Drugs For Diabetes

Question 1

What 2 pathways are used by insulin to lower blood glucose

Answer 1

PI3k Akt pathway - anabolic
MAP kinase pathway - cell proliferation

Question 2

Name the rapid acting insulins

Answer 2

Aspart
Lispro
Glulisine

Question 3

What is the intermediate acting insulin and what is its composition

Answer 3

NPH
Protamine with zinc insulin

Question 4

What are the long acting insulins and what is the unique property of both

Answer 4

Detemir - binds to albumin
Glargine - crystal stability, soluble at low PH and precipitates at Ph7

Question 5

What is the use of regular insulin

Answer 5

It can be used for maintinence, overnight coverage, postprandial (45min before meal)
*mostly used for IV urgent administration

Question 6

Aside from diabetes. What is another indication for insulin therapy

Answer 6

Severe hyperkalemia. Give with loop diuretics and glucose

Question 7

Name a amylin analog and it’s adverse effect.

Answer 7

Pramlintide. Increases ACh drug effects on GI. (Constipation)

Question 8

How do incretins work?

Answer 8

Activate GLP - 1 which inhibits glucagon and stimulates insulin

Question 9

Name the increetins and the specifics of each

Answer 9

Exenatide- less susceptible to hydrolysis by DDP4
Liraglutide- lipid modified, rapidly absorbed. Extended action due to albumin binding

Question 10

What should be changed when an incretins is started

Answer 10

Anti diabetic medications should be reduced to avoid hypoglycemia

Question 11

Name the DDP4 inhibitors

Answer 11

All end in -gliptin

Question 12

Name the first and second gen sulfonylureas

Answer 12

1. Chlorpropamide, tolbutamide, tolazamide
2. Glipizide, glybutide, glimepiride

Question 13

How do sulfonylurea drugs work

Answer 13

Bind to SUR1 and block K+ inward channel causing insulin release

Question 14

Name the meglitinides and the MOA

Answer 14

End in -glinide
Katp channel inhibition

Question 15

How does metformin work

Answer 15

Activates AMP protein kinase

Question 16

What is unique about metformin

Answer 16

It does not cause hypoglycemia or weight gain. It is excreted and changed in the kidneys, so it does not have drug drug interactions.

Question 17

Name the thiazolidinediones and their MOA

Answer 17

End in - glitazone
Are ligands for PPARy nuclear receptor.
Increases GLUT4 in cells
*do not cause hypoglycemia!

Question 18

What is a risk factor of thiazolidiones?

Answer 18

Increase vascular, permeability, creating edema and suppress osteoblast creation decreasing bone density

Question 19

Sodium glucose co-transporter two inhibitor and MOA

Answer 19

End in -gliflozin
Cause increased excretion of glucose in urine. Induces weight loss, but will not cause hypoglycemia.
Risk of hypotension, dizziness, and syncope

Question 20

a-glycosidase inhibitors and MOA

Answer 20

Acarbose
Miglitol
Lower postprandial hyperglycemia by inhibiting the absorption of starches through preventing their breakdown and the G.I. track