Diabetes Drugs

Question 1

What side effects are associated with insulin administration?

Answer 1

Hypersensitivity, lipoatrophy, lipohypertrophy, hypoglycemia

Question 2

Which diabetes drugs do not cause hypoglycemia?

Answer 2

Metformin, Pioglitazone, Sitagliptin, Acarbose, and Canagliflozin

*CAMPS- camps always have plenty of candy at the snack shack for kids

Question 3

Name the biguanide and its mechanism of action.

Answer 3

Metformin: It enhances the effect of insulin by activating AMP-dependent protein kinase (AMPK), which results in FA oxidation and glucose uptake, and decreases lipogenesis and gluconeogensis.

*acts on skeletal muscle (glucose uptake) and the liver (decreases gluconeogenesis)

Question 4

What is the clinical use of metformin?

Answer 4

It is first-line tx for diabetes Type 2.

Question 5

Which diabetes medications should be avoided in patients with liver disease?

Answer 5

Metformin, Glipizide, Repaglinide, and Pioglitazone

Question 6

Which diabetes medications are contraindicated in renal patients?

Answer 6

Metformin and Glipizide

Question 7

Aside from its effects on glucose levels, what are the other pros of using metformin?

Answer 7

It does not cause weight gain and it inhibits microvascular complications

Question 8

What adverse effects are associated with metformin?

Answer 8

n/v/d, lactic acidosis in renal impaired pts

Question 9

Name the sulfonylurea and its mechanism of action.

Answer 9

Glipizide: increases insulin release by binding & inhibiting K+ channels in beta cells, allowing for depolarization and Ca++ influx and subsequent insulin release.

*requires functional beta cells

Question 10

Name the non-sulfonylurea secretagogue and its mechanism of action.

Answer 10

Repaglinide: increases insulin release by binding SUR on ATP-sensitive beta cell K+ channels (same concept as Glipizide)

*requires functional beta cells

Question 11

Which medications require functional beta cells?

Answer 11

Glipizide and Repaglinide (because they block K+ channels in the beta cells to facilitate insulin release from the pancreas

Question 12

Name the thiazolidenedione (TZD) and its mechanism of action.

Answer 12

Pioglitazone: directly activates PPAR-y in the nucleus, increasing insulin sensitivity in target tissues, decreasing hepatic glucose output and FFA, and increasing glucose utilization

Question 13

What adverse effects are associated with pioglitazone?

Answer 13

Fluid retention, increased risk of heart failure, weight gain, and decreased bone density in chronic use

Question 14

Name the GLP-1 receptor agonist and its mechanism of action.

Answer 14

Exenatide: agonist at the GLP-1 receptor, increasing cAMP and thus increasing insulin secretion and decreasing post-prandial glucagon release. Also slows gastric emptying, increases satiety, decreases hepatic fat accumulation, and may increase beta cell mass (decreased apoptosis)

Question 15

In what patients should exenatide be avoided?

Answer 15

Pts w/ gastroparesis (b/c it slows gastric emptying)

Question 16

Name the DPP-4 inhibitor and its mechanism of action.

Answer 16

Sitagliptin: prolongs endogenous GLP-1 action by inhibting DPP-4 from converting GIP and GLP-1 to inactive metabolites. By inhibing DPP-4, the incretins remain active and stimulate insulin secretion

Question 17

What is the major warning for sitagliptin?

Answer 17

Severe joint pain

Question 18

Name the alpha-glucosidase inhibitor and its mechanism of action.

Answer 18

Acarbose: slows digestion of carbohydrates, decreases GI glucose absorption and post-prandial glycemia

Question 19

In what patients is acarbose contraindicated?

Answer 19

Those with chronic intestinal dz

Question 20

Name the renal SGLT-2 inhibitor and its mechanism of action.

Answer 20

Canagliflozin: inhibits glucose reabsorption in the proximal tubule by blocking the SGLT-2 sodium/glucose co-transporter

Question 21

What is the major warning for canagliflozin?

Answer 21

Ketoacidosis

Question 22

Discuss the role of insulin in diabetes management.

Answer 22

Insulin is the primary tx for Type 1 diabetes and comes in various forms distinguished by duration of action. Can supplement long-acting insulin with short-acting before meals. The kinetics are different from physiologic insulin.