Endo Meds and treatments

Question 1

Biguanide

Answer 1

Metformin

Decreases hepatic gluconeogenesis
Improve insulin sensitivity

Caution with risk of lactic acidosis and renal failure

Weight neutral
No hypoglycemia

S/E: GI: N/V/D
Decreased vitamin B 12 absorption

Question 2

Sulfonylureas

Answer 2

Glimepiride
Glipizide
Glyburide

Inhibit potassium ATP channel, increasing insulin release
-requires functioning pancreas

Caution in elderly, hepatic and renal failure
-increased risk of hypoglycemia

Weight gain

Question 3

Thiazolidinediones

Answer 3

Rosiglitazone
Pioglitazone

Activate PPARy , improving tissue uptake of glucose
-increased insulin sensitivity

Caution with CHF - pioglitazone (pulmonary edema, CHF exacerbation)

Weight gain
No hypoglycemia

S/E:
Edema - peripheral
Fluid balance

Question 4

DPP-4 inhibitors

Answer 4

Sitagliptin
Saxagliptin
Linagliptin
Alogliptin

Improve glucose-responsive insulin release
Modest effects on gastric empty

Reduced dose in renal dysfunction

Weight neutral
No hypoglycemia (lowers A1c 0.5%)

SE: mild GI

Question 5

GLP-1 receptor agonists

Answer 5

Exenatide
Liraglutide (lowest cardiac risk, most wt loss)
Dulaglutide
Albiglutide

“incretin-mimetics”

Decreases glucagon secretion
Improve glucose-responsive insulin release
Delayed gastric emptying
Improve satiety

Caution in renal dysfunction, caution in pre-existing gastroparesis

Weight loss
No hypoglycemia

S/E:
GI - can be significant - Nausea
Injection related: minor burning, lumps

Question 6

SGLT2 inhibitors

Answer 6

Dapagliflozin
Canagliflozin
Empagliflozin

Block reabsorption of glucose in the renal tubule

Contraindicated in renal dysfunction
Caution in volume sensitive diseases (CHF)

Weight loss
No hypoglycemia

S/E:
UTI
Mycotic infections - common potentially severe

Question 7

alpha-glucosidase inhibitor

Answer 7

Acarbose

Blocks absorption of carbohydrates in the intestine
Used in reactive hypoglycemia after gastric bypass

Caution in bowel disease

weight neutral
No hypoglycemia

S/E: significant G.I. - D, flatulence, low abd cramping

Question 8

Amylin analog

Answer 8

Pramlintide

TIDM approved

Augments insulin release
Suppresses glucagon
Improve satiety

Caution in patients with gastroparesis

Weight loss
Hypoglycemia

S/E:
GI
Injection related effects

Question 9

Meglitinides

Answer 9

Nateglinide
Repaglinide

Inhibits potassium ATP channel, increases insulin release

Caution in elderly, hepatic and renal failure
-increased risk hypoglycemia

Weight loss

Question 10

Basal insulin - long acting

Answer 10

Glargine
Detemir

peakless - glargine
Duration up to 24 hrs

Question 11

Basal insulin - intermediate acting

Answer 11

NPH

Onset 2-4 hours
Peak 4-8 hours
Duration 12 hours (BID for basal use)

Less expensive

Question 12

Rapid acting insulin (bolus)

Answer 12

Lispro
Aspart
Glulisine

Onset less than 30 min
Peak 1-2 hours
Duration 4 hours

Insulin pumps and IV infusion

Question 13

Short acting insulin

Answer 13

Regular

onset 30-60 min
peak 2-3 hours
Duration 6 hours

less expensive
higher risk of hypoglycemia

Question 14

Medications used for weight loss

Answer 14

Phentermine
Phentermine/topiramate - 5-10 lbs over 6 mo
Lorcaserine - central appetite control
Liraglutide

Question 15

Methimazole

Answer 15

thionamide medication

blocks new thyroid hormone synthesis (does not change release of pre-formed)

Question 16

Propylthiouracil (PTU)

Answer 16

thionamide medicaiton

blocks peripheral conversion of T4 to T3

S/E severe liver damage