Diabetes: Drugs

Question 1

What are the short acting insulins?

Answer 1

lispro, aspart, glulisine

Question 2

What are the side effects of lispro, aspart, glulisine?

Answer 2

most dangerous is hypoglycemia

also allergies and local reactions

Question 3

What are the long acting insulins?

Answer 3

ultralente, glargine, detemer

Question 4

What are the side effects of ultralente, glargine, detemer?

Answer 4

hypoglycemia, allergy, local reactions.

Question 5

How do the sulfanylureas work?

Answer 5

bind to and inhibit the ATP dependent, outward flowing K channel. this triggers insulin release from the beta cell- insulin secretegogue.

Question 6

What are the side effects of sulfanylureas?

Answer 6

1. hypoglycemia, especially in patients with renal failure.
2. can cause beta cell failure
3. can cause an allergic reaction in people with sulfa allergies.

Question 7

What are meglitinides?

Answer 7

insulin secretegogues that bind to the ATP-dependent outward flwing K channel, triggering depolarization, and, ultimately, insulin release.

Question 8

What are the advantages of meglitinides?

Answer 8

it is rapid and fast acting, making it good for post-prandial hyperglycemia. also, causes less hypoglycemia, even in renal patients, than sulfanylureas.

Question 9

What is exanatide?MOA

Answer 9

GLP-1 analogue

it is like GLP-1 but isn’t degraded as quickly by DPP. this increases insulin release in response to glucose.

Question 10

What are disadvantages of exanatide?

Answer 10

it must be injected, it causes nausea and vomiting, and is quite expensive.

Question 11

What are the advantages of exanatide?

Answer 11

it increases pancreatic beta cell mass, can cause weight loss, and stimulates insulin production only when glucose levels are high (not a hypoglycemia risk_

Question 12

What is vidagliptin/sitagliptin?

Answer 12

DPP-IV inhbitor. that leads to slower degradation of GLP-1.

Question 13

Whar are advantages and disadvantages of vidagliptin and sitagliptin?

Answer 13

• Advantage: can be taken orally, causes less nausea

disadvantages: no weight loss, less potente than exenatide/GLP1 analogues, very,very expensive

Question 14

What are thiazolidinediones? MOA

Answer 14

they are drugs taht interact with PPAR, a transcription faction that increases glucose sensitivity, among other things. also decreases free fatty acids.

Question 15

What are the advantages of thiazolidinediones?

Answer 15

they correct insulin resistance, they are only taken 1 time per day, they don’t cause hypoglycemia, they decrease serum triglycerides

Question 16

What are the disadvantages of thiazolidinediones?

Answer 16

may not work alone, they cause weight gain and edema, they increase LDL, they take weeks/months to see max response, and they may cause sudden cardiac death/ worsen osteoporosis

Question 17

What are bigaunides?

Answer 17

metformin
increeases insulin sensitiviy and decreases gluconeogenesis and glucose output form the liver. acts primarily on the live
may also reduce glucose absorption.

Question 18

What are the advantages of bigaunides?

Answer 18

rapid onset, no weight gain, no hypoglycemia, improved lipid profile.

Question 19

What are the disadvantages of bigaunides?

Answer 19

lactic acidosis a risk for patients with liver, renal and heart problems.
may initially have GI effects
can’t take IV contrast.

Question 20

clinical features of short acting insulin

Answer 20

convenient administration prior to meals, fast onset of action, limit post-prandial hyperglycemic peaks
shorter duration of activity reduces late postprandial hypoglycemia but often results in post-prandial hyperglycemia

Question 21

What are alpha glucosidase inhibitors? MOA etc.

Answer 21

alpha glucosidase is the enzyme that breaks down complex carbs i nthe stomach and digestive tract to glucose. alpha-glucosidases inhbitors competitively inhibt alpha-glucosidase, causingdecreased glucose absorption
most effective for pts with significant post-prandial hyperglycemia
expampels: acarbose, miglitol

Question 22

disadvantages of alpha glucosidase inhibitors

Answer 22

gas and diarrhea
eventually, you induce alpha glucosidases in the distal bowel, which reduce the gas and diarrhea
start low and go slow

Question 23

contraindications to alpha glucosidase inhibitors

Answer 23

DKA, colonic ulceration, IBD, allergy

Question 24

What are SGLT2 inhibitors

Answer 24

drugs that prevent resorption of glucose in the kidney

Question 25

What is the role of bariatric surgery in treatment of DM type 2

Answer 25

80% of the time, it can induce remission

combined restrictive and malabsorptive is most effective