Diabetes Therapy

Question 1

name the three sulfonyureas

Answer 1

glipizide
glyburide
glimepiride

Question 2

name the two meglitinides

Answer 2

repagalinide

nateglinide

Question 3

what is the MoA of sulfonyureas and meglitinides?

Answer 3

increase insulin secretion by binding the SUR channel and blocking K+ efflux and starting insuln secretion pathway

Question 4

what can sulfonyureas and meglitinides cause?

Answer 4

hypoglycemia

Question 5

what is drug class of glipizide, glyburide and glimepiride?

Answer 5

sulfonyureas

Question 6

what is the main biguanide to know?

Answer 6

metformin

Question 7

what is the MoA of metformin?

Answer 7

though to sensitize liver to glucose and deacrease gluconeogenesis

Question 8

what are three SEs of metformin?

Answer 8

diarrhea, nausea and low B12

Question 9

what is the main risk with metformin? what further increases this risk?

Answer 9

lactic acidosis…if patient has renal fialure

Question 10

other thn glucose levels, what does metformin help with?

Answer 10

thought to decrease lipid levels and maybe even cause some weight loss

Question 11

what molecule is it suspected that metformin activates in the liver?

Answer 11

AMPK

Question 12

does metformin cause hypoglycemia?

Answer 12

NO

Question 13

name the two thiazolidinediones

Answer 13

pioglitazone and rosiglitazone

Question 14

what is the MoA of pioglitazone and rosiglitazone?

Answer 14

insulin sensitizer of muscle and adipose tissue

Question 15

do pioglitazone and rosiglitazone cause hypoglycemi?

Answer 15

no

Question 16

name the three SEs of pioglitazone and rosiglitazone?

Answer 16

edema and weight gain and fractures

Question 17

what is main severe risks with pioglitazone and rosiglitazone?

Answer 17

CHF and liver toxicity

Question 18

what cancer might there be increased risk with pioglitazone?

Answer 18

bladder cancer

Question 19

what molecule on fat do pioglitazone and rosiglitazone activate? what does this do?

Answer 19

activate PPAR-gamma and this increases insulin sensitivity of the adipose cells and increases levels of adiponectin

Question 20

name the two a glucosidase inhibitors

Answer 20

acarbose and miglitol

Question 21

what is the MoA of miglitol and acarbose?

Answer 21

inhibit intestinal BB enzyme a glucosidases to delay absorption of glucose…lowering postprandial glucose

Question 22

when do acarbose and miglitol have their main effects?

Answer 22

postprandial

Question 23

what is the main SE with acarbose and miglitol?

Answer 23

bloating and Gi upset

Question 24

what is the normal fxn of incretin GLP-1?

Answer 24

promotes satiety
stimulates glucose dependent insulin secretion
slows gastic emptying
inhibits glucagon release

Question 25

name the two GLP-1 incretin analogues?

Answer 25

exenatide | liraglutide

Question 26

what is the MoA of exenatide and liraglutide?

Answer 26

promotes satiety stimulates glucose dependent insulin secretion slows gastic emptying inhibits glucagon release

Question 27

what are the SEs of exenatide and liraglutide?

Answer 27

nausea and pancreatitsi

Question 28

what is a sometimes desired SE of exenatide and liraglutide?

Answer 28

weight loss and satiety increase

Question 29

what is secreted with insulin from beta cells?

Answer 29

amylin

Question 30

what is role of amylin in body?

Answer 30

inhibit glucagon release increase satiety slow gastric emptying

Question 31

what is drug that can act as amylin in diabetes rx?

Answer 31

pramlinitide

Question 32

what is MOA of pramlinitide?

Answer 32

inhibit glucagon release | increase satiety and slow gastric emptying

Question 33

what is drawback of use of pramlinitide?

Answer 33

have to give injcn with every meal

Question 34

name the four SGLT2 inhibitors

Answer 34

canagliflozin dapagliflozin empagliflozin ertugliflozin

Question 35

what is the ending of all the SGLT2 drugs?

Answer 35

gliflozin

Question 36

what is MoA of SGLT2 inhibitors?

Answer 36

inhibit the SGLT2 transporter in the PCT of the kidney so glucose secreted

Question 37

what is insulin therapy effect on liver?

Answer 37

increase glucose storage as glycogen

Question 38

what is insulin therapy effect on muscle?

Answer 38

increase glycogen and protein synthesis

Question 39

what is insulin therapy effect on fat??

Answer 39

increase TG storage

Question 40

what are the two subunits of human insulin?

Answer 40

alpha and beta chain

Question 41

what are the two modified human insulins?

Answer 41

regular insulin and NPH insulin

Question 42

regular insulin has what duration effect?

Answer 42

short acting insulin

Question 43

NPH insulin has what duration effect?

Answer 43

intermediate acting insulin

Question 44

short acting normal insulin lasts about how many hours?

Answer 44

6-8

Question 45

intermediate acting NPH insulin lasts about how long?

Answer 45

12-20 hours

Question 46

name the three insulin analogues that are rapid acting?

Answer 46

aspart glulisine lispro

Question 47

how quickly is peak effect of aspart, glulisine and lispro?

Answer 47

1 hr after administration

Question 48

what is mnemonic to remember the rapid acting insulins?

Answer 48

no LisproAaspartGlulisine

Question 49

name the two long acting insulins

Answer 49

detemir and glargine

Question 50

why are rapid acting insulins able to act so fast?

Answer 50

because they are monomers and wuickly absorbed

Question 51

what makes long acting insulins act longer?

Answer 51

they are hexamers and have to be broken down to monomers to act

Question 52

how long to long acting insulins act?

Answer 52

no real peak time...system for say 24 hrs

Question 53

when is peak of NPH?

Answer 53

4-10 hrs

Question 54

when is peak or normal insulin?

Answer 54

2-3 hrs

Question 55

when is peak of fast acting?

Answer 55

1 hr peak

Question 56

what is average insulin requirement in type 1 DM?

Answer 56

0.5-0.6U/Kg/day

Question 57

what is a normal insulin routine for type I DM?

Answer 57

regular insulin in AM and before dinner | intermediate insulin in AM and at dinner

Question 58

overnight glucose is controlled by what part of insulin dose?

Answer 58

prior nights intermediate acting insulin

Question 59

pre lunch glucose is controlled by what part of insulin dose?

Answer 59

morning short acting insulin

Question 60

pre supper glucose is controlled by what part of insulin dose?

Answer 60

morning intermediate acting dose

Question 61

bedtime glucose is controlled by what portion of the insulin dose?

Answer 61

supper short acting insulin

Question 62

what is a dermatologic manifestation of insulin use?

Answer 62

lipdystrophy where you can get lipohypertrophy around injxn sites

Question 63

what is lipoatrophy?

Answer 63

immune mediated with loss of fat at insulin injxn sites...this is very uncommon