DM drugs

Question 1

Difference between DM1 and DM2?

Answer 1

DM1 born with it—>need insulin injection—>prone to DKA

DM2 late onset—>HHS

Question 2

What increase and inhibits insulin?

Answer 2

Increase insulin—>glucose/sulfonylurea/M agonist/beta 2 agonist
Decrease insulin—>alpha 2 agonists

Question 3

What are the short, intermediate, long acting insulin?

Answer 3

Short—>listpro/aspart/glulisine/regular
Intermediate—>NPH/NPL/NPA
Long acting—>glargine (basal)

Question 4

What kind of insulin is used for meals?

Answer 4

Shorting acting after each meal

Question 5

When is glargine’s peak?

Answer 5

NONE—>less hypoglycemia

Question 6

What are the symptoms of DKA?

Answer 6

polyuria/polydipsia/dehydration/Kussmaul breathing/fruity breath

Question 7

How to treat DKA

Answer 7

Replenish K first if K is low/IV regular insulin and hydration /dextrose when glucose is 200-300

Question 8

What is the only kind of insulin that can be given IV?

Answer 8

Regular

Question 9

Which presents with higher glucose level, DKA or HHS?

Answer 9

HHS

Question 10

Which glucose transporter is on beta cell of pancreas?

Answer 10

GLUT2

Question 11

How does thiazide and loop cause hyperglycemia?

Answer 11

They cause hypokalemia—>keep K channel in beta cell of the pancreas open—>prevent insulin release—>hyperglycemia

Question 12

What drug is used for insulinoma? how does it work?

Answer 12

Diazoxide—>keep K channel of the beta cell in pancreas open

Question 13

What are sulfyonlurea and what are their MOA? side effect?

Answer 13

1st gen—>chlorpropamide
2nd gen—>Glyburide/glipizide—->inhibit K channel of the beta cell of pancreas—>increase insulin release
Weight gain and hypoglycemia

Question 14

What are the 2 drugs that work just like sulfonylurea but short acting?

Answer 14

Repaglinide/Nateglinide

Use before meals

Question 15

What are the symptoms of hypoglycemia? tx?

Answer 15

Lip/tongue tingling/lethargy/sweating/tachy

IV dextrose/glucagon

Question 16

MOA of metformin? side effect?

Answer 16

Inhibit hepatic gluconeogensis
Lactic acidosis with renal dysfunction
B12 deficiency

Question 17

When else can you use metformin?

Answer 17

For PCOS—->offset insuline resistance

Question 18

What is the MOA of acarbose and miglitol?

Answer 18

Inhibit alpha-glucosidase in small intestine—>prevent glucose breakdown

Question 19

What is the MOA of TZD (thiazolidinediones)? and what are they? side effects?

Answer 19

“glitazone”—>bind to PPARs—>increase insulin receptor—>increase insulin sensitivity
Weigh gain/edema

Question 20

What other group of drugs bind to PPAR?

Answer 20

Fibrate—>increase LPL

Question 21

What are the GLP-1 receptor agonists?

Answer 21

Exenatide and the “glutide”—>increase insulin release via incretin

Question 22

What are the DDP-4 inhibitors? and what does DDP-4 do?

Answer 22

“gliptin”

DDP-4 degrade GLP-1

Question 23

Which drug is an amylin analog and what is its MOA?

Answer 23

Pramlinitide—>make you feel full—>decrease appetite

Question 24

What are SGLT-2 do and what drugs inhibit them?

Answer 24

SGLT-2 mediate glucose reabsorption in the proximal tubule of kidney
“glifloxin”

Question 25

SUMMARY:

How to treat DM1 and DM2?

Answer 25

DM1—>basal insulin with meal time insulin
DM2—>check liver—>if liver is bad—>insulin
If liver is good check kidney—>if kidney is bad can’t use metformin
If kidney is good—>use metformin first

Question 26

What is the long term complications of DM? and what drugs are used for them?

Answer 26

Nephropathy—>ACEI/ARB
Neuropathy—>Gabapentin/TCAs
Gastroparesis—>metoclopramide/erthromycin