Endo - FA Pharm p348 - 350

Question 1

what is the treatment strategy for type 1 DM?

Answer 1

low carb diet, insulin replacement

Question 2

treatment strategy for type 2 DM?

Answer 2

dietary modification, exercise for weight loss, oral agents

Question 3

name 2 long acting insulin

Answer 3

Detemir, glargine

Question 4

intermediate acting insulin? How often does a pt take it?

Answer 4

NPH (2x day)

Question 5

name 3 rapid acting insulin - how long is the peak? When does a patient take it?

Answer 5

aspart, glulisine, lispro

2-3 hr peak, with each meal

Question 6

When is metformin contraindicated?

Answer 6

renal insufficiency

Question 7

Name 3 oral hypoglycemics that dec glucagon release and gastric emptying

Answer 7

Pramlintide
Exenatide, Liraglutide

DPP4 (-)’rs (gliptins)

Question 8

MoA of Metformin

Answer 8

(-) hepatic gluconeogenesis and glucagon

Inc glycolysis, and insulin sensitivity

Question 9

Major SE of Metformin - causes which vitamin def?

Answer 9

lactic acidosis, GI issues, B12 def (no hypoglycemia)

Question 10

name 5 drugs that inc insulin and dec glucagon release

Answer 10

GLP-1 analog - exenatide - liraglutide - these are incretin analogues

DPP-4 inhibitors - linagliptin - saxagliptin - sitagliptin - inhibits the breakdown of incretins

inc INCretINs - INC INsulin

Question 11

name two 1st generation sulfonylureas

Answer 11

chlorpropamide, tolbutamide

Question 12

side effects of 1st generation sulfonylureas (chlorpropamide, tolbutamide)?

Answer 12

disulfiram like effects

Question 13

other drugs that lead to disulfiram like effects

Answer 13

metronidazole, griseofulvin, procarbazine (Hodgkins anti alkylating agent), some cephalosporin

Sulfonylureas

DiSulfiraM

Question 14

name three 2nd generation sulfonylureas

Answer 14

glimepiride, glipizide, glyburide

Question 15

what is the mech of sulfonylureas?

Answer 15

close K+ channel of beta cell –> cell depolarizes –> insulin release via Ca2+ influx

Question 16

name the general side effect of sulfonylureas

Answer 16

risk of hypoglycemia ( esp in renal failure)

Question 17

List DPP4 (-)’rs and their MoA

Answer 17

Linagliptin, Saxagliptin, Sitagliptin

Inhibit dipeptidyl peptidase that deactivates incretins like GLP1 ( remove the inhibition)

dec glucagon rel, gastric emptyin

inc glucagon dep insulin rel, satiety

Question 18

Major SE of DPP4 (-)’rs

Answer 18

urinary or respiratory infections

Question 19

Drugs that (+) PPAR-γ

Answer 19

Rosiglitazones, Pioglitazones

gamma looks like a y - followed by z for zones

Question 20

what are the 2 roles of genes activated by PPAR-gamma

Answer 20

1. fatty acid storage 2. glucose metabolism

Question 21

what are the drugs that bind to PPAR-gamma nuclear transcription regulator to inc insulin sensitivity?

Answer 21

glitazones/thiazolidinediones - pioglitazone - rosiglitazone

Question 22

what drug blocks the reabsorption of glucose in PCT?

Answer 22

SGLT-2 inhibitors (canagliflozin)

flo - like urinary flow in tubules

Question 23

drug that dec postprandial hyperglycemia

Answer 23

acarbose, miglitol (alpha glucosidase inhibitors)

Question 24

activation of what gene increases insulin sensitivity and levels of adiponectin?

Answer 24

PPAR-gamma

Question 25

what gene activation leads to HDL synthesis?

Which rx targets PPAR -alpha

Answer 25

PPAR - alpha;

fibrates

Question 26

name of the enzyme that propylthiouracil blocks

Answer 26

5’ deiodinase, thyroid peroxidase

Question 27

side effects of propylthiouracil?

Answer 27

skin rash, agranulocytosis, aplastic anemia, hepatotoxicity

Question 28

unique side effect of methimazole?

Answer 28

aplasia cutis

Question 29

name of the enzyme that methimazole blocks

Answer 29

thyroid peroxidase

Question 30

How does one differentiate between exogenous vs endogenous hyperthyroidism

Answer 30

using a combination of TSH receptor antibodies, radioactive iodine uptake, and/or measurement of thyroid blood flow on ultrasound.

Question 31

name 3 ADH antagonists (V2 blockers) - use them to tx what disease?

Answer 31

conivaptan, tolvaptan, demeclocycline
SIADH

Question 33

clinical application of somatostatin (octreotide)

Answer 33

acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices

Question 34

SE of Demeclocycline

Answer 34

Nephrogenic DI, photosensitivity, abnormalities of bone and teeth.

Question 35

Use of Desmopressin

Answer 35

Central DI, von Willebrand disease, sleep enuresis, hemophilia A.

Question 36

what drug is used for central DI?

Answer 36

desmopressin acetate

Question 37

what is the clinical application of fludrocortisone?

Answer 37

mineralocorticoid replacement in primary adrenal insufficiency

Question 38

name 3 side effects of fludrocortisone

Answer 38

edema, exacerbation of heart failure, hyperpigmentation

Question 39

name of the drug that sensitizes Ca2+ sensing receptor (CaSR) in parathyroid gland to circulating Ca2+?

Answer 39

cinacalcet - leads to dec PTH

Question 40

how does cinacalcet change the level of PTH?

Answer 40

dec PTH

Question 41

Nonabsorbable phosphate binder that prevents phosphate absorption from the GI tract.

Answer 41

Sevelamer

Question 42

Use of Sevelamer

Answer 42

Hyperphosphatemia in CKD.

Sevelamer - Saves you from high phosphate

Question 43

Q. what drug is used for Turner syndrome?

Answer 43

GH

Question 44

DOC to control uterine hemorrhage?

Answer 44

Oxytocin

Question 45

if glucocorticoids are suddenly stopped after the chronic usage, what is the consequence?

Answer 45

adrenal insufficiency

Question 46

what is triamcinolone?

Answer 46

glucocorticoids