Keystone Exam 1

Question 1

Acarbose

Answer 1

Alpha Glucosidase Inhib. Inhibits breakdown of polysaccs into glucose thus preventing absorption. Sx: Bac eat polysaccharide -> flatulence, diarrhea.

Question 2

Sulfonylureas and Meglitinides (Mech)

Answer 2

Block K channel -> depolarization of cell -> calcium influx -> increase glucose independent insulin secretion. Sx: hypoglycemia, weight gain (insulin is anabolic).

Question 3

Glipizide, Glimepiride, Glyburide, Repaglinide, Nateglinide

Answer 3

Sulfonylureas and Meglintinides.

Question 4

Exenatide, Liraglutide

Answer 4

GLP-1 agonist. GLP-1 incrs glucose dependent insulin secretion. Sx: NO hypoglycemia, weight loss, nausea, pancreatitis.

Question 5

Sitagliptin

Answer 5

DDP-IV inhibitor. Block DPP-IV, which normally breaks down GLP-1. increase in GLP-1 -> increases glucose dependent insulin secretion. Sx: NO hypoglycemia, pancreatitis.

Question 6

Metformin

Answer 6

Inhibit hepatic gluconeogenesis. Sx: No hypoglycemia or weight gain (no insulin invovlement).

Question 7

Pioglitazone

Answer 7

PPAR y agonists increase adiopocytes and skeletal muscle glucose uptake, and fat storage. Sx: No hypoglycemia, weight gain (fat storage), fluid retention (DO NOT USE for CHF).

Question 8

Canagliflozin

Answer 8

Block SGLT2 which causes reabsorption of glucose -> more glucose excreted in urine. Sx: no hypoglycemia, weight loss (pee out glucose), decrease BP.

Question 9

Raloxifine

Answer 9

SERM. Agonist in bone (inhibs osteoclasts) antagonist in breast. Neutral effects on CV and endometrium. Improves BMD. Less potent than bisphosphonates and denosumab. Sx: DVT, hot flushes.

Question 10

Alendronate

Answer 10

Bisphosphonate. Impair osteoclast function, decr differentiation and incr apoptosis -> incr BMD and decr fractures. Sx: Esophagitis, bone and muscle pain, hypocalcemia. Contraindicated if creatinine clearance <30.

Question 11

Risedronate

Answer 11

Bisphosphonate. Impair osteoclast function, decr differentiation and incr apoptosis -> incr BMD and decr fractures. Sx: Esophagitis, bone and muscle pain, hypocalcemia. Contraindicated if creatinine clearance <30.

Question 12

Ibandronate

Answer 12

Bisphosphonate. Impair osteoclast function, decr differentiation and incr apoptosis -> incr BMD and decr fractures. Sx: Esophagitis, bone and muscle pain, flu symptoms, hypocalcemia. Contraindicated if creatinine clearance <30.

Question 13

Zoledronic Acid

Answer 13

Bisphosphonate. Impair osteoclast function, decr differentiation and incr apoptosis -> incr BMD and decr fractures. Sx: Flu symptoms, bone + muscle pain, hypocalcemia. Contraindicated if creatinine clearance <30.

Question 14

Pamidronate

Answer 14

Bisphosphonate.NOT FOR OSTEOPOROSIS. Impair osteoclast function, decr differentiation and incr apoptosis -> incr BMD and decr fractures. Sx: Flu symptoms, bone and muscle pain, hypocalcemia. Contraindicated if creatinine clearance <30.

Question 15

Denosumab

Answer 15

Binds RANKL preventing osteoclast differentiation. Incr BMD and decr fractures. SC injection every 6 months. Sx: hypocalcemia, infect, subtrochanteric fracture, ONJ.

Question 16

Teriparatide

Answer 16

Induces differentiation and maturation of osteoclast precursors, increases preexisting osteoblast function, reduces osteoblasts apoptosis. Incr BMD and decr fractures. Daily SC injection $$$$. **For most severe cases or antiresportive failure. Sx: gout attack, hypercalcemia, osteosarcoma risk. Contraindicated: pts w/ osteosarcoma, pts with cancer within 5 years, pts w/ elevated PTH. Follow with an antiresorptive.

Question 17

Abaloparatide

Answer 17

Synthetic analog of human PTHrP. Mech similar to teriparatide by bind to the PTH receptor. Daily SC injection $$$$. Sx: hypercalcemia, osteosarcoma not seen. Same Contraindications as teriparatide. Follow by antiresorptive.