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Spring 2018 Pharm Exam 2 > Lecture 2: Drugs for DM > Flashcards

Lecture 2: Drugs for DM Flashcards

1
Q

What is the primary Tx for Type 1 DM

A

insulin replacement

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2
Q

What is the MC form of insulin used today

How is insulin normally given
- how given in emergency?

A

Recombinant products

Normally insulin injected SC
- in emergency: IV or IM

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3
Q

How are insulin preps classified?

A

by duration of action

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4
Q

What 3 types are ULTRA short acting insulin

A
  1. Lispro
  2. Aspart
  3. Glulisine
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5
Q

What 3 types are rapid short acting insulin

A
  1. standard insulin
  2. humulin-R
  3. Purified insulin
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6
Q

What 2 types are intermed acting insulin

A
  1. novolin-N

2. humulin-N

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7
Q

What 2 types are long acting insulin?

A
  1. Detemir

2. Glargine

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8
Q

How does glucose uptake/peak differ from short and long acting?

A

Short acting

  • quick glucose uptake
  • immed peak

Long acting
- NO PEAK

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9
Q

When should short acting insulin be used?

long acting?

A

short acting –> at mealtime

long acting –> overnight

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10
Q

definition of Dawn Effect in DM

- d/t?

A

increase in AM blood glucose d/t overnight insulin dosing and cortisol

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11
Q

2 ways to monitor response to insulin replacement

A
  1. Blood glucose

2. Glycated Hb

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12
Q

What is the major AE a/w insulin Tx?

What can be given to reverse this?

A

HYPOglycemia ( <70) - can be fatal

Give glucose or glucagon to reverse hypoglycemia

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13
Q

What are 2 common causes of HYPOglycemia w/insulin Tx

What is hypoglycemia a/w later in life?

A
  1. Too much insulin given
  2. insulin given at incorrect time

A/w dementia later in life

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14
Q

Where in the body does physiologic insulin go 1st?

Insulin replacement go 1st?

A

physiologic –> Liver

insulin replacement –> circulation

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15
Q

Other AEs a/w insulin Tx

Note: no risk in pregnancy

A
  1. Hypersensitivity rxns (less w/recombinant)

2. lipoatrophy or lipohypertrophy

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16
Q

2 pathophys probs in Type 2 DM

A
  1. insulin resistance
  2. impaired insulin secretion

incr: hepatic gluc production & glucagon
decr: gluc utilization & secretion

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17
Q

What is the 1st line tx for Type 2 DM

is insulin typically used initially for Tx of type 2 DM

A

lifestyle modifications
- exercise and wt control

No insulin not usu used initially

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18
Q

W/severe hypoglycemia how do you know whether its d/t OD of self admin insulin or insulin secreting tumor?

A

C-peptide

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19
Q

7 Classes of drugs that Tx Type 2 DM

A
  1. Biguanides
  2. Classic Secretagogues
  3. Thiazolidinediones
  4. Renal SGLT-2 inhibitors
  5. GLP-1 agonists
  6. DPP-4 inhibitors
  7. Alpha-glucosidase Inhibitors
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20
Q

What type of drugs are Biguanides?

prototype drug for Biguanides?

A

insulin sensitizers –> enhances insulin’s effects

Metformin

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21
Q

MOA for Metoformin?

end results?

A

Activates AMPK

incr: gluc uptake and FA oxidation
decr: gluconeogenesis and lipogenesis

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22
Q

how can you incr the activity of AMPK

A

exercise

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23
Q

What is metformin often used in combo w/ and why?

A

often in combo w/PO anti-diabetic meds –> additional glucose control

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24
Q

GI effects of metformin = N/V/D and metallic taste

- dose effect and how long they last?

A

Dose-dependent and transient

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25
Who is metformin CI in?
pts w/ renal dysfx or severe liver dz
26
What can occur if metformin given to renal impaired pt why must d/c metformin before radiographic procedures w/contrast
renal impaired--> Lactic acidosis d/c before proced --> may cause rapid decline in renal fxn
27
What is metformin 1st line for?
Type 2 DM
28
3 benefits of metoformin?
1. Does NOT induce hypoglycemia 2. NO wt gain 3. inhibits microvascular complications
29
Two type of Classic secretagogues general MOA for them? hence what do both require?
1. Sulfonylureas 2. Non-sulfonylurea secretagogues Mimic glucose --> bind/inhibit ATP sensitive K channel --> block K efflux --> depol --> incr insulin rel - requires fxnl beta cells
30
Prototype drug for Sulfonylureas
Glipizide
31
What does Glipizide not affect?
insulin resis/sensitivity
32
2 major AEs a/w Glipizide
1. HYPOglycemia | 2. Wt gain
33
What pts is Glipizide CI in? cautioned use in?
CI - pts w/liver or renal dz caution - elderly, cardiac pts
34
2 major results of drug interactions w/Glipizide
1. enhanced HYPOglycemic effect (w/decr metab, excretion, protein binding) 2. compromised glucose lowering effect (w/incr metab, excretion, inhibition of insulin secretion)
35
prototype drug for Non-sulfonylurea secretagogues/Meglitinides?
Repaglitinide
36
how are Non-sulfonylurea secretagogues similar to sulfonylureas and how different (5)?
same MOA Non-sulfonylurea secretagogues - share 2 binding sites w/SU but diff kinetics - shorter acting (give right before meal) - lower risk of HYPOglycemia - less wt gain - caution w/liver dz (CI in SU)
37
what are two ways drug interactions/enhancement of HYPOglycemia occurs w/Non-sulfonylurea secretagogues
1. drugs that displacement from protein binding sites | 2. drugs interfere w/metab
38
What types of drugs are Thiazolidinediones?
insulin sensitizers (like Biguanides)
39
prototype drug for Thiazolidinediones?
Pioglitazone
40
general MOA for Pioglitazone what alters expression of insulin responsive genes that results in the MOA?
incr insulin sensitivity in target tissues | PPAR-gamma ligands Peroxisome Proliferator-Activated Rec
41
major benefit of Pioglitazone?
NOT HYPOglycemic
42
Effect of Pioglitazone on hepatic glucose output, gluc utilization and FFA
decr hepatic glucose output and FFA | incr gluc utilization
43
2 major AEs a/w Pioglitazone Other AEs: 1. decr bone density w/chronic use 2. incr risk of HF, bladder CA? 3. liver failure (caution in liver dz)
1. Fluid retention | 2. Wt gain
44
prototype drug for GLP-1 rec agonists
Exenatide (injectable)
45
MOA for Exenatide? result? Others: decr post prandial gluc rel and hepatic fat acculm
incr glucose dep insulin secretion--> less chance of HYPOglycemia
46
How does Exenatide help facilitate wt LOSS?
slows gastric empty/incr satiety
47
What AE a/w Exenatide decr w/continued use and leads to acute renal failure Other AE: acute pancreatitis
GI SEs: N/V/D vomiting a/w acute renal failure
48
when is there a higher risk of HYPOglycemia w/ Exenatide?
when given w/insulin secretagogues
49
What pts is Exenatide CI in?
gastroparesis
50
Prototype drug for DPP-4 inhibitors | dipeptidyl peptidase
Sitagliptin note: wt neutral
51
2 MOA for Sitagliptin
1. prolongs action of endogenous GLP-1 | 2. incr glucose mediated insulin secretion
52
4 major AEs a/w Sitagliptin? Others: 1. acute pancreatitis 2. Hypersensitivity rxns 3. unknown long term safety
1. incr risk hypoglycemia w/insulin secretagogues 2. cleavage not specific to incretins 3. hepatic failure (can be fatal) 4. may cause severe joint pain
53
prototype drug for alpha-glucosidase inhibitors
acarbose (NOT absorbed)
54
2 MOA of acarbose?
1. inhibits alpha-glucosidase --> slows carb digestion--> decr GI gluc absorption 2. decr postprandial glycemia --> must take w/meal
55
3 AEs a/w acarbose that is alleviated w/dose titration and continued use? Others: 1. incr LFTs/hepatic failure 2. incr risk hypoglycemia w/SU or insulin
abd pain, diarrhea, flatulence
56
CI for acarbose
Chronic intestinal dz
57
What is prototype drug for Renal SGLT-2 inhibitors (glucose transport inhibitors)
Canagliflozin | not FDA approved
58
MOA for Canagliflozin
inhibits SLGT-2 (Na dep glucose co-transporter in kidney) --> suppresses renal gluc abs --> lowers blood glucose
59
what is Canagliflozin metab by? result?
metab by UDP-GT inducers --> decr blood levels of drug
60
4 major AEs a/w Canagliflozin? Others =HYPER: P, Mg, K
1. genital myocotic inf 2. reccurent STIs 3. unknown long term safety --> incr risk of bone fx? 4. Ketoacidosis
61
POSSIBLE benifits of Canagliflozin
1. facilitate wt loss | 2. improve health in CV pts (excrete more Na--> decr BV)

Spring 2018 Pharm Exam 2 (6 decks)

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