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Endo Pharm Flashcards

0
Q

What is the tx strategy for type II diabetic patients?

A

Diet modification
Exercise/ weight loss
Oral hypoglycemics
Insulin replacement (end-stage)

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1
Q

What is the treatment strategy for a type I diabetic?

A

Low sugar diet and insulin replacement

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2
Q

What is the MOA of insulin?

A

Bind insulin receptor - tyrosine kinase activity
Causes increased glucose storage as glycogen in liver, muscle
Increased protein synthesis
Potassium uptake (forces potassium into the cells)
Aids in TG storage

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3
Q

What are the rapid acting insulins?

A

Lispro
Aspart
Glulisine

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4
Q

What is the intermediate acting insulin?

A

NPH

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5
Q

What are the long acting insulins?

A

Glargine

Detemir

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6
Q

What are the toxicities of insulin?

A

Hypoglycemia

Hypersensitivity

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7
Q

What is the action of biguanides?

A

Decrease gluconeogenesis
Increase glycolysis
Increase peripheral glucose uptake

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8
Q

What are biguanides used for?

A

First line for Type II

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9
Q

What is the tox of biguanides?

A 
GI upset
Lactic acidosis (CI in renal failure)
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10
Q

What is the MOA of sulfonylureas?

A

Close K channel in beta cell membrane so cell depolarizes and insulin is released via calcium influx

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11
Q

What are sulfonylureas used for?

A

Stimulate release of insulin in Type II

Requires some islet fxn

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12
Q

What are the side effects of first gen sulfonylureas?

A

Disulfiram-like effects

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13
Q

What are the first gen sulfonylureas?

A

Tolbutamide

Chlorpropamide

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14
Q

What are the second gen sulfonylureas?

A

Glyburide
Glimepiride
Glipizide

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15
Q

What is the tox in second gen sulfonylureas?

A

Hypoglycemia

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16
Q

What is the MOA of glitazones?

A

Increase insulin sensitivity in peripheral tissue

Binds PPAR-gamma nuclear transcription regulator

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17
Q

What are glitazones used for?

A

Used as monotherapy in type II

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18
Q

What is the tox in glitazones?

A

Weight gain
Edema
Hepatotoxicity
Heart failure

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19
Q

What is the MOA of alpha glucosidase inhibitors?

A

Inhibit intestinal brush border alpha glucosidase

Delay sugar hydrolysis and glucose absorption so it decreases postprandial hyperglycemia.

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20
Q

What are the alpha glucosidases?

A

Acarbose

Miglitol

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21
Q

What are alpha glycosidase inhibitors used for?

A

Monotherapy type II

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22
Q

What is the tox of alpha glucosidase inhibitors?

A

GI disturbances

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23
Q

What is the MOA of amylin analog (pramlintide)?

A

Decreases glucagon

24
What is pramlintide used for?
Type I and type II DM
25
What are the side effects of pramlintides?
Hypoglycemia Nausea Diarrhea
26
What is the MOA of GLP-1 analogs?
Increase insulin | Decrease glucagon release
27
What are the GLP-1 analogs?
Exenatide | Liraglutide
28
What are GLP-1 analogs used for?
Type II DM
29
What are the side effects of GLP1 analogs?
Nausea Vomiting Pancreatitis
30
What is the MOA of Dpp-4 inhibitors?
Increase insulin | Decrease glucagon release
31
What are the Dpp 4 inhibitors?
The gliptins Linagliptin Saxagliptin Sitagliptin
32
What are Dpp 4 inhibitors used for?
Type II DM
33
What are the side effects of Dpp 4 inhibitors?
Mild urinary or respiratory infections
34
What does activation of PPAR- gamma cause?
Increase insulin sensitivity | Increased levels of adiponectin
35
What is the MOA of propylthiouracil?
Blocks peroxidase thereby inhibiting organification of iodide and coupling of thyroid hormone synthesis Blocks 5'-deiodinase blocking conversion of T4 to T3
36
What is the MOA of methimazole?
Blocks peroxidase thereby inhibiting organification of iodide and coupling of thyroid hormone synthesis
37
What are methimazole and propylthiouracil used for?
Hyperthyroid
38
What are the toxicities of propylthiouracil and methimazole?
``` Skin rash Agranulocytosis Aplastic anemia Hepatotoxicity (propylthiouracil) Teratogen (methimazole) Edema ```
39
What is GH given for?
Turner syndrome and GH deficiency
40
What is octreotide given for?
``` Acromegaly Carcinoid Gastrinoma Glucagonoma Esophageal varices ```
41
What is oxytocin given for?
To stimulate labor, uterine contractions, milk-let down | Controls uterine hemorrhage
42
What is desmopressin given for?
Central diabetes insipidus
43
What is the MOA of demeclocycline?
ADH antagonist
44
What is the demeclocycline used for?
SIADH
45
What is the tox of demeclocycline?
Nephrogenic DI Photosensitivity Abnormalities of bone and teeth
46
What are the glucocorticoids?
``` Hydrocortisone Prednisone Triamcinolone Dexamethasone Beclomethasone ```
47
What is the MOA of glucocorticoids?
Decreased production of leukotrienes and prostaglandins by inhibiting phospholipase A2 and expression of COX2
48
What is the tox of glucocorticoids?
Iatrogenic Cushing's
49
How do the glitazones work?
They increase insulin sensitivity in target tissues by increasing the expression of GLUT4 in target tissues and causes differentiation of pre-adipocytes to adipocytes by up regulating transcription of insulin responsive genes
50
What is repaglinide?
A meglinitide derivative, short-acting insulins tropic agent used in type II with diet and exercise. MOA is similar to sulfonylureas but doesn't cause insulin release when extra cellular glucose is low
51
When should executive be used?
For type II diabetics with suboptimal glucose control despite adequate levels of metformin and sulfonylureas
52
Which drugs are known to cause SLE-like syndrome?
``` Hydralazine Procainamide Isoniazid Minocycline Quinidine ```
53
Which insulin is best to decrease postprandial glucose level?
Lispro Aspart Glulisine Peak at 45-75 minutes
54
Which insulin is best for IV use DKA?
Regular insulin - peak 2-4 hours
55
What is the duration of NPH and why?
It is a crystalline suspension of protamine and zinc which prolongs the duration of action. It starts working within 2 hours, peaks at 12 and ends at 18
56
What is the duration of glargine and why?
It last 24 hours because it precipitates in the subcutaneous tissue allowing for slow absorption
57
What is the duration of action of detemir and how does it work?
It has a fatty acid bound to a losing residue that allows it to bind to albumin and slowly dissociate from there. It lasts 24 hours and peaks between 3-9

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