diabetes drugs

Question 1

insulin glargine

Answer 1

insulin analog with no peak action. ultralong duration of action. used to supply basal level. onset within 1 hr and last > 24 hrs.

Question 2

mechanism of glargine/insulin

Answer 2

binds to the membrane surface receptor of beta cells. activates tyrosine kinase to phosphorylate tissue specific substrates.

Question 3

lispro

Answer 3

peak 1-2hrs. duration 3-4 hours. rapid onset.

Question 4

regular insulin

Answer 4

onset 0.5-1, peak 2-4 hours. duration 5-7 hours.

Question 5

sulfonylureas 1st gen agents

Answer 5

acetohexamide, tolbutamide, chlorpropamide

Question 6

sulfonylureas 2nd gen agents

Answer 6

glipizide, glyburide

Question 7

acetohexamide in renal failure?

Answer 7

lower dose

Question 8

tolbutamide in renal dysfunction

Answer 8

ok for use.

Question 9

what are the SE for chlorpropamide

Answer 9

SIADH and disulfiram RXNs.

Question 10

how do we use chlorpropamide

Answer 10

long-acting

Question 11

when do we alter the dose of glipizide

Answer 11

decrease in hepatic dysfunction

Question 12

when do we decrease the dose of glyburide

Answer 12

in renal dysfunction

Question 13

what are the SE of the sulfonylureas

Answer 13

fasting hypoglycemia, weight gain, HSR.

Question 14

what drugs do the first gens interact with

Answer 14

cimetidine, insulin, salicylates, sulfonamides, causing increased hypoglycemia. inhibition of p450.

Question 15

metformin

Answer 15

activates PPARs to increase the sensitivity to insulin. decreases hepatic gluconeogenesis. this is a euglycemic and does not cause hypoglycemia or weight gain.

Question 16

SE of metformin

Answer 16

RARE lactic acidosis. GI distress is common

Question 17

acarbose/miglitol

Answer 17

inhibit alpha-glucosidase in brush border of intestine. decreases the psotprandial glucose and decreases the insulin need. there is no hypoglycemia.

Question 18

what are the Se of acarbose/miglitol

Answer 18

GI distress, flatulence and diarrhea. possible hepatotoxic.

Question 19

thiazolidinediones

Answer 19

pioglitazone and rosiglitazone

Question 20

what is the mechanism of the thiazolidinediones

Answer 20

bind to the PPAR-gamma and transcribe insulin response genes. sensitization of tissues to insulin. decreases gluconeogenesis, triglycerides, increase the number of receptors.

Question 21

SE of the thiazolidinediones

Answer 21

less hypoglycemia. weight gain and edema.

Question 22

glucagon-like peptide 1 drugs

Answer 22

exenatide,

Question 23

exenatide mechanism

Answer 23

long-actign GLP-1 full agonist. used in combo with other drugs.

Question 24

se of exenatide

Answer 24

nausea and hypoglycemia.

Question 25

sitgaliptin

Answer 25

dipeptidylpeptidase 4 inhibitor. inhibits the inactivation of GLP-1