Diabetic medications

Question 1

Sulfonyl ureas _____ insulin secretion

Answer 1

stimulate

Question 2

_____ is the only insulin preparation that can be injected IV.

Answer 2

Regular insulin (short-actin)

Question 3

What is NPH insulin?

Answer 3

Intermediated acting insulin

Question 4

What is lente insulin?

Answer 4

Mixture of 30% semilente (short acting) and 70% ultralente (long acting) zinc insulin crystals–> intermediate acting insulin

Question 5

How many times is insulin measured a day? How often will insulin be injected?

Answer 5

4- before each meal

2- one before breakfast one before dinner

Question 6

What is humulin?

Answer 6

recombinant human insulin made in bacteria/yeast

Question 7

What is novolin?

Answer 7

made by switching the aa that is different in pork insulin

Question 8

T or F. Insulin in circulation forms hexamers with Zn, but hexamers dont bind the insulin receptor until dissoc.

Answer 8

T

Question 9

Structure of insulin lispro

Answer 9

proline B28 and lysine B29 of humulin are switched— doesnt form hexamers

Question 10

MOA of insulin lispro

Answer 10

doesn’t form hexamers, faster onset of action and shorter half-life than regular insulin

Question 11

Describe insulin glulisine

Answer 11

rapid acting-insulin analogue that differs from human insulin in that the amino acid Asp at B3 is replaced by lysine and the lysine in B29 is replaced by glutamic acid. Does not form hexamers

Question 12

Describe nsulin aspart

Answer 12

rapid acting insulin analog that exists only as a monomer

Question 13

___, ____, and ____ all have the same pharmacokinetic properties - faster onset of action and shorter duration than regular insulin- because they exist in monomer form.

Answer 13

Insulin lispro, insulin aspart, insulin glulisine

Question 14

What insulin therapies have an altered isoelectric point?

Answer 14

Insulin glargine, insulin detemir

Question 15

What is insulin glargine?

Answer 15

recombinant human insulin analogue used for injection. Differs in a few amino acids, Long duration of action. Can be injected once a day.

Question 16

What is insulin detemir?

Answer 16

Long acting human insulin recombinant analogue

Question 17

Explain why insulin glargin and determir are long-acting.

Answer 17

When injected, the acidic solution is neutralized causing crystals to precipitate=slow absorption=long acting. The low peak insulin concentration decreases chances of nocturnal hypoglycemia.

Question 18

____ is the treatment for DKA.

Answer 18

Insulin

Question 19

____ is the treatment for hypoglycemic coma.

Answer 19

glucagon

Question 20

Normal HbA1C is ___. Over __ is not good. ___ is dangerous

Answer 20

6,8,10

Question 21

What are the sulfonylureas

Answer 21

glyburide, glipizide, gliclazide, glimepiride

Question 22

MOA of sulfonylureas

Answer 22

Oral hypoglycemics. Act on insulin. Initially may increase insulin release. Long term treatment may decrease insulin metabolism and increase insulin sensitivity.

Question 23

ADME of sulfonyureas

Answer 23

Rapidly absorbed from GI. extensively protein bound, metabolized in liver, excreted by kidney

Question 24

What are the meglitinides

Answer 24

repaglinide and nateglinide

Question 25

MOA of meglitinides

Answer 25

Oral hypoglycemics. Benzoic acid derivatives that increase insulin secretion.

Question 26

ADME of meglitinides

Answer 26

Oral, GI rapid absoprtion, short half-life, take before each meal to control post-prandial glucose, metabolized by liver

Question 27

AD of meglitinides

Answer 27

hypoglycema

Question 28

What are the biguanides

Answer 28

metformin, metformin+glyburide

Question 29

MOA and ADME of biguanides

Answer 29

oral hypoglycemics, does not affect insulin secretion, no hypoglycemia. Decreases hepatic glucose production Absorbed from GI; little metabolism

Question 30

What are the thiazolidinediones?

Answer 30

rosi-, pio-, rosi- + metformin ...-glitazone

Question 31

MOA and ADME of thiazolidinediones?

Answer 31

Bind PPARy, increase insulin sensitivity, increase glucose transport, absorb GI tract, little metabolism

Question 32

What are the a-glucosidase inhibitors?

Answer 32

acarbose, miglitol

Question 33

MOA, ADME of a-glucosidase inhibitors

Answer 33

reduce intestinal absorption of starch at brush border, reduce uptake of carbs to reduce post-prandial glucose rise, used in combination with other hypoglycemic drugs/insulin

Question 34

Which oral hypoglycemic drugs act on hepatic glucose secretion?

Answer 34

Biguanides: metformin +/- glyburide

Question 35

Which oral hypoglycemic drugs act on the brush border?

Answer 35

a-glucosidase inhibitors, acarbose and miglitol

Question 36

Which oral hypoglycemic drugs act on insulin secretion?

Answer 36

meglitinides: regalinide, nateglinide

Question 37

Which oral hypoglycemic drugs act on insulin sensitivity and increase glucose transport?

Answer 37

Thiazolidinediones- rosi, pio glitazone

Question 38

Which oral hypoglycemic drugs decrease insulin metabolism, increase insulin sensitivity, and increase insulin uptake?

Answer 38

Sulfonylureas: glyburide, glipizide, gliclazide, glimepiride

Question 39

_____ enhance the hypoglycemic actions of sulfonyureas.

Answer 39

NSAIDs

Question 40

Therapeutic uses of somatostatins

Answer 40

insulinomas, glucagonomas, acromegaly

Question 41

_____ is an antihypertensive antidiuretic that has potent hyperglycemic actions

Answer 41

Diazoxide

Question 42

MOA of diazoxide

Answer 42

inhibits insulin secretion but NOT synthesis. So there is a build up in B cells.

Question 43

Therapeutic uses of diazoxide

Answer 43

various forms of hypoglycemia including inoperable insulinomas

Question 44

GLP-1 ____ glucose-dependent insulin secretion.

Answer 44

Increases

Question 45

MOA for GLP1

Answer 45

increase glucose dependent insulin secretion, inhibits glucagon stimulated glycogenolysis, slow gastric emptying, decrease appetite, decrease glucagon, decrease postprandial glucose

Question 46

What are incretins?

Answer 46

hormones that increase insulin secretion

Question 47

What are the GLP1 receptor agonists?

Answer 47

Exenatide, liraglutide

Question 48

What are the DPP4 inhibitors?

Answer 48

sitagliptin, saxagliptin, linagliptin

Question 49

What are the amylin analogues

Answer 49

Pramlintide symlin

Question 50

MOA of amylin analogues

Answer 50

aids glucose absorption, promote satiety, inhibits inappropriate secretion of glucagon, weight loss

Question 51

MOA of colesevelam hydrochloride

Answer 51

bile acid sequesterant, lowers blood cholesterol, lowers HbA1C by .5%, LDL by 15%, interrupts enterohepatic cycling