Exam 7: Diabetes

Question 1

Thiazolidinediones uses

Answer 1

Type 2 diabetes
Pioglitazone is only one commonly prescribed
Taken daily in combo with other drugs for diabetes
Effects are mediated by gene expression, so it may take 1-3 months to see benefits

Question 2

Name 1 alpha-glucosidase inhibitor

Answer 2

Acarbose

Question 3

Acarbose

Answer 3

Alpha-glucosidase inhibitor
Used for type 2 DM, pre diabetes
Slowly titration up to desired dose
Inhibits enzymes that break down complex carbs
Delays and spreads out absorption of glucose after meals
Minimally absorbed
If a patient on Acarbose gets hypoglycemic, they need to get glucose or dextrose, not sucrose which requires alpha-glucosidase to be broken down

Question 4

Acarbose adverse effects

Answer 4

GI disturbances
Flatulence, diarrhea, abdominal pain
Side effects get less prominent over time due to up regulation of alpha-glucosidases in the distal small intestines

Question 5

Acarbose contraindications

Answer 5

IBD
Renal impairment
Other GI problems

Question 6

Which bile acid sequesterant can be used in treatment of DM?

Answer 6

Colesevelam

Question 7

Pramlintide

Answer 7

Amylin analog, acts on receptor in hindbrain
Suppresses Glucagon release, delays gastric emptying….
Can cause nausea, weight loss, hypoglycemia.
Adjunct to insulin therapy, must be injected separately
Lowers amount of insulin need, mealtime insulin doses should be reduced by about 50%

Question 8

Pramlintide contraindications

Answer 8

Gastroparesis or any other GI motility disorder

Question 9

GLP-1 agonist

Answer 9

Exenatide

Question 10

Exenatide

Answer 10

Synthetic exenidin 4, an incretin
Glucagon like peptide 1 receptor agonist
Therapy for type DM
Causes increased insulin synthesis and secretion in a glucose dependent manner (as opposed to sulfonureas). Less likely to cause hypoglycemia
Also causes delayed gastric emptying and decreased appetite
Also suppresses post prandial glucagon release
Rapidly absorbed after injection
GI disturbances are a common side effect

Question 11

Liraglutide

Answer 11

GLP1 agonist
Like Exenatide, but is more slowly absorbed. It also binds to albumin, slowing its metabolism
Black box warning, not for use in patients with family history of medullary cancer or multiple endocrine neoplasia type 2

Question 12

GLP1 agonist adverse effects

Answer 12

GI disturbances
Weight loss
Hypoglycemia maybe 
Pancreatitis
Can alter pharmacokinetics of drugs that require Rapid GI absorption

Question 13

GLP1 contraindication

Answer 13

Pancreatitis

Question 14

DPP-4 inhibitors

Answer 14

Sitagliptin

Other gliptins

Question 15

Sitagliptin

Answer 15

DPP-4 inhibitor
Increases levels of circulating incretins
Can be taken orally
Result in increased insulin, decreased glucagon release after meals

Question 16

DPP-4 adverse effects

Answer 16

Increased risk of infection
Headache
Hypoglycemia when combined with a sulfonurea
Hyper sensitivities
Pancreatitis

Question 17

Saxagliptin

Answer 17

DPP-4 inhibitor that is a prodrug, doses need to be adjusted with CYP inhibitors

Question 18

SGLT2 inhibitors

Answer 18

Canagliflozin

Other flozins

Question 19

Canagliflozin

Answer 19

SGLT2 inhibitor
Decreased glucose reabsorption in kidneys
Increase risk of genital mycotic infections, UTIs
Contraindication = severe renal impairment

Question 20

Glucagon

Answer 20

Peptide produced by pancreatic alpha cells
Used for emergency treatment of severe hypoglycemia when patient is unconscious and intravenous glucose isn’t feasible
Also treats beta blocker overdose
Binds to G protein receptor, increases cAMP
Raises blood glucose (glycogenolysis)
Can cause nausea, vomiting, hypertension, tachycardia

Question 21

Contraindications for Thiazolidinediones

Answer 21

Pregnancy
Hepatic impairment (periodic liver function tests required)
Heart failure

Question 22

Sulfonureas Mechanism

Answer 22

Increase secretion of endogenous insulin

Inhibit K ATP channels in pancreatic Beta cell membranes

Question 23

Name 1 Sulfonurea

Answer 23

Glyburide

Question 24

Glyburide

Answer 24

Sulfonurea

Question 25

3 Side effects of Sulfonureas (glyburide)

Answer 25

Hypoglycemia, weight gain, sulfa allergy

Question 26

Contraindications for Sulfonureas (glyburide)

Answer 26

Hepatic or renal impairment could compromise metabolism or excretion of the drug
Pregnant/breastfeeding women (teratogenic)
Patients especially susceptible to hypoglycemia (elderly, acute cardiovascular disease)

Question 27

Clinical Uses of Sulfonureas

Answer 27

Glyburide
Used to treat DM type II.
They get less effective as pancreatic beta cells lose function
Widely used, often with metformin, thiazolidones.

Question 28

Name one Meglitinide

Answer 28

Repaglinide

Question 29

Repaglinide

Answer 29

Meglinitide
Like sulfonureas, increases endogenous insulin secretion by inhibiting K ATP channels
May cause hypoglycemia, weight gain
Use with caution in patents with renal/hepatic impairment
Nateglinide may be safer for those with renal/hepatic impairment

Question 30

Meglinitide Uses/Advantages

Answer 30

(Repaglinide, nateglinide)
Treats DM type II
Pre-prandial delivery because they are more rapidly acting than sulfonureas.
Safe for those with sulfa allergies

Question 31

Name two Thiazolidinedione

Answer 31

Pioglitazone

Rosiglitazone

Question 32

Thiazolidinedione Mechanism

Answer 32

Increase insulin sensitivity in tissues by being Peroxisome proliferator-activated receptor gamma (PPARγ) agonists
These are nuclear receptors that regulate genes involved in glucose and lipid metabolism

Question 33

What are the two most common side effects of Thiazolidinedione?

Answer 33

Weight gain and edema (edema may lead to CHF)
May also increase risk of osteoporosis in women.
Pioglitazone may increase risk of bladder cancer