Diabetic pharmacology

Question 1

Name the insulin analogues

Answer 1

Lispro
Aspart
Glulisine

Question 2

What is the onset of Lispro, Aspart and Glulisine

Answer 2

15 min

Question 3

What is the Peak of Lispro, Aspart and Glulisine

Answer 3

0.5- 1.5 hrs

Question 4

What is the Duration of Lispro, Aspart and Glulisine

Answer 4

3-5 hrs.

Question 5

What is the onset of human insulin

Answer 5

0.5-1 hr

Question 6

What is the Peak of human insulin

Answer 6

2-3 hrs

Question 7

What is the duration of human insulin

Answer 7

5-8 hrs

Question 8

What is the onset human NPH/Lente

Answer 8

1-3 hrs

Question 9

What is the peak of human NPH/Lente

Answer 9

4-8 hrs

Question 10

What is the duration of human NPH/Lente

Answer 10

8-20 hrs

Question 11

What is the onset of human ultralente

Answer 11

4-8 hrs

Question 12

What is the Peak of ultralente

Answer 12

8-12 hrs

Question 13

What is the duration of ultralente

Answer 13

18-36 hrs

Question 14

What is the onset of glargine, determir

Answer 14

1-2 hrs

Question 15

What is the peak of glargine, determir

Answer 15

Flat

Question 16

What is the duration of glargine, determir

Answer 16

24 hrs

Question 17

Name the 2nd generation sulfonylureas

Answer 17

Glyburide
Glipizide
Glimepiride

Question 18

What is the MOA of the sulfonylureas

Answer 18

stimulates insulin secretion from pancreatic islet beta cells

• Inhibits SUR1 ATP-sensitive potassium channels on beta cells
• Does NOT decrease insulin resistance

Question 19

Thiazide diuretics have what effect on sulfonylureas

Answer 19

excretes it from blood

*Must increase the dose of sulfonylurea

Question 20

Renal disease has what effect on sulfonylureas

Answer 20

decreases elimination

Question 21

Meglitinides are the newer oral diabetic agents and include which drugs

Answer 21

“NIDEs”
Repaglinide
Netaglinide
Miglitinide

Question 22

What is the MOA of Meglitinides

Answer 22

Stimulates insulin secretion from beta cell

*Same MOA as sulfonylurea but peaks in 1 hour and shorter DOA of 4 hours

Question 23

Meglitinides are active ONLY

Answer 23

in the presence of glucose

*less risk of hypoglycemic episodes

Question 24

What is the major Biguanides

Answer 24

Metformin

Question 25

What is the MOA of metformin

Answer 25

Decrease hepatic glucose production Decreases absorption from gut Increases insulin sensitivity in skeletal muscles and adipose tissue *Does NOT stimulate insulin secretion

Question 26

What are the adverse effects associated with metformin

Answer 26

Hypoglycemia (rare) Diarrhea (20%) Lactic acidosis

Question 27

Why does metformin cause lactic acidosis

Answer 27

Blocks mitochondrial membranes preventing mitochondria from converting pyruvate to acetyl-CoA and oxidation

Question 28

What are alpha glucosidase

Answer 28

enzymes that breakdown starch and dissacharides into glucose

Question 29

What are the a-Glucosidase inhibitors

Answer 29

Acarbose Miglitol Voglibose

Question 30

Where do a-Glucosidase inhibitors exert their effects in the body

Answer 30

On the enzymes in intestinal brush border

Question 31

What are a-glucosidase inhibitors used for

Answer 31

to prevent post-prandial hyperglycemia

Question 32

What are the PPAR gama-agonists

Answer 32

"litazones"

Question 33

Why were the PPAR gama-agonists pulled off the market

Answer 33

Cause CHF, MI

Question 34

What is amylin

Answer 34

a polypeptide cosecreted with insulin from the pancreatic beta cells responsible for slowing gastric emptying, suppressing glucagon, and promoting satiety

Question 35

What drug mimics amylin

Answer 35

Pramlintide

Question 36

Amylin is ------ in diabetics

Answer 36

deficient

Question 37

What are incretins

Answer 37

a group of GI hormones that stimulate insulin release and inhibits glucagon release with net effect of lowering blood glucose *Glucagon-like polypeptide-1 (GLP-1)

Question 38

What inactivates incretins

Answer 38

DPP-4

Question 39

What are the drugs designed to MIMIC incretins

Answer 39

Liraglutide Exenatide Taspoglutide

Question 40

GLP-1 activity is similar to amylin activity in what three ways

Answer 40

Suppresses glucagon secretion from pancreatic alpha cells slows gastric emptying Promotes satiety

Question 41

What are the two additional MOA of GLP-1 that distinguishes it from the amylins

Answer 41

Improves insulin sensitivity Stimulates insulin secretion from pancreatic beta cells

Question 42

Exenatide does what to the hemoglobin A1c levels

Answer 42

decreases it by 1%

Question 43

Exenatide does what for weight

Answer 43

decreases by 2.5 kg or 5 lbs

Question 44

exenatide is associated with what disease

Answer 44

acute pancreatitis *don't give to patients with severe abdominal pain radiating to back and vomiting

Question 45

What is DPP-4

Answer 45

The enzyme that inactivates incretins

Question 46

What are the DPP-4 inhibitors

Answer 46

"...gliptins"

Question 47

What are the concerns with Vildagliptin

Answer 47

Skin lesions Bowel CA Lung CA

Question 48

What is Sodium Glucose Transporter 2 (SGLT-2)

Answer 48

Receptors found on proximal kidney tubules that reabsorb glucose from ultrafiltrate regardless of hyperglycemia

Question 49

What are the SGLT-2 inhibitors

Answer 49

"...liflozin"