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Endo Repro 1 > Diabetes Podcast 3-5 > Flashcards

Diabetes Podcast 3-5 Flashcards

1
Q

2nd gen ___ are more potent than 1st

A

Sulfonylureas

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2
Q

After a meal, a rise in BG results in glucose

Glucose metabolized, inc ATP to close

when ATP low
high

B cells become

Due to block of

Depolariztion inc Ca2+ influx through

Ca2+ causes the fusion of insulin ____ to the membrane, resulting in

A

transport into panc B cells

ATP dep K channels

channels open
channels close

Depolarized

K efflux

voltage sensitive Ca2+ channels

stroage vesicles, insulin release

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3
Q

SFU/Glinides stimulate insulin release from B cells by

Side effects

SFU drop A1C by
drop FPG by

Use as ____ therapy to pt unable to achieve target BG goals on

considered 1st line in pt w contraindication to

A

blocking ATP dep K channels

WG, hypoglycemia

1.5-2%
50-60 mg

add on, metformin

metformin

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4
Q

SFU absorbed well in

___ delays time to peak action

Signif binding to

Metabolized by

Excreted by

Duration of action (Glyburide, Glmepiride)

A

GI

Food/hypergly

plasma proteins

liver

kidney

10-24

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5
Q

Drugs that may reduce effects of SFU (lost glucose control)

impair

Drugs that potentiate SFU effects (hypoGly)

displace SFU ____

A

Thiazides, CCB

mechanism

Salicylates, aspirin, sulfa

binding

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6
Q

SFU AE

BC SFU has long duration, hypoGly can be

____ causes less hypoGly

account for most ___ in elderly

Contraidnications
T
P/BF
H
H/R
A

hypogly

protracted

Glimepiride

hypoGly

T1DM
Preg, BF= cross placenta, deplete fetal insulin
Hypersensitivity to sulfa
Hepatic/renal dysfxn

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7
Q

SFU considered

Pt predisposed to SFU induced hypoglycemia

Risk for mortality greater with

Glimepiride more selective for

SFU can dec

may cause MI bc interaction w

A

oral hypoglycemic

Elderly, high dose SFU, renal impairment, hypoglycemic unawareness

Glyburide than Glimepiride

panc ATP dep K channels

macrovasc comps (reduce MI)

ATP dependent K channels in heart

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8
Q

Meglitinides dec A1C by
Dec
which is preferred

Clinical use
P
Used as \_\_\_ to metformin
Can be used
Pt w A1C < \_\_\_ responds better
Dosed at
A

1-1.5%
PP hyperGly
Repaglinide

PP hyperGly
add on
alone
8%
mealtimes
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9
Q

Meglitinides

___ onset and ___ DOA

good absorption

absorption delayed if taken

Metabolized by

Excretion by ___, N/R

W renal insuff, caution use w

___ more appropriate

A

Rapid, onset

0-30 before meal

after meal

different liver CYPs

kidney, 80/10

Nateglinide

Repaglinide

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10
Q

Meglinitides AE
More w
N has __ onset but ___ sec of insulin

Drugs that interfere w ___ metabolism via __ can inc risk for

A

HypoGly, wg
Repaglinide
rapid, less sustained

Repaglinide, CYP3A4, hypogly

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11
Q

Factors contributing to T2DM

Metformin and TZD can ___ insulin resistnace, ___ tissues, and restore

Insulin resistance in peripheral tissue leads to ____ prod of glucose

A

insulin resistnace + dec sec

dec, re-sensitize, normal fxn

increase

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12
Q

Metformin MOA

Activates __ in liver/muscle

___ lipogenesis, fatty liver
___ hepatic insulin sensitivity

Can reduce ____ to dec glucose output

inc AMPK leads to
___ gene expression of enzyes in gluco
___ gene exp of lipogenic enzymes (dec FL)
___ muscle glucose uptake by making more

A

dec hepatic glucose prod

AMPK (inc glucose uptake)

Dec
Inc (dec gluco, FPG)

Glucagon sec

dec
Dec
Inc, glut 4

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13
Q

Metformin dec A1C by
dec FPG by

Advantages

used as ____ for T2DM
___ pt

measure ___ at baseline

absorbed from

__ binding to plasma proteins

Excreted unchanged in

DOA

A

1.5-1.7%
50-70

no wg, hypogly
Pos effect on lipid profile (dec TG, LDL inc HDL)

1st line therapy
Prediabetic

eGFR, LFT

SI

no

urine

6hrs

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14
Q

Metformin contra

Conditions predisposing to inc
Such as

For kidney dz, avoid if eGFR <

OK for ____ impairment

____ procedures w iodinated dyes

Metformin should be ____ for 48hrs

confrm normal ___ fxn after dye

A

lactate

hepatic, renal, heart dz
hypoxic lung dz
elderly, LA, active EtOH abuse

30

mild-mod

Radiological

withheld

renal

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15
Q

AE of Metformin

Alcohol can potentiate metformins effect to inc

___ more likely

Sx

____ OTC H2 recep antag

blocks

inc ___

Lactate is normlly taken up by ___ and converted to

Metformin dec _____

A

D/A/N, metallic taste, dec VB12/folate absorp

lactate accumulation

LA

malaise, myalgia, ab discomfort, heavy breathing

Cimetidine

Stomach Acid

Metformin conc

liver, glucose

conversion to glucose

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16
Q

TZDs MOA

Activates _____ nuclear receptors

present in ____ sens tissues, mostly the

activation of PPAR leads to

circulating FFA leads to

Improves ability to

dec circulating

Dec TG and inc HDL better w

A

PPAR G

insulin, adipose

FFA storage

insulin resistance

store lipids/glucose

TG

Pioglitazone > Rosiglitazone

17
Q

TZD can ___ in muscle/adipose

___ HGP

_____ onset of action is

Dec A1C by

Greatest effect on

Reverses ____
Favorable effect on

___ glycemic control
___ insulin requirements

A

GLUT 4

dec

delayed

1-1.5%

FPG

Insulin resistance
Lipid prof (inc HDL, dec TG)

inc
Dec

18
Q

TZD typically not used as
Use w
___ onset of effect

PIO/ROSI metabolized by

elim for ROSI but not PIO

AE

DOA

A

1st line
mod-severe metabolic syndrome
Slow

diff CYP enzymes

kidney

WG, cv risks

24hrs

19
Q

TZD Precautions
___ fxn

___ In liver dz

Take ___ prior to and @ 1yr

___ retention, can exacerbate

contra in pt w

Dec

Possible

A

Liver (hepatotoxicity)

contraindicated

LFT

Fluid, HF

symptomatic HF

bone mineral density

bladder Ca

20
Q

Alpha glucosidase inhib

MOA

reduces

dec A1C by
better at reducing

___ PPG levels
Used as

in pt w

Dosed w

A

dec activity of alpha gluc on intestinal BB

CHO absorption

.5%
PPG

dec
Alone/in combo

T1/T2

meals

21
Q

Alpha gluco inhib

Minimally ___ and ____ by GI enzymes

DOA

AE

Measure ___ during 1st year

Contraind w

Hypogly can occur when used w

tx w

may influence ___ of co-admin drugs

A

absorbed, metabolized

6hrs

ab pain, flatulence, D/cramps

LFT

IBD/IBS, malabsorption

other antiDM meds

dextrose

absorption

22
Q

T2DM defects

Insulin
Dec
Impaired
Impaired

results in loss of

(incretin) GI hormones released upon eating can trigger ___ before BG levels rise

____ is endo incretin

Incretin GI horones can also ___ and reduce

Drugs can ____ effects

A

resistance
insulin sec
glucagon sec
Incretin response

1st phase insulin response

insulin release

GLP1

slow GE, glucagon

mimic/prolong action

23
Q

Incretin analogs
Oral DPP4 inhibs

IA are analogs of

DPP4 inhib works through

A

Exenatide/liraglutide
Sitagliptin

GLP1

preventing degredation

24
Q

GLP1 analogs

MOA
Restore
Moderate
Slow
Suppress
inc panc

Administered via

DOA for E/L

E excretion

SE

A 
1st phase insulin
Glucagon
GE
appetite
B celll mass

SQ injections

shorter, 2x day/longer 1x day

Renal

N/V/D/hypoG

25
Q

GLP 1 analog dec A1c by
greater effect on

Adv

use when T2DM cannot achieve

Usef as add on w ____

to avoid hypoGly ___

can be used as

A

1%
PPG

Wl

PPG

metformin, SFU

dec SFU Dose

monotherapy

26
Q

Rare AE of GLP1 ag

Contra

Hypogly w
Reduce absorption of
May affect ___ therapy/bleeding

A

Antibodies to drug, hyprsensitivity rxn, acute panc, RF

Panc, impaired renal xn, thyroid ca, GI dz

other agents
coadmin drugs (ab/OC)
warfarin, inc

27
Q

DPP4 effect

MOA of DPP4 inhib

Restore
Moderate
Weight

Dec A1c by
More effet on

ADV

T2DM use to control
Used as ___, w

asses ___ prior to therapy

A

degrade endo incretin

prolong endo GLP1

1st phase insulin
glucagon sec
netural

.5%

oral, fewer SE

PPG
add on/mono- metformin/SFU/insulin

eGFR

28
Q

DPP4 inhib absorbed

excreted by

Half life

AE effect

possible

another drug in class

A

Rapid

kidney

6-12hr

hypersens- SJS/angio/anaphyl

panc metaplasia\

saxagliptin

29
Q

Amylin analog

___ secreted by B cells along w insulin

MOA
suppresses

Dec A1c by

used as ___ for
targets

dose w

co administer w

A

panc hormone

delay gastric emptying
glucagon

.3-.6%

add on
PPG

meals

insulin, SFU

30
Q

SE of amylin analog

Contraindic

Avoid w

A

GI sx, hypogly

hypogly unawareness, GI dz

heavy machines/high risk acts

31
Q

SGLT2 inhib

SGLT2 contransports

expressed in

mediates reabsorption of

drugs work to

dec A1C by

ADV

A

Na-Glucosee

proximal tubule

90% filtered load of glucose

promote renal exc, lower BG

.5-.7%

wl, dec BP

32
Q

SGLT2 inhib absorbed
___ DOA
___ requires adjustment

\_\_ _genital/UTI
D
inc \_\_\_ sec
K w BG less than 200
Dec
A

rapidly
long
CKD

inc
dehydration
glucagon
KA
BMD (inc PO4 reabsorp)

Endo Repro 1 (24 decks)

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