Diabetes Treatment

Question 1

lispro, aspar, glulisine

Answer 1

rapid acting insulins

Question 2

novolin R, humulin R

Answer 2

short acting insulins

Question 3

NPH humulin N, NPH novolin N

Answer 3

intermediate acting insulings

Question 4

detemir, glargine

Answer 4

long acting insulins

Question 5

insulin secretion stimulated by increase ________ ratio

Answer 5

ATP/ADP (glucose, AA, FA, parasympathetics, GPL-1)

Question 6

insulin acts through stimulation of _________ receptor, acts in liver/muscle/adipose to decrease blood glucose levels and shift from energy use to storage

Answer 6

tyrosine kinase

Question 7

treatment of DKA:

• ______ of regular insulin at low rate
• may need to admin _____ along with insulin to prevent hypoglycemia

Answer 7

IV infusion

glucose

Question 8

• tolbutamide, tolazamide, chlorpropamide (1st gen)

- glyburide, glipizide, glimepride (2nd gen)

Answer 8

sulfonylureas

Question 9

• activate residual beta cells to release insulin, bind K/ATP channel
• hypoglycemia and weight gain
• control hyperglycemia in type 2DM
• contra: type 1DM, pregnancy, hepatic or renal insufficiency

Answer 9

sulonylureas (glyburide, glipizide, glimepride, tolbutamide, tolazamide, chlorpropamide)

Question 10

• bind different site than sulfonylureas to activate K/ATP channel
• hypoglycemia, conta in hepatic insufficiency
• repaglinide, nateglinide

Answer 10

meglitinides

Question 11

• increase peripheral insulin sensitivity, reduce hepatic gluconeogenesis, no weight gain or hypoglycemia, reduce triglycerides
• 1st line therapy for t2DM
• toxicity: lactic acidosis (impair hepatic metabolism of lactic acid), GI upset, vitamin B12 deficiency

Answer 11

metformin (biguanide)

Question 12

• PPAR agonists, transport serum lipids to adipose tissue, promote insulin sensitivity, decrease gluconeogenesis, enhance glucose uptake in skeletal muscles
• reduce glucose and triglycerise levels
• adverse: weight gain, hepatix tox, CHF

Answer 12

thiazolidinediones (rosiglitazone, pioglitazone)

Question 13

• reversible inhibitors of pancreatic alpha-amylase and alpha glucoside (increase time required to absorb complex carbs, reduce postprandial glucose peak)
• used in combo with other agents
• flatulence, bloating, diarrhea

Answer 13

alpha-glucosidase inhibitors (acarbose, miglitol)

Question 14

• increase insulin, decrease glucoagon
• delay gastric emptying, decrease appetite
• release stimulated by nutrients entering gut

Answer 14

GLP-1 incretins (-tide)

Question 15

• increase level of endogenous incretins (inhibit degradation)
• don’t use with GLP-1 analogs

Answer 15

DDP-4 inhibitors (-gliptin)

Question 16

• inhibition causes glycosuria and lowers glucose levels
• efficacy reduced in chronic kidney disease
• increases UTIs, osmotic diuresis causes hypotension
• weight loss

Answer 16

SGLT2 inhibitors (-flozin)

Question 17

canagliflozin, dapagliflozin, empagliflozin

Answer 17

SGLT2 inhibitors

Question 18

• mimics high dose effects of amylin
• increase insulin, decrease glucagon, delay emptying, decreases appetite
• hypoglycemia, GI symptoms

Answer 18

pramlintide

Question 19

• bile acid sequestrant, cholesterol lowering drug

- can exacerabte hypertriglyceridemia

Answer 19

covesevalam

Question 20

• dopamine agonist, lowers glucose levels

- nausea, fatigue, dizziness, vomiting, headache

Answer 20

bromocriptine

Question 21

• monotherapy: begin with metformin, GLP-1, SGLT2, or DDP-4 inhibitor
• sulfonylureas and TZDs are ______ agents

Answer 21

second choice