diabetes drugs (From farm exam)

Question 1

Insulin:name the 3 rapid acting/short action drugs:

Answer 1

lispro, aspart, glulisine;

ie act within 15 min, last for 4-8 hours

Question 2

insulin:____ has a rapid onset and is short acting.____ has intermediate action and onset;

Answer 2

regular insulin (ie act within an hour, last 12 hours); NPH (neutral protamine hagedorn) (acts within an hour, lasts 24 hours)

Question 3

insulin:name the 2 slow onset, long acting insulins

Answer 3

glargine, detemir

Question 4

why are the rapid onset insulins so rapid? what are they used for?

Answer 4

they don’t polymerize into insulin hexamers (due to altered amino acids); for post-prandial spike (ie administer immediately before meal

Question 5

mixtures of _____ and _____ insulin can give a transient preprandial bolus and a prolonged basal level in a single injection

Answer 5

fast-onset, long acting

Question 6

routes of administration:subcutaneous = _____;insulin infusion pump = ____ _____ and the rapid acting ones

Answer 6

all forms; buffered regular

Question 7

____ insulin may be administed via IV for ____ or ____

Answer 7

regular; hyperglycemia, ketoacidosis

Question 8

_____ is a regular human insulin inhaled as a dry powder. it has a _____ duration of action than regular sub-cu insulin. contradicted in patients with ___ or ____ due to decreased FEV

Answer 8

afrezza; shorter;asthma, COPD

Question 9

insulin side effects:_____ due to too much insulin or not enough food. treat with ____ or _____;important agent that can increase risk of this side effect?

Answer 9

hypoglycemia; Glucagon, glucose;alcohol

Question 10

other insulin side effects:____ or _____ at an injection site

Answer 10

lipodystrophy, lipoatrophy

Question 11

mechanism of action of sulfonylureas

Answer 11

bind and close K+ channel–>depolarization–>calcium influx and insulin release

Question 12

what transporter does glucose use to enter a beta cell?

Answer 12

GLUT2

Question 13

the 1st gen sulfonylureas end in ___. name 2 of them

Answer 13

“-amide”;chlorpropamide (more potent, longer lasting ie 1-3 days), tolbutamide (12 hr duration)

Question 14

2nd gen sulfonylureas (3):

Answer 14

glimepiride, glipizide, glyburide;all have 24 hour duration

Question 15

name the 2 meglitinides: (end in ____) mechanism of action?

Answer 15

glinide = nateglinide, repaglinide; bind K+ channels (similar to sulfonylureas)

Question 16

sulfonylurea vs meglitinides:which are used for post prandial insulin release (ie short acting)?which can cause a sulfa allergy?which require functional beta cells?

Answer 16

meglitinides; sulfonylureas ;both

Question 17

sulfonylurea side effects risk of _____;weight ____

Answer 17

hypoglycemia (can be severe);weight gain

also disulfiram-like effects

Question 18

name 2 GLP1 analogs: end in “___“these are used for type __ DM

Answer 18

tide = exenatide, liraglutide, 2

Question 19

side effects of GLP1 analogs: nausea, vomiting, ____;

Answer 19

pancreatitis

Question 20

name the 3 gliptins :what do these molecules do?

Answer 20

lina, saxa, sitagliptan; inhibit dipeptidyl-peptidase 4 (DDP4), which deactivates GLP1; thus, increase endogenous insulin release

Question 21

gliptin side effects: increased ____ or ____ infections due to reduced WBC.

Answer 21

UTI, respiratory;

Question 22

pramlintide is a _____ ____ that blunts the ____ ____ in blood glucose. used in what diabetes?

Answer 22

amylin analog; postprandial rise;ptype 1 and 2

Question 23

pamlinitde slows ____ ____ and inhibits ___ release;

Answer 23

gastric emptying, glucagon

Question 24

mechanism of action of acarbose and miglitol:

Answer 24

inhibit alpha glucosidases on brush border (Sucrase, maltase, glucoamylase) = decreased carb absorption

Question 25

side effects of the alpha glucosidase inhibitors:____ ferment carbs, leading to ____ disturbances

Answer 25

bacteria;GI

Question 26

the “-gliflozins” (name the 3 of them) are _____ inhibitors

Answer 26

cana-, dapa-, empagliflozin; SGLT2 ie block reabsorption in PCT = decrease threshold for glucose excretion

Question 27

SGLT2 inhibitor side effects:weight _____; increased risk of ____ and ____ infections;contraindicated in patients with _____ impairment

Answer 27

loss; UTI, vaginal;renal

Question 28

SGLT2 inhibitor side effects: volume _____; ____ hypotension;

Answer 28

depletion; orthostatic;

Question 29

metformin is a _____. it rarely causes ____ or ____, as opposed to sulfonylureas

Answer 29

biguanide, weight gain, hypoglycemia

Question 30

metformin activates ______. this causes decreased ____ in the liver and increased ____ and _____ in muscle and fat cells. it ____ insulin sensitivity

Answer 30

AMP-activated protein kinase; gluconeogensis; glycolysis, glucose uptake; increases

Question 31

metformin side effets:_____ ____, GI upset

Answer 31

lactic acidosis

Question 32

____ and ____ are thiazolidinediones. they are activators of ____, which is a _____ factor

Answer 32

pioglitazone, rosiglitazone ;PPAR gamma (peroxisome proliferator-activated receptor);transcription

Question 33

glitazones: increase insulin _____ in peripheral tissue. the main target is _____.

Answer 33

sensitivity; adipocytes

Question 34

glitazone side effects:weight ____; contraindicated in patients with ____. some _____ toxicity

Answer 34

gain;CHF;liver;

Question 35

_____ are factors regulated by activation PPAR gamma. they are released by _____ adipose tissue

Answer 35

adipokines;white

Question 36

more glitazone side effects:increased risk of fractures due to _____;peripheral _____ due to ____ retention

Answer 36

decreased differentiation of stem cells into osteoblasts;edema, Na