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ENRP Exam II > Drugs for Diabetes Konorev > Flashcards

Drugs for Diabetes Konorev Flashcards

(69 cards)

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1
Q

What are the rapid acting Insulins?

A
  • Aspart
  • Lispro
  • Glulisine
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2
Q

Short acting insulins?

A

Regular insulin

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3
Q

Intermediate acting insulin

A

NPH

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4
Q

Long acting insulin

A

Detemir and Glargine

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5
Q

Insulin Secretagogues GLP-1 agonists?

A
  • Exenatide
  • Liraglutide
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6
Q

Insulin Secretagogues Dipeptidyl Peptidase 4 inhibitors?

A
  • Sitagliptin
  • Linagliptin
  • Saxagliptin
  • Alogliptin
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7
Q

First generation Katp channel blockers

A
  • Chlorpropamide
  • Tolbutamide
  • Tolazamide
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8
Q

Katp channel blocker Sulfonylurea Second gens?

A
  • Glipizide
  • Glyburide
  • Glimepride
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9
Q

Katp channel blockers Meglitinides?

A
  • Nateglinide
  • Repaglinide
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10
Q

Biguanides?

A

Metformin

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11
Q

Thiazolidinediones?

A

Pioglitazone and Rosiglitazone

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12
Q

SGLT2 inhibitors?

A
  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
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13
Q

Alpha glycosidase inhibitors?

A

Acarbose

Miglitol

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14
Q

What hormones increase blood glucose?

A
  • Glucagon
  • T3 and T4
  • Epinephrine
  • GLucocorticoids
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15
Q

Which of the following actions contributes to antihyperglycemic effect of insulin?

  • Activation of gluconeogenesis
  • Suppression of lgycolysis
  • Activation of glycogenolysis
  • Suppression of glucose transport into cells
  • Activation of glycogen synthesis
A
  • Activation of glycogen ssynthesis
  • rest incr. production of glucose
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16
Q

What does insulin do to gluconeogenesis and glycogenolysis?

A

Inhibits them

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17
Q

What are rapid acting insulins used for?

A

Postprandial hyperglycemia → taken before a meal as sc injections

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18
Q

What is short acting regular insulin used for?

A
  • basal insulin maintenance
  • overnight coverage
  • 45 minutes before a meal
  • Can be given IV in urgent situations
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19
Q

What is NPH?

A
  • complex of protamine with zinc insulin
  • used for basal insulin maintenance and or overnight coverage
  • use is declining being replaced by long acting insulins
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20
Q

What is Detemir?

A
  • long acting insulin rapidly absorbed into blood but binds strongly to albumin, allows slow release
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21
Q

What is Glargine?

A
  • long acting insulin made by changing amino acids iin both A and B chains, changing the pKa of insulin
  • used for basal insulin maintenance
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22
Q

What is an unexpected indication for insulin?

A
  • Severe hyperkalemia
    • Insulin + glu + furosemide
    • IV insulin activates Na/K ATPase to shift K from extracellular fluid into cells
    • K is then eliminated using loop diuretics
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23
Q

24 yo woman wants to tighten control of her diabetes to improve long term prognosis. Which regimen is most appropriate?

  • morning insulin injections mixed insulin lispro and insulin aspart
  • injections of mixed regular insulin and insulin glargine before bed
  • morning and evening injections of regular insulin supplemented by small amounts of NPH at meals
  • Morning injections of insulin glargine supplemented by insulin lispro at meal times
A
  • Morning injections of insulin glargine supplemented by insulin lispro at meal times
    • glargine is long acting used for basal coverage
    • lispro is rapid acting used for post prandiol control
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24
Q

what are the ways insulin can be delivered?

A
  • Standard by subQ injection with disposable needles
  • Portable pen injectors
  • Continuous subQ infusion devices
    • pumps
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25
Adverse effect of Insulin?
* Hypoglycemia * Lipodistrophy * Resistance * Allergic rxn
26
Most common complication of insulin therapy?
* hypoglycemia * caued by delayed or missed meal * exercise * overdose
27
Signs of hypoglycemia? Tx?
* Confusion, bizarre behavior seizure coma * tachycardia, palpitation, sweat, tremor * hunger nausea * Glucose or sucrose
28
Hypokalemia is a side effect of insulin that occurs due to? * inc. elimination of K in urine * inc. secretion of K in bile * inc. transport of K from ECF to cells * dec. absorption of K from GI tract
* Inc. transport of K from extracell fluid into cells
29
What is Amylin and its uses?
* pancreatic hm made by beta cells * enhances action of insulin through * inhibiting glucagon * dec. gastric emptying → slows intestinal glucose absorption * causes feeling of satiety
30
What is Pramlintide?
* amylin analog drug * used in patients with absolute insulin deficiency * all type 1 and advanced type 2 * inject before meals as adjunct to insulin therapy to control postprandial hyperglycemia
31
Pramlintide AE? Drug interaction?
* N/V, diarrhea, anorexia * severe hypoglycemia if used with insulin * enhances effects of anticholinergic drugs on GI tract → constipation
32
Which of the following regarding Pramlintide as adjunct to insulin therapy is correct? * used primarily for T2DM patients * given orally * taken before bed * manage postprandial hyperglycemia * can cause hyperlgycemia
manage postprandial hyperglycemia
33
34
Isoproterenol a non selective Beta agonist
35
How do incretin mimetics work?
* activates GLP-1 receptor or boosts endogenous GLP-1 levels
36
What are incretins? Example?
* group of GI hormones that caue decrease in glucose levels * GLP-1: * promotes Beta cell proliferation and insulin gene expression * inhibits glucagon secretion * causing satiety and inhibits gastric emptying * NOT AN EFFECTIVE DRUG → very short half life
37
What are two types of incretin mimetics?
* Long acting GLP-1 receptor agonists * Dipeptidyl peptidase 4 inhibitors
38
What are the long acting GLP1 agonsits?
* Exenatide * AA subs make it less susceptible to hydrolysis of DPP4 * 2.5 half life * Liraglutide * rapidly absorbed but binds albumin * half life 11-15 hrs
39
Clinical use for GLP-1 receptor agonists?
* Approved for T2DM patients who are not controlled by metformin/sulfonylurea/thiazolidinediones * other anti diabetic meds should be reduced to avoid hypoglycemia
40
GLP-1 agonist AE's?
n/v diarrhea anorexia hypoglycemia
41
What are the DPP 4 inhibitors?
* “gliptins” * Sitagliptin * LInagliptin * Saxagliptin * Alogliptin
42
DPP-4 MOA and indications??
* Increase levels of GLP-1 to enhance its interactions with cognate receptor * given PO, as adjunct therapy to diet and exercise in those with T2DM * can be used monotherapy or combo with metformin/sulfonylurea/TZDs
43
First gen vs second gen sulfonylureas?
44
Katp channel blocker MOA?
* Binds SUR1 blocking K current through an inwardly rectifying K channel
45
Sulfonylureas use? AE's?
* T2DM as monotherapy or in combo with insulin or other anti diabetic drugs * Hypoglycemia * weight gain * secondary failure leading to hyperglycemia
46
Sulfonylurea drug interactions?
Enhancing hypoglycemic effects: * Ethanol * Inhbits CYP enzymes: azoles, gemfibrozil, cimetidine * salicylates and other NSAIDs Decrease glucose lowering effect: * inhibit insulin secretion → Beta blockers and CCBs * inducing hepatic CYP enzymes phenytoin griseofulvin rifampin
47
Meglitinides? use? MOA?
* Repaglinide and Nateglinide * Katp channel inhibition similar to sulfonylureas * use to control post prandial hyperglucemia T2 * PO before meal * used alone or combo
48
* Glyburide and aspirin
49
Metformin MOA?
Activation of AMP activated protein kinase
50
Advantages to using Metformin?
* Superior glu lowering efficacy compared to other oral meds * Doesn't cause hypoglycemia or weight gain * oral * alone or combo use * dec risk of macro and microvascualr complications
51
Pharmacokinetics meetformin?
Not bound to plasma proteins not metabolized, decreases drug interactions
52
AE and contraindications of Metformin?
* anorexia, n/v, diarrhea * lactic acidosis if renal and hepatic insufficiency * contraindicated in conditions predisposed to hypoxia * COPD, renal failure, alcoholism, cirrhosis
53
What are the thiazolidinediones?
* Pioglitazone and Rosiglitazone * Ligands of peroxisome proliferatior activated receptor gamma, a nuclear receptor expressed in fat, mm, liver and endothelium * increase glut4 in sk mm, adipocytes * dec PEPCK
54
Pharmacokinetics of Thiazolidinediones?
* orally once a day * delayed onset → 1-3 month and effects persist after drugs are eliminated * half life reduced by CPY inducing drugs such as rifampin * half life prolonged by CYP inhibitor ssuch as gemfibrosil * safe for patients with renal fialure
55
TZD AE's?
* Weight gain * Edema: * incr vascular permeability * inc exprssion of ENaC increased sodium and water reabsorption in collecting duct * exacerbate heart failure * osteoporosis
56
Which of the following is euglycemic? * insulin * glimepiride * pioglitazone * repaglinide * tolazamide
* Pioglitazone
57
Other effects of SGLT2?
* osmotic diuresis * weight loss * dec BP * reeduce plasma uric acid * don't cause hypoglycemia
58
SGLT2 use?
T2DM in combo, orally before first meal
59
SGLT2 AE's?
* hypotension * hypovolemia * orthostatic hypotension, dizziness, syncope * UTI * hypoglycemia if combined with insulin
60
alpha glycosidase inhibitors?
* competitive inhibition of alpha glycosidases * lowers postprandiol hyperglycemia to create an insulin sparing effect * Acarbose and Miglitol are the drugs
61
alpha glycosidase inhibtor uses?
* T2DM as monotherapy or combo * taken orally at meal time * no weight gain and no hypoglycemia when used alone
62
Which stimulates insulin secretion by beta cells? * metformin * rosiglitazone * pramlintide * repaglinide * miglitol
* repaglinide
63
Which drugs can increase risk of hypoglycemia?
* sulfonylurea (highest risk) * SGLT 2 Inhibitors (lower risk) * DPP4 inhibitors (lower risk)
64
Which drugs cause increase in weight gain?
Sulfonylureas and TZD
65
Which class of drugs causes weight loss
GLP 1 analogs
66
Which classes can be used in CKD?
DPP4 inhibitors and TZD
67
Which classes can be used in HF?
* SUlfonylurea * SGLT2 inhibitors * GLP 1 analogs
68
Contraindications for HF?
DPP4 and TZD
69
COntrainidcations for CKD
* Sulfonylurea * SGLT2 * GLP1

ENRP Exam II (9 decks)

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