Diabetes Non-Ins-I (met, sulf, meglit)

Question 1

Name the 4 groups of ORAL hypoglycemics

Answer 1

Insulin secretagogues (sulfonylurea and meglitinides)
Biguanides
Thiazolidinediones (TZDs)
Alpha- glucosidase inhibitors

Question 2

Which non-insulin anti-diabetic drugs (2) produce the biggest drop in fasting plasma glucose AND HbA1c? MOAs?

Answer 2

Sulfonylureas: Stimulate insulin release via SUR1 subunit and reduce serum glucagon levels

metformin: inhibits gluconeogenesis

Question 3

Name the two first generation sulfonylureas

Answer 3

Tolbutamine

Chlorpropamide

Question 4

Which first generation sulfonylurea has a short half life and rarely causes hypoglycemia?

Answer 4

Tolbutamide

Question 5

Which first generation sulfonylurea has a long half life and is contraindicated in patients with hepatic or renal insufficiency?

Answer 5

Chlorpropamide

Question 6

Which sulfonylurea causes jaundice in doses over 500mg?

Answer 6

Chlorpropamide

Question 7

Which sulfonylurea is contraindicated in the elderly? Why?

Answer 7

Chlorpropamide

Higher risk of prolonged hypoglycemia

Question 8

Which sulfonylurea causes a hyperemic flush if taken with alcohol?

Answer 8

Chlorpropamide

Question 9

Which non-insulin anti-diabetic drugs can be used to treat central diabetes insipidus? How?

Answer 9

Sulfonylureas
esp Chlorpropamide
Can cause SIADH -> hyponatremia

Question 10

Name the three second generation sulfonylureas

Answer 10

Glyburide
Glipizide
Glimepride

Question 11

Which sulfonylurea results in hypoglycemia in 20-30% of pts?

Answer 11

Glyburide

Question 12

How do second generation sulfonylureas differ from first?

Answer 12

100x more potent and fewer adverse effects

Question 13

Which sulfonylurea has the shortest half life? Why is this important?

Answer 13

Glipizide

Less likely to cause serious hypoglycemia

Question 14

Which sulfonylurea is approved for once-daily monotherapy or in combo with metformin or insulin?

Answer 14

Glimepiride

Question 15

How are sulfonylureas delivered?

Answer 15

Orally

Question 16

Which oral anti-diabetic agents are associated with wt gain?

Answer 16

Sulfonylureas
Meglitinides
Thiazolidinediones (TZDs)

Question 17

Which group of oral anti-diabetic drugs can lead to tachyphylaxis? (where they initially respond to treamtent then regress)

Answer 17

Sulfonylureas

Question 18

Name the two meglitinides. Which is more effective? MOA?

Answer 18

Repaglinide - more effective
Nateglinide
Like sulfonylureas, stimulate insulin secretion by binding SUR1 (at different place though)

Question 19

Which group of oral anti-diabetic drugs have
rapid onset,
short duration
and are used for postprandial glucose regulation?
When are they taken?

Answer 19

Meglitinides

Taken before each meal

Question 20

Which class of oral anti-diabetic drugs can safely be given to patients with a sulfa allergy?

Answer 20

Meglitinides

Question 21

Which insulin secretagogue produces fewer incidences of hypoglycemia?

Answer 21

Nateglinide

Secretagogues are sulfonylureas and meglitinides

Question 22

Name the only biguanide. MOA?

Answer 22

Metformin

Inhibits gluconeogenesis by reducing gene expression of necessary enzymes

Question 23

Which oral anti-diabetic drug doesn’t cause hypoglycemia even at large doses?

Answer 23

Metformin

Question 24

Which oral anti-diabetic drug is associated with a LOSS of weight?

Answer 24

Metformin

Question 25

What is the only hypoglycemic drug shown to reduce macro vascular events in type II DM?

Answer 25

Metformin

Question 26

What is the first line therapy in type II DM?

Answer 26

Metformin + diet and exercise

Question 27

Which oral anti-diabetic drug is not metabolized and excreted in urine?

Answer 27

Metformin

Question 28

Which oral anti-diabetic drug used long term can interfere with B12 absorption?

Answer 28

Metformin

Question 29

What is metformin's major adverse effect in 20% of pts?

Answer 29

GIT: anorexia, nausea, vomiting, diarrhea

Question 30

Which oral anti-diabetic drug is contraindicated in pts with renal or hepatic disease due to increased risk of lactic acidosis?

Answer 30

Metformin

Question 31

What is a major off label use for metformin?

Answer 31

It lowers insulin resistance and can lead to ovulation in PCOD and possibly pregnancy

Question 32

What is the only drug approved for use in conjunction with insulin for type II diabetes?

Answer 32

Metformin

Question 33

If initial treatment with metformin does not work, what is the next step? How do you choose which drug to give?

Answer 33

Either insulin or a sulfonylureaGive insulin if HbA1c is >8.5%