Diabetes

Question 1

What are the three rapid acting insulins?

Answer 1

Glulisine
Aspart
Lispro

Question 2

Rapid acting insulin: indication?

Answer 2

For meals or acute hyperglycemia- inject immediately before meals

Question 3

Regular insulin: indication?

Answer 3

For meals or acute hyperglycemia: needs to be injected 30-45 minutes before meals

Question 4

NPH: indication

Answer 4

Provides basal insulin and overnight coverage

Question 5

Name two long acting insulins

Answer 5

Glargine

Detmir

Question 6

Glargine/detmir; indications?

Answer 6

Provides basal insulin and overnight coverage

Question 7

Metformin: MOA?

Answer 7

Inhibition of mito complex I –> increased AMP –> decreased adenylate cyclase and increased AMPK

This OPPOSES glucagon and decreases hepatic gluconeogenesis (increases glucose utilization and insulin sensitivity)

Question 8

What is the main advantage of metformin?

Answer 8

Lowers fasting glucose levels

Question 9

Main side effect of metformin?

Answer 9

Lactic acidosis

Question 10

Metformin: contraindications?

Answer 10

Renal insufficiency, MI, CHF

Question 11

MOA of sulfonylureas?

Answer 11

Inhibition of beta cell K+ channels –> increased insulin secretion

Question 12

What is the advantage of sulfonylureas?

Answer 12

Slow onset/long duration –> lowers fasting glucose

Question 13

What is the main adverse effect associated with sulfonylureas?

Answer 13

Increased risk of hypoglycemia

Question 14

Sulfonylureas: contraindications?

Answer 14

Renal/liver disease

Question 15

Meglitinides: MOA?

Answer 15

Inhibition of K+ channels –> glucose-dependent insulin secretion

Question 16

Meglitinides: advantages?

Answer 16

Fast acting, short duration to decrease postprandial glucose

Question 17

Thiazolidinediones: MOA?

Answer 17

Agonist of PPARgamma TF

Increased insulin sensitivity
Increase glucose utilization
Decrease insulin resistance

Question 18

Thiazolidinediones: advantages?

Answer 18

Lowers fasting glucose

Lowers triglycerides

Question 19

Thiazolidinediones: Adverse effects?

Answer 19

Weight gain (subQ)
Fluid retention/edema
Increased HF Risk
Increased bone fractures in women

Question 20

Pioglitazone and Rosiglitazone are what type of drugs?

Answer 20

thiazolidinediones

Question 21

Name two alpha-glucosidase inhibitors

Answer 21

Acarbose, Miglitol

Question 22

What is the MOA of the alpha-glucosidase inhibitors?

Answer 22

Inhibits the conversion of carbohydrates into monosaccharides/inhibits absorption

Question 23

Name two incretin mimetics

Answer 23

Exenatide

Liraglutide

Question 24

What is the MOA of exenatide/liraglutide?

Answer 24

Potentiates glucose-induced insulin release as a GLP-1 analog

Decreases pancreatic glucagon and decreases hepatic gluconeogenesis

Question 25

Sitagliptin and Saxagliptin are what type of drug?

Answer 25

DPP4 inhibitors

Question 26

How do the DPP-4 inhibitors work?

Answer 26

Potentiates GLP-1 through inhibition of DPP-4, the peptidase that breaks down GLP-1

Question 27

What is the MOA of pramlitide?

Answer 27

Amylin mimetic- decreases postprandial glucagon and decreases hepatic gluconeogenesis

Question 28

Canagliflozin and dapagliflozin are what class of drug?

Answer 28

SGLT2 inhibitors

Question 29

How do the SGLT2 inhibitors work?

Answer 29

Inhibit the sodium/glucose transporters of the proximal renal tubule –> osmotic diuresis of glucose