DRUG in Diabetus

Question 1

First line line treatment in Type 2 DM <9% of HbA1C?

Answer 1

-Life style modification.

Question 2

What do you give for
Type 1
Type 2 :
Gestational Diabetus:

Answer 2

1:Insulin Therapy
2:Metformin
3:Insulin therapy + modifications.

Question 3

Metformin:
Action
A.E:where is prevented.

Answer 3

-Binds to mitocindrial Glycerol 3 Phosphate dehydrogenase–>incr AMP–>INCR ampk–>1.Decr Hepatic Glucogeogenesis 2.Decr Glucagon activity= Incr Insulin sensitivity.
-Most common GI distress (metalic taste), Lactic acidosis (Glucose–>Lactic acid), Vit.B12 defc, weight loss, **prevented in renal insuficency **(getting contrast dye or acute illness).

-An accumulation of lactate to dangerous levels (lactic acidosis) can occur when metformin is taken by patients with other conditions resulting metabolic acidosis (liver disease, heart failure, sepsis, alcohol abuse), or kidney disease because metformin is eliminated by renal excretion.

Question 4

ALL types of Diabetus drugs categories

Answer 4

-Insulin Analogs
-Insulin secretants (Sulfanylureas)
-Incr Insulin sensitivity
-Incretin Insulin Induced rel.
-Decr glucose reasp.
-Other:Amyloid.

Question 5

Insulin Analogs diff types?

Answer 5

1.Rapid Acting (LAD/Lispro, Aspart,Glulisine):peak 1hr.
2.Short Acting (Regular):IV for Hospitalized patients (DKA).Peak 2-4Hr. Watch for Hypoglycemia + Hypokalemia
3.Intermediate(NPH):14hr. peak
4.Long Acting(Determir/Glargine): NO peak.

Question 6

Drug and A.E (contraindictaed)

PPAR Gamma (present in adipose tissues) –>incr adiponectin secretion–>promotes incr insulin sensitivity.

-How do they work

Answer 6

-TZD (-glitazone)–> Promotes Na+ reabsp in kidney–> edema.Prevented in HF patients
-Rosiglitazone and Pioglitazone.

-**PPAR-γ receptor belongs to a family of nuclear receptors. **When activated, these receptors translocate to the nucleus, where they regulate the transcription of genes encoding proteins involved in the metabolism of carbohydrate and lipids.

-Activating nuclear receptors in regulating transcription of genes involved in glucose utilization

Question 7

What is chlorpropamide?
A.E

Answer 7

-Sulfanylurea FIRST generation
-Act via K+ATPase inhibitor–>incr Insulin rels.
-Causes **Disulfiram reaction **(inhb acetoaldehyde dehydrogenase)

Question 8

Glypizide and Glyburide??

Answer 8

-Sulfonylurea 2nd Generation.
-Hypoglycemia (incr risk of renal insufficency)

Question 9

Repaglinide??
-Used

Answer 9

-Another Insulin secretant that acts the same way as Sulfonylurea.
-Patient that have renal insufficency and cannoy take Metformin in Type 2 Diabetus.

Question 10

What drug is used to control post-prandial Hyperglycemia?

Answer 10

-alpha glucosidase inhb. (acarbose,miglitol)
-Inhbn enzyme that reabsp glucose–>Bloating and GI upste (glucose osmotic)
-Cause Liver damage–>contraindicated

Question 11

Ganagliflozin and Dapagliflozin (-Gliflozin)??

Answer 11

-SGLT-2 recep blockers. in PCT. Reduce glucose absport–>glycosuria.
-A.E:** vulvovaginitis, candidiasis and UTI’s**, dehydration (orthostatic hypotesion), not used in renal Insufficency.

Question 12

What drugs are not used in diabetus if patient has Renal insufficency?

Answer 12

-Metformin,SGLT-2 inhibitors,sulfanylureas.

Question 13

DDP4 inhib mechanism caction?
-A.E

Answer 13

-Inhibits DPP4 enzymes that degradated Incrteins (GLP1)–>incr insulin sensitivity.
A.E: Respiratory and UTI’s

Question 14

Mayor side effect in sulfanylurea?

Answer 14

-HYPOGLYCEMIA

Question 15

Why this drugs are long-acting?
Determir
Galargine

Answer 15

Determir–> binds to albumin–> it has added fatty chains
Galargine–>precipitates at body pH–> reabsp slower,

Question 16

What does metformin do to HDL,Triglycerides, Lactic acid ?

Answer 16

-Lowers TG, INCR HDL, and INCR lactic acid
-Incr lactic acid because it inhibits it absorption by liver–>causing dangerous lactic aciduria in condition that also raises lactic acid levels.