Endocrine: Pancreas

Question 1

Mechanisms of causing hypoglycaemia

Answer 1

1. Blocking ATP sensitive K channels (sulphonylurea and meglitinide)
2. AMPK Stimulators (biguanides)
3. PPAR gamma agonists (thiazolidinediones)
4. Alpha-glucosidase inhibitors
5. Incretin mimetic
   a) GLP1 analogs
   b) DPP4 inhibitors
6. SGLT2 inhibitors
7. Amylin analog
8. Bile acid binding resin (colesevelam)
9. D2 agonist (bromocriptine)

Question 2

SFU examples

Answer 2

First gen:
chlorpropramide (longest acting)
tolbutamide (shortest acting)

Second gen:
Glipizide
Gliclazide (anti platelet)
Glibenclamide (sequestered in b cells and makes active metabolite) 
Glimiperide (ischemic preconditioning)

Question 3

Hit and run drugs

Answer 3

MOGRA

MAO inhibitors irreversible 
Ondansetron and PPIs
Guanethedine
Reserpine
Aspirin

Question 4

ADRs of chlorpropramide

Answer 4

1. Dilutional hyponatremia (can cause SEIZURES)
2. Cholestatic jaundice
3. Disulfiram like reaction (ask them to avoid alcohol)
4. Obesity
5. Hypoglycemia

Question 5

Drugs causing disulfiram reaction

Answer 5

cGMP

Cephalosporin and chlorpropramide
Greisofulvin
Metronidazole
Procarbazine (Hodgkin lymphoma)

Question 6

Meglinitide examples and indications

Answer 6

Repaglinide
Nateglinide

Indications:
Post prandial hyperglycaemia (because short acting)

Question 7

AMP Kinase stimulators examples and indications

Answer 7

Metformin, phenformin

Indications:
DM type II (DOC)
PCOD (DOC)

Question 8

Metformin ADR and Contraindications

Answer 8

ADR:
Lactic acidosis
Megaloblastic anemia

Contraindications:
Liver failure
Kidney failure

Question 9

Metformin advantages

Answer 9

1. Efficacious
2. No hypoglycaemia
3. Causes weight loss
4. Only oral agent that reduces macrovascular complications of type 2 DM

Question 10

Thiazolidinediones examples and ADRs

Answer 10

Glitazones: troglitazone, pioglitazone, rosiglitazone

Tro: hepatotoxicity-withdrawn
Rosi: dyslipidemia: increases LDL-C (increased MI risk)
Pio: UB cancer (only in those with risk factors)
Na and water retention (C/I in CHF, HTN)

Question 11

à glucosidase inhibitors examples

Answer 11

Acarbose
Voglibose
Miglitol

Question 12

Acarbose ADRs and Contraindications

Answer 12

ADR: flatulence

Contraindication: IBS

Question 13

Incretin mimetics and examples

Answer 13

GLP-1 analogs
Exenatide
Liraglutide
Albiglutide
Dulaglutide

DPP-4 inhibitors (GLIPTINS)
Sitagliptin
Vildagliptin
Saxagliptin
Alogliptin
Linagliptin

Question 14

ADRs of GLP-1 analogs

Answer 14

1. Nausea
2. Medullary carcinoma of thyroid on long term use
3. Hypoglycaemia (Cuz -ide)
4. Acute pancreatitis
5. Have to be given s. c. (Unlike gliptins)

Question 15

Gliptin advantages

Answer 15

1. Oral

2. No hypoglycaemia because increase endogenous GLP1 which is secreted in hyperglycaemia only

Question 16

Gliptin ADRs and contraindications

Answer 16

ADR :
Nasopharyngitis
URTI

Contraindications:
Renal failure (only linagliptin is safe)
Liraglutide of GLP1 analog is also safe

Question 17

IAPP Analog examples, moa, indication, ADRs

Answer 17

Pramlintide

1. Decreases glucagon
2. Decreases appetite
3. Deays gastric emptying

Both type 1 and type 2 DM
Only drug other than insulin

Hypoglycaemia
S. C. Route

IAPP is amylin or islet amyloid polypeptide

Question 18

SGLT2 inhibitors examples, MOA, ADR

Answer 18

Canaglifloxin
Dapaglifloxin
Empaglifloxin

Causes glycosuria

UTI

Question 19

FACT:

Adrenergic system regulates insulin release via α2 (decreases) and b2 (increases) receptors.

Answer 19

Fact:

Conventional preparations are obtained from pork and beef. Addition of zinc makes it long acting.

Question 20

Rapid acting insulins

Answer 20

Lispro
Glulisine
Aspart

Aspart has the quickest onset

Question 21

Short acting insulins

Answer 21

Regular (crystalline zinc)
Semi-lente

Only insulin that can be given i. V. Is regular or cryst zinc

Question 22

Intermediate acting insulin

Answer 22

NPH or isophane

Lente

Question 23

Long acting insulins

Answer 23

Ultra lente
Glargine
Detemir
Degludec

Glargine can’t be mixed with others

Degludec is the longest acting

Question 24

Insulin preparations without buffer

Answer 24

GRG

Glulisine
Regular
Glargine

Question 25

Inhalational insulins

Answer 25

Exubera
Afrezza

Exubera withdrawn because led to lung cancer and fibrosis

Afrezza for type 1 DM
•contraindicated in bronchial asthma, COPD and other chronic lung diseases
•Indicated only with s. c. Insulin

Question 26

Complications of insulin therapy

Answer 26

Hypoglycemia (treat with glucose or glucagon)
Edema
Lipodystrophy (at injection site)
Allergy (eg lipoatrophy)

Question 27

Continuous s. c. Insulin infusion (CSII) uses what all insulins

Answer 27

Rapidly acting eg.
Lispro
Aspart
Glulisine

Question 28

Drugs decreasing the effectiveness of insulin

Answer 28

Corticosteroids
Diuretics
OCPs
Diazoxide

Question 29

Indications of insulin

Answer 29

A. IDDM
B. NIDDM in special cases
   1. Pregnancy 
   2. Poor control with OHDs
   3. Stressful situations eg. Surgery
   4. Complications eg. diabetic ketoacidosis and hyperosmolar coma
C. Hyperkalemia

Question 30

Fact:
According to some trials, acarbose et al drugs can help in restoring b-cell function and prevent new cases of type 2 diabetes in pre-diabetics

Answer 30

Fact:

They’re effective in both IDDM and NIDDM

Question 31

Actions of GLP-1

Answer 31

• Increase insulin release
• Suppresses glucagon secretion
  • Preserves islet cell integrity and decreases apoptosis.
• Delays gastric emptying resulting in reduced appetite

Question 32

Weight loss causing drugs

Answer 32

1. SGLT2 inhibitors
2. GLP1 analogs (because reduce appetite)
3. IAPP analog (‘’)

Examples:

Cana/dapa/empa-gliflozin

Exenatide, lira/dula/albi-glutide

Pramlintide

Question 33

Weight gain causing drugs

Answer 33

SFU
Insulin
Pioglitazone

Question 34

Weight neutral drugs

Answer 34

1. Metformin

2. Gliptins

Question 35

Glucagon indications

Answer 35

1. Hypoglycemia (not alcohol or starvation induced)

2. B blocker poisoning (DOC)