Diabetes Flashcards

1
Q

what drugs are insulin secretogogues?

A

sulfonylureas

meglitinides

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2
Q

name the 6 sulfonylureas

A
  1. Chlorpropramine
  2. Tolbutamide
  3. Tolazamide
  4. Glipizide
  5. Glyburide
  6. Glimepiride
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3
Q

what are the 2 Meglitinides?

A
  1. Repaglinide
  2. Nateglinide
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4
Q

how do all sulfonylureas work?

A

Block ATP sensitive K+ channels in pancreatic beta cells.

Inhibits efflux of K+ and opening Ca channels (influx) causing release of pre-formed insulin

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5
Q

which sulfonylureas are 1st generation?

A
  1. Chlorpropramide
  2. Tolbutamide
  3. Tolazamide
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6
Q

which sulfonylureas are 2nd generation?

A
  1. Glipizide
  2. Glyburide
  3. Glimepiride
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7
Q

which sulfonylurea has the longest half life?

how long does it last?

A

chlorpropramide

32 hours

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8
Q

when is chlorpropramide contraindicated?

A

patients with hepatic disease (slowly metabolized in liver)

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9
Q

which sulfonylurea has the shortest half life?

which is why it is perfect to use in which patient?

A

tolbutamide

elderly patients

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10
Q

sulfonylureas, all of them, are used for what condition?

A

diabetes mellitus type 2

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11
Q

what are signs of sulfonylurea toxicity?

A

hypoglycemia

disulfiram like reaction with alcohol

(nausea, palpitation, sweating)

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12
Q

all sulfonylureas are contraindicated when?

A

pregnancy

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13
Q

when is Glipizide contraindicated?

A

In patients with hepatic disease (can cause hypoglycemia)

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14
Q

which sulfonylurea has the highest potency?

A

Glimepiride

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15
Q

how do Meglitinides work?

A

sames as sulfonylureas:

block ATP sensitive K+ channels in pancreatic beta cells. Inhibits the efflux of K+, resulting in depolarization. Opening of voltage gated Ca influx. Release of preformed insulin and increase insulin receptors

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16
Q

Repaglinide and Nateglinide have what type of onset?

and how long do they last?

A

rapid onset

have a short duration

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17
Q

Repaglinide, Nateglinide are used for what?

A

**good for controlling Postprandial hyperglycemia

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18
Q

too much Repaglinide, Nateglinide may lead to what?

A

hypoglycemia

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19
Q

Name a Biguanide drug

A

Metformin

20
Q

how does biguinides work?

A

it is a Antihyperglycemic by Increasing peripheral insulin sensitivity by increasing insulin receptors and Inhibits hepatic gluconeogenesis.

21
Q

will metformin give you hypoglycemia?

is metformin euglycemic?

A

no

yes

22
Q

what is a secondary benefitial effect from metformin?

A

reduced triglycerides, reduced total cholesterol, reduced LDL, increased HDL.

23
Q

when is metformin used?

A
  1. Obese Type 2 DM
  2. Polycystic Ovarian Syndrome: lowers the serum androgens and restores normal menstrual cycles
24
Q

metformin toxicity will affect what organ only?

toxicity will elicit what effects?

A

GI

  1. Lactic acidosis
  2. Vitamin B12 deficiency.
  3. metabolic acidosis (extreme dehydration, hyperventialtion, high anion gap, acidic blood pH)
25
Q

metformin causes lactic acidosis, especially in which patients?

A

in alcoholics and patients with hepatic impairment

26
Q

what happens if you give metformin to an alcoholic?

A

he develops lactic acidosis

27
Q

what is the category name for Insulin Sensitizers?

A

Thiazolidinediones

28
Q

name the 2 Thiazolidinediones

A
  1. Pioglitazone
  2. Rosiglitazone
29
Q

how does Pioglitazone and Rosiglitazone work?

A

Activate peroxisome proliferator-activating receptors (PPAR’s)

these are involved in the transcription of insulin responsive genes. Increase the glucose uptake in muscle and adipose tissue and decreases hepatic gluconeogenesis.

30
Q

Insulin Sensitizers will have what effects?

A

Reduce plasma glucose and triglycerides.

31
Q

will you develop hypoglycemia with insulin sensitizers?

A

***No hypoglycemia because they are euglycemic

32
Q

toxicity with Thiazolidinediones will lead to what?

A

*****Hepatic enzyme inducers: hepatotoxicity (monitor)

33
Q

name the 2 Alpha Glucosidase Inhibitors

A
  1. Acarbose
  2. Miglitol
34
Q

how do Acarbose, Miglitol work?

A

they are competitive and reversible inhibitors of α-glucosidase in the small intestine.

35
Q

will you develop hypoglycemia with alpha glucosidase inhibitors?

how about lactic acidosis?

what about weight gain?

A

**No hypoglycemia, lactic acidosis, or weight gain.

36
Q

when are alpha glucosidase inhibitors used?

A

In significant postprandial hyperglycemia.

37
Q

Pramlintide (new drug) is used when?

how is it administered?

how does it work?

A

postprandial hyperglycemia

subcutaneous

Synthetic analogue of amylin, and suppresses glucagon release. (GLP-1)

38
Q

Exenatide (Incretin) (new drug) is used for what?

how does it work?

how is it adminstered?

toxicity may lead to what?

exenatide should never be given with what other drug?

Why?

A
  • only type 2 diabetes
  • Synthetic analogue of glucagon-like-peptide (GLP-1).
  • subcutaneously
  • loss of apetite because it slows gastric emptying
  • NEVER give with INSULIN because it can cause fatal necrotizing pancreatitis or hemorrhagic pancreatitis
39
Q

how does Sitaglyptin work?

A

Inhibitor of dipeptidyl peptidase-4 enzyme that degrades GLP-1.

40
Q

name a Hyperglycemic Agents

A

glucagon

41
Q

when is glucagon used?

A

in severe hypoglycemia

42
Q

what are the Rapid and Short-Acting Insulin (onset: 5-15 min, duration: 3-5 hrs.)?

A
  1. Insulin lispro
  2. aspart
  3. glulisine
  4. inhaled human insulin
43
Q

rapid and short acting insulin can be used in what other condition?

A

Can be used in diabetic ketoacidosis.

44
Q

What is the Short-Acting Insulin (duration: 5-8 hrs.) drug?

when is it used?

A

insulin

diabetic ketoacidosis and other emergency situations.

45
Q

what are the Intermediate-Acting Insulin (onset: 2-5 hrs, duration: 4-12 hrs.)?

A
  1. Lente insulin
  2. NPH insulin
46
Q

What are the Ultra Long-Acting Insulin (slow onset, duration: 20-24 hrs.)?

when is it used?

A
  1. Ultra lene
  2. Insulin glargine
  3. Insulin detemir

to control basal glucose

47
Q

identify the insulin preparations

A