Diabetes drugs

Question 1

What drugs are short acting insulins?

Answer 1

lispro
aspart
glulisine
regular

Question 2

What are uses for short acting insulins?

Answer 2

bolus insulin at mealtime
often used in pumps
used in hospitals- rapid onsiet

Question 3

What drugs are intermediate-long acting insulins?

Answer 3

NPH
glargine
detemer

Question 4

What are uses for intermediate-long acting insulins?

Answer 4

basal insulin, taken independent of food intake

Question 5

NPH does produce a _____

Answer 5

peak

Question 6

What drugs are sulfonylureas?

Answer 6

Glipizide
Glyburide
Glimepride

Question 7

What is the mechanism of action of sulfonylureas?

Answer 7

Bind to the sulfonylurea receptor (SUR1), closing the ATP-dependent potassium channel on the beta cells, depolarizing the cell, leads to increased insulin secretion

Question 8

What reduction in A1c can be expected in a patient taking a sulfonylurea?

Answer 8

1-2%

Question 9

What are adverse effects of sulfonylureas?

Answer 9

• Hypoglycemia
• Weight gain
• Use with caution in elderly, and in renal and liver failure

Question 10

What drugs are meglitinides?

Answer 10

Nateglinide

Repaglinide

Question 11

What is the mechanism of action of meglitinites?

Answer 11

Similar to sulfonylureas but shorter acting
Bind to the sulfonylurea receptor (SUR1), closing the ATP-dependent potassium channel on the beta cells, depolarizing the cell, leads to increased insulin secretion

Question 12

What reduction in A1c can be expected in patients taking meglitinides?

Answer 12

0.5-1%

Question 13

What are adverse effects of meglitinides?

Answer 13

MILD hypoglycemia, weight gain, caution in renal and liver failure

Question 14

What drugs are biguanides?

Answer 14

metformin

Question 15

What is the mechanism of action of metformin?

Answer 15

Poorly understood

• increases insulin sensitivity
• decreases hepatic glucose production

Question 16

What reduction in A1c can be expected in patients taking metformin?

Answer 16

1-2%

Question 17

Describe the advantages of metformin

Answer 17

weight loss or weight neutral

No hypoglycemia

Question 18

What are the adverse effects of metformin?

Answer 18

GI- nausea, diarrhea, metallic taste

Lactic acidosis

Question 19

What are contraindications to metformin use?

Answer 19

renal insufficiency
liver disease
alcohol abuse
heart failure
age >80
hold during acute illness

Question 20

What drugs are in the thiazolidinedione class?

Answer 20

rosiglitazone

pioglitazone

Question 21

What is the mechanism of action of thiazolidnediones?

Answer 21

PPAR agononist–> sensitizes skeletal msucle ot insulin, decreases hepatic glucose production

Question 22

What reduction in A1c can be expected in patients taking thiazolidinediones?

Answer 22

0.5-1.4%

Question 23

What are the advantages of thiazolidinediones?

Answer 23

NO hypoglycemia

Pioglitizone improves lipid profile

Question 24

What are adverse effects of thiazolidinediones?

Answer 24

Weight gain
Edema
Risk of osteoporosis/fractures
Contraindicated in heart failure, caution in liver failure
Rosiglitizone- associated with increased risk of CV events

Question 25

What are adverse effects of thiazolidinediones?

Answer 25

Weight gain Edema Risk of osteoporosis/fractures Contraindicated in heart failure, caution in liver failure Rosiglitizone- associated with increased risk of CV events

Question 26

What drugs are in the a-glucosidase inhibitor class?

Answer 26

acarbose

Question 27

What is the mechanism of action of acarbose?

Answer 27

a-glucosidase enzyme is intestinal wall responsible for conversion of carbohydrates into monosaccharides. inhibition of a-glucosidase--> delaying digestion and absorption of carbohydrate, lowering BG

Question 28

What are adverse effects of acarbose?

Answer 28

flatulence, diarrhea

Question 29

What drugs are in the incretin mimetic class?

Answer 29

Exenatide | Liraglutide

Question 30

What is the mechanism of action of incretin mimetics?

Answer 30

Promotes glucose-mediated insulin secretion (low risk of hypoglycemia- glucose must also be present). Decreases hepatic glucose production Slows gastric emptying

Question 31

What are advantages of incretin mimetics?

Answer 31

improves satiety leading to weight loss does not cause hypoglycemia may support beta cell survival

Question 32

What are adverse effects of incretin mimetics?

Answer 32

GI- NV | caution in renal insufficiency

Question 33

What drugs are in the dipeptidyl peptidase 4 inhibitor class?

Answer 33

sitagliptin | saxagliptin

Question 34

What is the mechanism of action of DPP-4 inhibitors?

Answer 34

Inhibits DPP-4, the enzyme responsible for degradation of GLP-1, increasing circulating endogenous GLP-1 levels and insulin secretion

Question 35

What drugs are in the SGLT2 inhibitor class?

Answer 35

Canagliflozin Dapagliflozin Empagliflozin

Question 36

What is the mechanism of action of SGLT2 inhibitors?

Answer 36

Inhibition of SGLT2 --> increased urinary glucose excretion and decreased

Question 37

What are advantages of SGLT2 inhibitors?

Answer 37

weight loss decrease in systolic BP low risk of hypoglycemia

Question 38

What are adverse effects of SGLT2 inhibitors?

Answer 38

GU infection orthostatic hypotension caution in renal insufficiency, severe liver impairment

Question 39

______ is used to treat hypoglycemia when oral glucose intake is not possible

Answer 39

glucagon