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Endocrine > Diabetes Rx > Flashcards

Diabetes Rx Flashcards

1
Q

NPH peak and duration

A

peak 4-12

duration 18-26

(intermediate acting)

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1
Q

mechanism acarbose

A

inhibits enteric enzymes that break down complex carbs > malabsorption

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2
Q

general goals for glycemic control

A

fasting+preprandial glucose 70-120mg%

2 hour Post pandrial glucose, < 180mg%

Hgba1C

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2
Q

DPP4 inhibitor, mechanism

A

Sitagliptin

inhbition of DPP-4 prevents degradation of GLP-1 to prolong action in portal circulation

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3
Q

Mitiglinide mechanism

A

binds to sulfonylurea K channel to increase insulin secretion

(OK in patients with Renal failure, vs sulfonylurea drugs)

3x dail dosing

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4
Q

sulfonylurea (glipizide, glyburide, glimepiride) side effects

A

hyponatremia

disulfiram like reaction

Rashes/GI upset

drug interactions (warfararin

hypoglycemia

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5
Q

GLP-1 analogs,

mechanism

A

Exenatide + liraglutide

long acting analog, increases beta cell mass

inhibits glucagon secretion

promotes weight loss

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6
Q

sulfonyurea drugs

mechanism+duration

A

stimulate insulin secretion by pancreas

(glipizide, glyburide, glimepiride)

(all 15-24)

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7
Q

insulin side effects

A

hypoglycemia

insulin allergy

lipoatrophy or lipihypertrophy

insulin edema

“weight gain”

at high doses: atherosclerosis, increased cancer (?)

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7
Q

glucosidase inhibitors, mechanism

A

Acarbose

inhibits enteric enzymes that break down compelx carbohydrates, causing malabsorption > reduces post-prandial hyperglycemia

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8
Q

insulin analogs

A

Lispro insulin

insulin aspart

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10
Q

insulin glargine peak and duration

A

no peak

24-36 hours

(long acting)

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12
Q

insulin detemir peak and time course

A

6-14 peak

24 duration

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13
Q

stimulates insulin secretion at pancreas

A

sulfonylureas

(glipizide, glyburide, glimeiride)

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14
Q

contraindications metformin

A

Renal insufciency

Elderly

CHG

Home oxygen

acute illness

binge drinking+ liver dysfunction

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15
Q

mechanistic advantage Lispro insulin, insulin aspart

(insulin analogs)

A

do not form hexamers as does regular insulin, allowing them to have a quicker onset of action more similar to normal meal-induced secretion

16
Q

Sitagliptin mechanism

A

DPP-4 inhbitor > slows degradation of GLP-1 in portal circulation

17
Q

SGTP-2 inhibitor, mechanism

A

canagliflozin

inhibits transport at sodium glucose transporter in proximal tubule

>glucose wasting in urine

17
Q

Canagliflozin mechanism

side effects

A

inhibits SGTP glucose transporter in proximal tubule > glucose wasting in urine

increase risk of genital yeast infection

19
Q

only insulin for IV use

A

regular insulin

20
Q

cloudy suspension aggregated with protamine and zinc

longer time course

A

NPH insulin

22
Q

decreases peripheral insulin resistance

decreases central insulin resistance

A

central - metformin

perpheral - Thiazolidinediones (rosiglitazone, pioglitazone)

23
Q

long acting insulin analogs and specific mechanism

A

insulin glargine - soluble at pH4, poorly at pH7
SubQ, forms fine percipitate in interstitial fluids

**Insulin detemir - **self-association at SubQ sites, also binds to albumin in blood stream

24
Q

thiazolidinediones mechanism

(rosiglitazone, pioglitazone)

side effects

A

activate PPAR to increase peripheral insulin sensitivity

liver toxicity

weight gain and fluid retention

contraindicated in heart failure

Rosiglitazone - ishemic cardiac events, increased bladder cancer

25
Q

Exanatide+liraglutide mechanism and side effects

A

SubQ long acting analog, increases beta cell mass

inhibits glucagon secretion

promotes weight loss

nausea, emyesis, diarrhea, headaches, possible pancreatitis

26
Q

Lispro insulin and insulin aspart

Peak and duration

A

Peak - 0.7

duration 2

(short acting)

27
Q

Metformin mechanism and side effects

A

reduce insulin resistance in liver

most side effects GI

lactic acidosis (do not prescribe in renal failure)

Endocrine (45 decks)

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