DM Pharm

Question 1

Biguanides

Answer 1

MOA: inhibits hepatic glucose production (gluconeogenesis and glycogenolysis) and improves insulin sensitivity

Metformin (Glucophage)
Metformin/Glyburide (Glucovance)
Metformin/Glipizide (Metaglip)

Question 2

Biguanides Contraindications

Answer 2

Alcoholics
Discontinue temporarily if receiving iodinated contrast
Renal dysfunction
Serum creatinine ≥1.5 mg/dL in males or ≥1.4 mg/dL in females)
BBW: Lactic Acidosis

Question 3

Sulfonylureas

Answer 3

Glipizide(Glucotrol) (Glucotrol XL)
Glyburide(Diabeta) (Micronase) (Glynase)
Glimepiride (Amaryl)

Correct derangements of metabolism of
Carbohydrates, lipid and proteins

Question 4

Sulfonylureas MOA

Answer 4

Bind to beta cell receptors and cause ATP-dependent potassium channels to close
The calcium channels then open = ↑ cytoplasmic calcium = ↑ insulin release from pancreas

Question 5

Sulfonylureas: critical information to know

Answer 5

Does nothing to increase insulin sensitivity
1/3 of patients with T2DM fail to respond adequately
Major risk of hypoglycemia (Elderly, ETOH abuse, poor nutrition, renal insufficiency)
WEIGHT GAIN

Question 6

Thiazolidinediones aka TZDs

Answer 6

Rosiglitazone (Avandia)
Pioglitazone (Actos)
MOA: Increase insulin sensitivity in skeletal muscle and fat thereby decreasing peripheral insulin resistance

Question 7

TZDs Black box warning

Answer 7

Congestive heart failure

Rosiglitazone BBW: Myocardial infarction

Question 8

Alpha-glucosidase inhibitors

Answer 8

Acarbose (Precose)

MOA: Slows the absorption of carbohydrates

Question 9

Meglitinides

Answer 9

Nateglinide (Starlix)
Repaglinide (Prandin)
MOA: similar to sulfonylureas, increases insulin secretion from the pancreas

Question 10

Uses of meglitinides

Answer 10

Alternative for patients who are candidates for Sulfonylurea’s but have a sulfa allergy

Question 11

Dipeptidyl Peptidase-4 Inhibitors

Answer 11

Sitagliptin (Januvia)
Saxtagliptin (Onglyza)
MOA: inhibits the enzyme that breaks down endogenous GLP-1 thereby allowing increased amounts

Question 12

Amylinomimetic

Answer 12

Pramlintide acetate (Symlin)
Reduces postprandial glucose increases via the following mechanisms:
1) prolongation of gastric emptying time
2) reduction of postprandial glucagon secretion
3) reduction of caloric intake through centrally-mediated appetite suppression

Question 13

Insulin

Answer 13

Aggressive treatment which requires close monitoring of blood sugar levels and frequent doses of insulin.

Close following of eating and exercise plans.

Question 14

Intensive Insulin Therapy Goals

Answer 14

Blood sugar level before meals
90-130

Blood sugar level two hours after meals
Less than 180

Hemglobin A1C
less than 7%

Question 15

Insulin categorized as

Answer 15

Basal- long acting
NPH, lente, glargine, detemir

Bolus-eating, short acting
Regular, lispro, aspart, glulisine

Question 16

How about a real easy way of remembering how to initiate long-acting insulin?

Answer 16

Every 3 days, increase by 2 units, until fasting plasma glucose of 100