.5

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10
Q

when should you look for DM 1.5

A

in all non obease adults who present with apparent type 2 DM or those with DM II who have rapid detoriation of glucose control

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11
Q

what are the two secreatogues

A

Sulfonylureas and meglitinides (non sulpher)

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12
Q

what aret he type 2 DM drug types

A

biguanides, sulfonylureas, meglitinides, A-glucosidase inhibitors, thiazolidinediones TZD glitazones, dipeptidyl peptidase-4 (DPP-4)

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13
Q

with which of the type 2 DM drug classes can you also give insulin

A

most of them: buguanides, sulfonylureas, meglitinides, a glucosidase inhibitors, glitazones, Don’t give insulin to DPP-4 inhibitors.

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14
Q

what type of drug is metformine

A

Biguanides

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15
Q

how does MOA of biguanides

A

inhibit glucose production by liver and decrease insulin resistance

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16
Q

how do the secreatogue work,

A

sulfonylureas and meglitinides increase secretion of insulin

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17
Q

how do the alpha glucosidase inhibitors work

A

delay absorption of glucose by intestines.

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18
Q

how to the glitazones, work

A

decrease insuline resistance

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19
Q

how do the DPP-4 work

A

promote release of insulin after eating meal

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20
Q

what meds delay absorption of glucose by intestines

A

alpha glucosidate inhibitors

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21
Q

what drugs decrease insuline resistance

A

biguanides and the glitazones

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22
Q

what drugs promote release on insulin after eating

A

DPP-4

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23
Q

what drug inhibit glucose production by liver

A

biguanides

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24
Q

what is the concern with oral diabetic medications and illness

A

may need to switch to insulin during acuted infection because they potentially will have wose glucose control. Also prior to inpatient surgery

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25
Q

when would type II diabetics be given insulin rather than oral right off

A

if they become pregnant or develop gestation diabetes to maintain tighter glucose control.

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26
Q

what has been associated wit horal diabetic medications and pregnancy

A

macrosomia

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27
Q

what oral diabetic drug dose not cause hypoglycemia when used alone

A

biguanide -metformin/ alpha glucosidase inhibitors - acarbose

28
Q

what 2 oral drugs can cause hypoglycemia

A

secreatagogues: sulfonylureas and meglitinides

29
Q

would metformin or a sulfonylurea cause weight loss

A

metformin about 4-7 lbs

30
Q

what is the vitain B12 deficiency offten associated with

A

metformin

31
Q

what drug has severe sideefect lactic acidosis

A

metformin a biguanide

32
Q

who should not be on metformin

A

those with impaired renal function

33
Q

how does sulfonylurease cause insulin release

A

partial blocking of potassium channels increasing Ca release stage that signals insulin release

34
Q

what generation of sulfonylureases are most often used

A

2nd generation Glipizide

35
Q

most concerning about sulfonylureas

A

hypoglycemia and then there is often weight gain and lose effectiveness withing 5-10 years

36
Q

which sulfonylureas is most likely to cause hypoglycemia

A

gyburide

37
Q

how often dose metformin

A

twice daily

38
Q

how often dose glipizide

A

one morning dose

39
Q

what are the two meglitinides secretagogues

A

nateglinide and repaglinide which is more effective

40
Q

what drug class would you not want to mix meglitinides with

A

sulfonylureas because it would increase risk of hypoglycemia

41
Q

how often are meglitinies taken

A

3-4 times a day unlike sulfonylureas which are once in the morning

42
Q

how often are the glitazones dosed

A

1-2 times each

43
Q

what are the two glitazones

A

glitazones: avandia and actos

44
Q

which of the glitazones may be used with insulin

A

ACTOS only

45
Q

what is concerning about glitazones

A

they increase risk of CHF and possibly MI, increased ALT and wt tain

46
Q

what diabetic drug must you test liver function

A

glitazones: avandia and actos

47
Q

what are the two a glucosidase inhibitors

A

a-glucosidase inhibitors: Acarbose and miglitol

48
Q

when are the a-glucosidase inhibitors taken

A

with each meal,

49
Q

when would acarbose and miglitol cause hypoglycemia

A

only if combined with sulfonylurea or insulin, never if given alone

50
Q

side effects of A glucosidase inhibitors

A

flatulance abd pain, diarrhea because it works at GI brush border

51
Q

what drug has a rare fatal hepatic failure

A

Acarbose: aglucosidase inhibitor

52
Q

what is unique about hypoglycemia of those on a glucosidase inhibitos

A

The antadote is Glucose and can not be sucrose.

53
Q

who can not take acarbose or miglitor:aglucosidase inhibitor

A

those with chronic intestinal diseases or obstruction

54
Q

what does preservation o GLP and GIPdo

A

DDP-4:drive blood glucose to normal to lower insulin release and glucagon supression reducing risk o hypoglyemia

55
Q

what is a DPP inhibitor

A

Sitagliptin/januvia: potientiate insulin effects so it is never used with insulin

56
Q

what of the oral diabetic drugs are never used with insulin

A

Sitagliptin/januvia: DPP-4 inhibitors

57
Q

what drugs can cause increase of pancreantitis

A

DPP-4 inhibitrs: Sitagliptin/januvia and janumet

58
Q

what is the good first choice drug

A

Metformin: Biguanides, then ad sulfonylurea if that diesn’t work.

59
Q

what are the two injectable DM type II drugs

A

Pramlintide and exenatide

60
Q

Pramlintide/symlin: injectable

A

Synthetic amylin - produced with insulin by beta cells, so can used less insulin while stil lowering average blood sugar

61
Q

Exenatide : injectable

A

syntehtic extendin -4 - gila monster saliva

62
Q

can pramlintide be used with insulin?

A

Yes but they can not be injected inside the same vial or syringe.

63
Q

why is pramlintide notable

A

first approved to lower blood sugar in diabetics since discovery of insulin

64
Q

why is pramalintide injected

A

at meals times, without causing wt gain or hypoglycemia although nausea is a side effect.

65
Q

incretin mimetics

A

Incretin mimetics: exenatide/byetta, lowers blood blucose by increasing insulin secretion

66
Q

what is unique about exenatides ability to lower blood glucose levels

A

it only lowers blood blucose in presence of high bloodglucose, so hypoglycemia is not a risk.

pharmacology II (31 decks)

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