Diabetes

Question 0

Metformin/glucophage

Answer 0

biguanide that decreases hepatic glucose production and enhances insulin sensitivity in the periphery;
has a similar efficacy to the sulfonylureas
can cause a little weight loss

Question 1

Diabetes qualifications

Answer 1

Fasting glucose> 126 mg/dL
non-fasting glucose>200
oral glucose tolerance>200

Question 2

Metformin side effects

Answer 2

abd cramping, nausea, metallic taste
Causing B12 deficiency 
lactic acidosis (don't use with impaired renal fxn)

Question 3

Metformin dosage

Answer 3

1500-2000 mg/day (usually dosed 1000 BID)

Question 4

Sulfonylureas MOA

Answer 4

stimulate in tact beta cells to release more insulin

Reacts with ATP sensitive potassium channels in the Beta cell membrane (more insulin release)

Question 5

Examples of sulfonylureas

Answer 5

1st gen- Chlorpropamide/ Diabinese
Tolbutamide
2nd gen- Glipizide (glucotrol)

Question 6

Side effect of sulfonylureas

Answer 6

hypoglycemia, particularly with renal impairment
wt gain
generally become ineffective after 5-10 years because total beta cell fxn declines

Question 7

Meglinitides MOA

Answer 7

stimulate beta cells to release insulin
bind to ATP sensitive potassium channels and increase insulin release

non-sulfonylurea secretagogue

Question 8

Examples of meglinitides

Answer 8

Natelinide (Starlix)

Repaglinide (Prandin)

Question 9

Characteristics and side effects of Meglinitides

Answer 9

rapidly absorbed (insulin peaks 30-60 mins)
rapidly cleared.  Take with meals.  No generics
Sides: hypoglycemia, wt gain, avoid combining with sulfonylurea

Question 10

Thiazolidinediones/ glitazones MOA

Answer 10

Improve insulin sensitivity in skeletal muscle, fat cells, and liver cells
decrease hepatic glucose production

Takes 6-14 weeks to achieve max effects

Question 11

Thiazolidinediones/Glitazones examples

Answer 11

Rosiglitazone (Avandia)
Pioglitazone (ACTOS)

Only ACTOS is approved for use with insulin

Question 12

Side effects of Thiazolidiendiones/Glitazones

Answer 12

Increased risk of CHF 
Test liver fxn before and throughout tx
reduce bone density
increase fracture risk
wt gain

Question 13

MOA alpha glucosidase inhibitors

Answer 13

inhibit enzymes on the brush border and interfere with hydrolysis of carbohydrates ->delay absorption of glucose
Must be taken WITH EACH MEAL

Question 14

Examples of alpha glucosidase inhibitors

Answer 14

acarbose (precose)

miglitiol (glyset)

Question 15

Characteristics of alpha glucosidase inhibitors

Answer 15

unabsorbed carbs are going to lead to abdominal pain diarrhea and flatulence
if given with sulfonylurea or insulin -> increased hypoglycemia
with hypoglycemic event- give glucose rather than sucrose
C/I in pts with intestinal dz, IBD, colonic ulceration, intestinal obstruction

Question 16

Sitaglipitin/ Januvia

Answer 16

Competitively inhibits DPP-4 -> No breakdown of GLP1 and GIP-> potentiate insulin, suppress glucagon
doesn’t overshoot to hypoglycemia
can combine with metformin, sulfonylurea, or TZD
100 mg qD

Question 17

Tx hierarchy for diabetes

Answer 17

Metformin
Metformin + glimepiride or glipizide
Glimepiride
glipizide
metformin, amaryl, and insulin
ACTOS