Diabetes Drugs

Question 1

Insulin toxicity

Answer 1

Hypoglycemia

Question 2

Rapid acting insulins

Answer 2

Aspart
Glulisine
Lispro

Question 3

Intermediate acting insulin

Answer 3

NPH

Question 4

Long acting insulin

Answer 4

Detemir

Glargine

Question 5

Biguanides (Metformin) action

Answer 5

Decreased gluconeogenesis
Increased glycolysis
Increased peripheral glucose uptake (increased insulin sensitivity)

Question 6

Use for Metformin

Answer 6

Oral
First line therapy in type 2 DM; causes modest weight loss
Can be used in patients without islet function

Question 7

S/E of Metformin

Answer 7

GI upset
Lactic acidosis (C/I in renal insufficiency)

Question 8

Sulfonylureas

Answer 8

First gen - Chlorpropamide, Tolbutamide

Second gen - Glimepiride, Glipizide, Glyburide

Question 9

Sulfonylureas mechanism

Answer 9

Closes K+ channel in Beta cell membrane –> cell depolarizes and insulin is released via increased Calcium influx

Question 10

Use for Sulfonylureas

Answer 10

Type 2 DM - require some islet function

Question 11

S/E of Sulfonylureas

Answer 11

Hypoglycemia risk increases in renal failure
First gen - Disulfiram like effects
Second gen - Weight gain, hypoglycemia

Question 12

Glitazones/Thiazolidinediones mechanism

Answer 12

Increased insulin sensitivity in peripheral tissue (binds to PPAR-gamma nuclear transcription regulator) –> increased synthesis and translocation of GLUT4

Question 13

When is Metformin C/I?

Answer 13

Any condition that precipitates lactic acidosis

Liver dysfunction, CHF, sepsis, alcoholism

Question 14

S/E of Glitazones

Answer 14

HEPATOTOXICITY, HF, increased risk of fractures

Question 15

GLP-1 Analogs

Answer 15

Exenatide

Liraglutide

Question 16

Exenatide, Liraglutide mechanism

Answer 16

GLP 1 analogs that increase insulin and decrease glucagon release

Question 17

S/E of GLP 1 analogs

Answer 17

Pancreatitis, N/V

Question 18

DPP-4 Inhibitors

Answer 18

Linagliptin, Saxagliptin, Sitagliptin

Question 19

DPP-4 inhibitors mechanism

Answer 19

DPP4 usually inactivates GLP-1; inhibition causes increased insulin and decreased glucagon release

Question 20

Amylin analogs mechanism (Pramlintide)

Answer 20

Decreased gastric emptying and decreased glucagon

Question 21

Amylin analog

Answer 21

Pramlintide

Question 22

SGLT-2 Inhibitors (Canagliflozin)

Answer 22

Block reabsorption of glucose in PCT

Question 23

S/E of Canagliflozin (SFLT-2 inhibitor)

Answer 23

Glucosuria
UTis
Vaginal yeast infections

Question 24

Alpha-glucosidase inhibitors

Answer 24

Acarbose, Miglitol

Question 25

Alpha-glucosidase inhibitors mechanism

Answer 25

Inhibit intestinal brush border alpha-glucosidases –> delay carbohydrate hydrolysis and glucose absorption –> decrease postprandial hyperglycemia

Question 26

S/E of propylthiouracil and methimazole

Answer 26

Agranulocytosis, aplastic anemia
Hepatotoxicity (Propylthiouracil)
Methimazole is teratogen in first trimester

Question 27

Conivaptan, Tolvaptan

Answer 27

ADH antagonists used for SIADH

Question 28

Uses for Somatostatin

Answer 28

Acromegaly
Carcinoid syndrome
Gastrinoma
Glucagonoma
Esophageal varices

Question 29

Demeclocycline

Answer 29

ADH antagonist used for SIADH (Tetracycline family so it causes nephrogenic DI, photosensitivity, bone/teeth abnormalities)

Question 30

Cinacalcet

Answer 30

Sensitizes Ca sensing receptor in parathyroid gland to circulating Ca –> causes decreased PTH

• Used for Hypercalcemia due to primary or secondary hyperparathyroidism
• S/E is hypocalcemia