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Endocrine Pharmacology > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

List drugs causing diabetes

A
  1. Glucocorticoids, OCP
  2. Thiazide diuretics (dec insulin release), BBs (glucose intolerance)
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2
Q

Mention properties of regular insulin

A

Short-acting, rapid onset, short duration, given 30-45 min before meals
Used IV/IM in emergencies: DKA

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3
Q

Mention properties of insulin lispro (& mention other preparations)

A

Very rapid onset, very short duration, given SC 15 min before meals
Rapid absorption & rapid onset, better postprandial glycemic control
Very short duration of action, less risk of late PP hypoglycemia
Available as premixed fixed conc with protaminated lispro/aspart
……
Aspart, glulisine

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4
Q

Mention properties of lispro-aabc (& mention other preparations)

A

Could be injected at mealtime 0-2 min before meal (better effect on 1& 2-hr PP glucose), upto 20 min after starting meal.
…..
Fast acting insulin aspart

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5
Q

Mention properties of NPH

A

Intermediate onset & duration, given SC 2-4 times/d in DM1 or once in DM2
Variable absorption >50%
Can be mixed with regular insulin. Also with lispro/aspart but immediately before administration
Not used in DKA
Premixed fixed conc are availabe with regular inuslin.

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6
Q

Mention properties of glargine 100U (& mention other preparations)

A

Long acting. Slow onset, long acting upto 24 hrs (better compliance than NPH)
Injected SC once/twice daily
Broad conc plateau, less risk of hypoglycemia
Should not be mixed with other types in same syringe
……
Detemir

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7
Q

Mention properties of degludec (& mention other preparations)

A

Ultra-long acting. Does not peak & lasts for 36hrs, can be mixed with rapid-acting insulin with no effect on kinetics.
…..
Glargine U-300

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8
Q

Mention properties of Afrezza

A

Only covers prandial insulin requirements, thus DM1 patients also require SC long-acting insulin
Dis:
1. Fine dose adjustments are not possible
2. Not recommended in smokers & CI in chronic lung disease

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9
Q

List indications of insulin therapy

A
  1. Type 1 DM & DKA
  2. Type 2 DM (failure of diet regulation & exercise + metformin or other oral AB)
  3. DM with pregnancy & lactation
  4. DM with stress & emergency (inc insulin requirements)
  5. Treatment of hyoerkalemia
  6. DM with severe liver/renal disease
    Causes 3-5 are temporary
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10
Q

List adverse effects of Insulin

A
  1. Hypoglycemia (most frequent & most serious)
  2. Inc body weight
  3. Immune reactions: A. Insulin resistance B. Allergy
  4. Lipodystrophy: lipohyoertrophy (change injection site to avoid), lipoatrophy
  5. Hypokalemia (high doses)
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11
Q

Treatment of hypoglycemia

A

Rapid administration of glucose (sugar or candy)
IV glucose or glucagon 1 mg IM/SC

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12
Q

Describe insulin therapy in DKA

A

IV approach: regular insulin (low dose IV infusion) until blood acetone disappears, IV dose: dec by half if blood glucose falls to 250 mg/dl, once patient is stable switch to SC 4times/d
SC approach: in mild to moderate uncomplicated DKA SC rapid-acting insulin analogs with aggressive fluid management

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13
Q

Mention subcutaneous antidiabetic drugs (other than inuslin)

A

Incretin mimetics
Amylin analogues

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14
Q

Describe MOA of metformin

A

Insulin sensitizer (biguanide)
Not fully understood
1. Dec hepatic gluconeogenesis (main)
2. Direct stimulation of glycolysis in skm & adipose t, remove glucose & inc lactate in blood
3. Dec intestinal glucose absorption with mild anorectic effect

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15
Q

Describe adv & indications of metformin

A

Adv: no inc in body weight, no hypoglycemia
Ind:
1. initial therapy of DM2 with diet & exercise
2. Off-label uses: DM1 adult with high BMI & desiring to improve control while minimizing effective use of insulin, PCO, Prediabetes, anti-psychotic induced weight gain

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16
Q

Side effects of metformin
Preparations are availabe combined with…..

A
  1. GIT: metalic taste, dyspepsia, diarrhea (common, start with small dose & inc)
  2. Lactic acidosis (uncommon but serious) thus CI in liver/renal failure, severe hypoxia
  3. Dec absorption of vit B12
    …..
    Sulfonylureas, SGLT-2-I, DPP-4-I, TZDs
17
Q

Describe MOA of Pioglitazone

A

TZD, euglycemic, but delayed effect as its mechanism involves gene regulation
PPARG-agonists:
1. Enhanced adipocyte differentiation, dec circulating FFA through inc uptake of circulating FFA into fat cells, dec intracellular lipolysis thus dec FFA mobilization
2. This effect causes dec inuslin resistance, inc glucose uptake & dec hepatic glucose production, dec BG

18
Q

Mention indications, adverse effects & precautions of TZDs

A

Ind: used as monotherapy or combined in DM2
AE: weight gain, fluid retention & edema thus may precipitate HF
PREC: avoid in HF & liver dysfunction, monitor signs of liver injury, consider risk of fractures

19
Q

Describe MOA of canagliflozin

A

Inhibit SGLT-2 in proximal tubules in kidney, prevents reabsorption of filtered glucose in kidney, remove excess glucose
Reduce HbA1c, weight & BP

20
Q

Indications, adv, AE, & pecautions of SGLT-2-I

A

Ind: DM2 monotherapy/combined with TZDs/metformin
Adv: orally once daily, beneficial in DKD
AE: genitourinary infections, mild hypoglycemia with inuslin, inc risk of fractures
PREC: adequate renal function needed

21
Q

Describe MOA of sitagliptin

A

DPP-4 inhibitors, which degrades incretins secreted from GIT following meals thus cause inc glucose-dependent insulin rise & dec glucagon secretion thus dec PP hyperglycemia

22
Q

Indications & AEs of DPP-4 inhibitors

A

Ind: DM2 monotherpay of combined with metormin of TZDs (given orally once daily)
AE: Nasopharyngitis, URTI, joint pain (well-tolerated)

23
Q

Describe MOA of liraglutide

A

GLP-1 R agonist
1. Inc glucose-dependent insulin secretion thus inc acute responsiveness of b-cells
2. Suppress inappropriate pp glucagon
3. Slow gastric emptying & reduce food intake (used in obesity)

24
Q

Describe AEs of GLP-1-R agonists

A
  1. Nausea (most common)
  2. Possibly pancreatitis
  3. Avoid in patients with family history of medullary carcinoma
25
Q

GR: Combination of basal insulin & GLP-1RA is favorable

A

Has potent glucose-lowering actions & less weight gain & hypoglycemia compared with intensified insulin regimens

26
Q

Describe MOA of glimepride & ind

A
  1. Inc insulin secretion by binding with specific receptor in b-cells linked to ATP sensitive K+ channels, it blocks them, causes depolarization & Ca++ influx & insulin release from granules (main)
  2. Dec glucagon on chronic use
    Ind: DM2 if initial therapy with lifestyle + metformin failed or if the latter is CI or not well-tolerated
27
Q

CIs of sulfonylureas

A
  1. Allergy to sulfa
  2. Type 1 DM
  3. DM with pregnancy & lactation crosses placenta & execreted in milk (fetal/newborn hypoglycemia)
  4. DM with stress (ineffective)
  5. DM with liver/renal disease prolonged action & more risk of hypoglycemia (metabolised in liver, execreted in urine)
28
Q

AEs of sulfonylureas

A
  1. Hypolycemia: more in long t1/2 as glibenclamide
  2. Hypersensitivity
  3. Heavy weight
29
Q

List adv, disadv & precautions of repaglinide

A

Nonsulfonylrea insukin secretagogue
Adv: very rapid onset & shorter duration than sufonylurea thus less pp hyperglycemia & less late pp hypoglycemia. May be given in sulfa allergy
Dis: frequent dosing (3/d pradial), weight gain & hypoglycemia (less than sulfonylurea)
PREC: used cautiously in liver impairment

30
Q

Describe MOA of acarbose

A

a-glucosidase inhibitors, as normal brush border of intestine contains this enzyme which converts oligosaccharides into disaccharides thus this drug causes glucose absorption.

31
Q

List adv, ind & AEs of acarbose

A

Adv: limits postprandial rise in BG (insulin sparing effect), no hypoglycemia
Ind: adjuvants to sulfonylureas in DM2 or metformin intolerance
AEs: GIT upset, flatulence, abdominal pain diarrhea due to sugar fermentation in colon

32
Q

Describe MOA of premalintide & its ind & AEs

A

Analogue of amylin (hormone co-secreted with insulin following food intake)
1. Dec pp glucagon secretion
2. Delays gastric emptying & improves satiety
Ind: type 1 & 2 DM prior to meal adjunct to insulin (but no in same syringe)
AEs: hypoglycemia (reduce inslin by 50%), NV, anorexia

33
Q

In DM-2, Consider intiating dual/triple therapy if……, & insulin therapy if……..

A

A1c more or e 9%
A1c more or e 10% esp w/ catabolic features

34
Q

Classify antidiabetic drugs according to cardiac safety into
1. Neutral
2. Unfavourable
3. Beneficial

A
  1. Metformin (PREC: lactic acidosis), gliptins (ex, saxagliptin- >HF)
  2. SGLT-2-I, GLP-1-RA
  3. Glitazones

Endocrine Pharmacology (5 decks)

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