Diabetes

Question 1

Formulations attempt to cover insulin peaks at mealtimes
Peak: around 2.5 hrs (range 1-6 hrs)
Duration: 15-18 hrs
Efficacy: decrease both FPG and PPG

Answer 1

Pre-Mixed Insulins

Question 2

Admin of Regular Insulin

Answer 2

30 min before meals

Question 3

MOA of Pioglitazone (Actos) and Rosiglitazone

Answer 3

TZDs- MOA: improve insulin sensitivity, reduce hepatic glucose production

Question 4

Rapid Acting Insulins

Answer 4

Lispro
Aspart
Glulisine

Question 5

Admin of regular intermediate insulin

Answer 5

30 min before meals

Question 6

Admin of rapid acting insulins

Answer 6

15 min before or immediately after meals

Question 7

What is the major AE for sulfonylureas? What risk factors contribute to this?

Answer 7

Hypoglycemia

exercise, missed meals, long acting formulations, ETOH, renal failure

Question 8

Exenaglutide (Byetta ), liraglutide (Victoza)

Answer 8

GLP 1 Agonists [SQ]

Incretin Mimetics

Question 9

Drug Classes that cause Hypoglycemia?

Answer 9

Sulfonylureas
Insulin
Meglitinides
SGLT2 Inhibitors

“SIMS”

Question 10

which insulin does not have a peak?

Answer 10

Glargine (lantus)

Question 11

Onset, Peak, and Duration of long acting glargine (lantus)

Answer 11

Onset= 2-4 hr
NO PEAK
Duration= 20-24 hr

Question 12

When would a patient most likely experience hypoglycemia after administering Humulin R?

Answer 12

2-4 hrs later

Question 13

Advantages/ Disadvantages of Premixed Insulin?

Answer 13

Advantage: 2 shots daily, relatively simple to use
Disadvantages: not much flexibility in dosing and meals must be eaten at regular schedule; cannot adjust insulins separately

Question 14

Onset, Peak, and Duration of intermediate Isophane Insulin

Answer 14

onset= 2-4 hr 
peak= 4-10 hr 
duration= 10-16 hr

Question 15

What patient population should you avoid TZD -Pioglitazone (Actos ) and Rosiglitazone agents in?

Is there a low or high risk of hypoglycemia with these agents

Answer 15

Avoid in pts with symptomatic heart failure

Low risk of hypoglycemia

Question 16

MOA of Sodium Glucose CoTransporter 2 (SGLT2) Inhibitors:

Dapagliflozin (Farxiga ), Canagliflozin (Invokana)

Answer 16

Inhibiting SGLT-2 enhances the renal excretion of glucose by blocking reabsorption of glucose in the kidneys- more glucose excreted in urine

Question 17

Humilin R

Novolin R

Answer 17

regular insulin

Question 18

what med class can have weight gain from heart failure but mostly causes weight loss/ weight neutral?

Answer 18

TZDs

Pioglitazone (Actos) and Rosiglitazone

Question 19

What are the unique benefits of Metformin (a Biguanide) ?

Answer 19

moderate weight loss. Decreases LDL, TG

Increases HDL. Cardiovascular mortality benefit.

Question 20

how does Glargine (Lantus) have a prolonged duration of action

Answer 20

low solubility at physiological pH which leads to precipitation at the injection site and therefore an extended duration of action

Question 21

when should sulfonylureas be administered and why?

Meglitinides?

Answer 21

sulfonylureas 30 min before to increase absorption

Meglitinides 15-30 min before meal. Skip a meal… skip dose. Add meal… add dose

Question 22

Long acting insulins

Answer 22

Glargine (lantus)

Detemir (Levemir)

Question 23

Glipizide (Glucotrol), Glyburide

Micronase, Diabeta ), Glimepiride (Amaryl

Answer 23

2nd Gen Sulfonylureas

Insulin Secretagogues

Question 24

Intermediate acting insulins

Answer 24

Isophane (NPH)- Humulin N / Novolin N

Regular (U-500)- Humulin R

Question 25

Drug Class that causes heart failure

Answer 25

TZDs - Pioglitazone (Actos) and Rosiglitazone

Question 26

Do we use 1st Gen Sulfonylureas?

Answer 26

No more SE

Question 27

Onset, Peak, and Duration of long acting Detemir (levemir)

Answer 27

``` Onset= 3-4 hr Peak= 6-and 8 hr Duration = 6-23 hr ```

Question 28

Which 2nd gen sulfonylurea is “safer” to use in patients with renal impairment?

Answer 28

Glipizide

Question 29

What is one of the concerns of using Sodium Glucose CoTransporter 2 (SGLT2) Inhibitors agents as pertaining to risk of infection?

Answer 29

UTI, Genital fungal yeast infection

Question 30

When can you not use SGLT2 Inhibitors?

Answer 30

Crcl < 45: canagliflozin, dapagliflozin, empagliflozin | Crcl < 60: ertugliflozin

Question 31

Onset, Peak, and Duration of intermediate Regular Insulin

Answer 31

``` Onset= 30 min Peak= 3.5-4.5 hr Duration= 6.5-10hr ```

Question 32

Med class that lowers lipids

Answer 32

Biguanides

Question 33

Advantages/ Disadvantages of Premixed Insulin?

Answer 33

Advantage: 2 shots daily, relatively simple to use Disadvantages: not much flexibility in dosing and meals must be eaten at regular schedule; cannot adjust insulins separately

Question 34

Admin of Glargine (Lantus)

Answer 34

Every 24 hr

Question 35

what is significance of fact that incretin mimetics ( GLP-1 Agonists and DPP-IV inhibitors) are glucose dependent? MOA?

Answer 35

low risk of hypoglycemia increases insulin secretion by the beta cells suppresses glucagon secretion by the alpha cells

Question 36

What kind of drugs are Sitagliptan (Januvia), Saxagliptan Onglyza)

Answer 36

DPP IV Inhibitors [PO] | Incretin Mimetics

Question 37

Onset, Peak, and Duration of regular insulin

Answer 37

``` Onset= 30-60 min peak= 2-3 hr Duration= 5-8 hr ```

Question 38

What kind of drugs are Exenatide (Byetta ), Liraglutide (Victoza)

Answer 38

GLP 1 Agonists [SQ] | Incretin Mimetics

Question 39

Sitagliptan saxagliptan Algogliptan Linagliptan

Answer 39

DPP IV Inhibitors [PO] (Incretin Mimetics) stimulate glucose dependent release of insulin

Question 40

Med class that causes weight loss/ weight neutral

Answer 40

Biguanides TZDs GLP-1 agonists

Question 41

Meds that give cardiovascular benefit

Answer 41

``` Metformin Pioglitazone Liraglutide Canagliflozin Empagliflozin ```

Question 42

Stimulates insulin release from pancreatic beta cells

Answer 42

Insulin Secretagogues Sulfonylureas Glyburide, Glipizide, Glimepiride Meglitinides Nateglinide, Repaglinide

Question 43

Admin of Detemir (levemir)

Answer 43

every 12-24 hr

Question 44

Drug Classes that cause GI Effects

Answer 44

Mainly Biguanides and alpha glucosidase also: Sulfonylureas, Meglitinides, GLP-1 agonists

Question 45

Drug Classes that cause weight gain?

Answer 45

Sulfonylureas, Meglitinides, TZDs, Insulin

Question 46

Admin of intermediate Isophane Insulin

Answer 46

30-60 min before meals or at bedtime

Question 47

Onset, Peak, and Duration of Rapid Acting Insulins

Answer 47

``` onset= 15-30 min peak= 0.5-2.5hr Duration= 3-5 hr ```

Question 48

Repaglinide ( Prandin ), | Nateglinide (Starlix)

Answer 48

Meglitinides:(Insulin Secretagogues ) stimulate pancreatic insulin secretion

Question 49

What is a major AE of exenatide (Byetta)? *

Answer 49

Pancreatitis

Question 50

who is metformin contraindicated for? allowed?

Answer 50

pts with renal dysfunction: CrCl less than 30 mL/min Safe in pts with moderate renal impairment (CrCl > 45 mL/min)

Question 51

What can occur with metformin if pt cannot adequately eliminate the drug?

Answer 51

Lactic Acidosis