Diabetes Pharmacology

Question 1

Biguanides - insulin sensitizer

Answer 1

unknown MOA
no hypoglycemia
weight loss
drug #1
time-limited diarrhea
renal failure
lactic acidosis
contra: CKD

metformin

Question 2

TZDs - insulin sensitizer

Answer 2

PPARY = GLUT4 (to adipocytes)
no hypoglycemia
weight gain
collecting duct - fluid retention
bone marrow - osteopenia
bladder cancer

-glitasone

Question 3

Sulfonylureas - insulin release

Answer 3

Increase insulin directly (receptors on pancreas)
yes hypo
weight gain
exacerbated in AKI

glimeperide
glypizide

Question 4

Dpp4-I and GLP1 analogs

Answer 4

mimick/sustain incretins > primes pancreas
very low hypo
early satiety > weight loss
cause pancreatitis, pancreatic cancer

GLP1 - enatides (exenatide injectable)
-glutides
Liraglutide
Dulaglutide
Semaglutide

DPP4-inhibitors - gliptins (saxogliptin) don’t work at all?

Question 5

SGLT2s, acarbose (alpha galactosidase inhibitor)

Answer 5

Total body glucose reducers
works on cells not metabolism
insulin independent
no hypo
no weight gain

acarbose < decr absorption by decr digestion - cause diarrhea, flatulence, decr adherence

SGLT2-inhibitors (gliflozins)
decr PCT resorption glc
glucosuria = diuretics
Euglycemic DKA in type 2

Question 6

Long acting insulin

Answer 6

glargine
detemir
degludec

Question 7

Rapid acting insulin

Answer 7

aspart
lispro
gluseline

Question 8

Mixed insulin

Answer 8

NPH
Regular

75-25
70-30
50-50

easy, no clicks, two stick, poor control, cheap

give BID q12h