Diabetic Drugs

Question 1

Insulin effects

Answer 1

-increase glycogen storage in the liver
-glycogen synthesis and protein synthesis in skeletal muscles
-triglyceride storage in adipose tissue

Question 2

Rapid acting insulin

Answer 2

Insulin lispro, aspart and glulisine taken immediately before a meal subcutaneously. Used for emergency diabetic ketoacidosis

Question 3

Short acting insulin

Answer 3

Regular insulin given by IV in emergencies or subcutaneously 1 h or more before a meal

Question 4

Intermediate acting insulin

Answer 4

Neutral protamine hagedorn NPH (regular insulin+protamine) delayed onset and peak of action
Combined with regular rapid acting insulin

Question 5

Long acting insulin

Answer 5

Glargine and detemir last for more than 20h to control basal glucose levels

Question 6

Adverse effects of insulin

Answer 6

Hypoglycemia, lipodystrophy, weight gain and hypersensitivity reactions

Question 7

Metformin effects and mechanism

Answer 7

Biguanide that stimulates glucose uptake and glycolysis peripherally, decreases plasma glucagon levels, gluconeogenesis and increases insulin resistance
It Inhibits mitochondrial enzyme glycerophosphate dehydrogenase in the liver

Question 8

Side effects of metformin

Answer 8

Lactic acidosis in renal insufficiency, anorexia, n&v, diarrhea, weight loss, B12 deficiency

Question 9

Insulin secretagogues mechanism and toxicity

Answer 9

Cause insulin release by closing K+channels in pancreatic beta cells.
They are sulfonylureas like glyburide, glipizide, glimepiride, tolbutamide, chlorpropramide or repaglinide and nateglinide used for postprandial glucose levels control.
Cause hypoglycemia, rash or allergies and weight gain

Question 10

Thiazolidinediones (glitazone, rosiglitazone, pioglitazone)

Answer 10

Ligands of peroxisome proliferator activated receptor gamma PPAR-gamma.
Upregulates adiponectin increasing insulin sensitivity and fatty acid oxidation, increase triglyceride storage, upregulates GLUT4 in peripheral tissue leading to increased glucose uptake

Question 11

Side effects of thiazolidinediones

Answer 11

Weight gain (with sulfonylureas), fluid retention and peripheral edema leading to HF, high risk of fractures in women bcz of decreased bone density

Question 12

Analog of amylin found in insulin secretory granules, its mechanism and side effects

Answer 12

Pramlintide reduces glucagon secretion, slows gastric emptying and decreases apetite
Hypoglycemia, n&v, anorexia

Question 13

Alpha glucosidase inhibitors affecting the GI taken at regular intervals throughout the day

Answer 13

Acarbose and miglitol
Side effects: diarrhea, flatulence, abdominal pain bcz of fermentation of carbs by gut bacteria

Question 14

Canagliflozin and dapagliflozin

Answer 14

SGLT2 inhibitors leading to glucose loss in the urine
Taken with an oral antidiabetic
Side effects: risk of UTI, vaginal candidiasis, hypotension, hyperkalemia, weight loss

Question 15

Exernatide

Answer 15

GLP1 analog (long-acting peptide) that increases glucose stimulated insulin release from Beta cells taken usually with metformin or sulfonylureas
Side effects: nausea, hypoglycemia (taken with sulfonylureas), acute pancreatitis, weight loss, increase satiety

Question 16

Sitagliptin, linagliptin, saxagliptin

Answer 16

Inhibit DPP4 so stimulate GLP1 receptors
Side effects: respiratory, urinary infections, weight neutral, increase satiety