Martin pharm DM part II

Question 1

what are adverse effects to insulin therapy

Answer 1

hypoglycemia
insuline allergy and resistance
lipoatrophy and lipohypertrophy

Question 2

biggest risk factor hypoglycemia

Answer 2

the more rigorous attempt to achieve euglycemia

Question 3

causes of hypoglycemia with Tx

Answer 3

inappropriate dose
mismatch of time of injection vs food intake
exercise induced increase glucose utilization

Question 4

what is the dominant counter regulatory hormone for hypoglycemia in DM I patients and why

Answer 4

epinephrine because glucagon secretion becomres deficient

Question 5

most frequent allergic reaction to insulin

Answer 5

IgE mediated local cutaneous reactions

occasionally anaphylactic reaction or insulin R due to circulating IgG Ab

Question 6

what causes the lipohypertrophy/atrophy from insulin

Answer 6

site of constant injection

Question 7

what are conditions that require IV insulin

Answer 7

ketoacidosis

perioperative control and childbirth

Question 8

msot common drug induced ypoglycemic states are those caused by

Answer 8

ethanol, beta-adrenergic antagonists and salicylates

Question 9

why can beta antagonists cause hypoglycemia

Answer 9

inhibit the effects of catecholamines on gluconeogensis and glycogenolysis
also mask the sympathetically mediated Sx assoc with fall in blood glucose (tremors and palpiataions)

Question 10

what drugs either have direct hyperglycemic effect ot indirect

Answer 10

epi, glucocorticoids, oral contraceptions (direct)
phenytoin, clonidine, Ca Ch blockers (inhibit insulin secretion
some diuretics deplete K and indirectly inhibit insulin secretion

Question 11

Initial monotherapy for DM II

Answer 11

metformin

Question 12

effects of metformin

Answer 12

reduce haptic glucose output by inhibiting gluconeogenesis
increase insulin action in peripheral tissues
increase glucose uptake dna utilization by muscle
reduce intestinal absorption of glucose

Question 13

why is metformin preferred over sulfonylureas

Answer 13

does not cause weight gain or provoke hypoglycemia

has lipid lowering effect

Question 14

side effects metformin

Answer 14

abdominal discomfort, anorexia, nausea, metallic taste, diarrhea

Question 15

CI to metformin

Answer 15

lactic acidosis, hepatic disease, renal impairment, cardiac failure, chronic hypoxic lung disease

Question 16

what clears metformin

Answer 16

kidneys

Question 17

what type of sulfonylureas are used now

Answer 17

the second generations
glipizide
glyburide
glimepiride

Question 18

glyburide should be used cautiously in what patients

Answer 18

elderly with renal failure and otheres predisposed to hypoglycemia

Question 19

how do sulfonylureas work

Answer 19

lower blood glucose by stimulating insulin release from pancreatic beta cells
bind to and bloc ATP sensitive K channel
extrapancreatic effects like increased # receprtors for insulin and LGUT transporters

Question 20

what metabolizes sulfonylureas

Answer 20

liver

Question 21

patients most likley to respond to sulfonlyureas

Answer 21

older than 30 recently Dx
not overtly obese
some beta cell function
<300 fasting level glucose

Question 22

drug of choice if CI for sulfonlyureas

Answer 22

insulin

Question 23

adverse reactions sulfonlyureas

Answer 23

hypoglycemic reactions like a coma

nausea, vomiting, cholestatic jaundice, hypoNa, agranulocytosis, aplastic anemia, HS reactions

Question 24

drug drug interactions with sulfonylureas

Answer 24

many transiently increase hypoglycemic effects

Question 25

CI to sulfonlyureas

Answer 25

type I DM, sulfa allergies, pregnant or nursing mothers and significant hepatic or renal insufficiency

Question 26

what are the non sulfonylure secretagogues

Answer 26

repaglinide and natedlinide

Question 27

what type of patient adheres better to repaglinide and nateflinide

Answer 27

those whoe are erratic eaters because rapid action if taken right before a meal

Question 28

can repaglinide and nateflinide be combined with metformin

Answer 28

yes

Question 29

how do acarbose and miglitol work

Answer 29

alpha glucosidase inhibitors | competitive inhibition of sugar digestion delaying absorption of carbs and limits postprandial rise in glucose

Question 30

drugs most useful in newly diagnosed DM II patients with mild hyperglycemia

Answer 30

alpha glucosidase inhibitors

Question 31

if combined with what drugs will the alpha glucosidase inhibitors cause hypoglycemia

Answer 31

insulin or sulfonlyureas

Question 32

side effects alpha glucosidase inhibitors

Answer 32

flatulence, diarrhea and GI upset from undigested carbohydrate

Question 33

CI for alpha glucosidase inhibitors

Answer 33

diabetic ketoacidosis, cirrhosis, IBD, colonic ulcers, partial intestinal obstruction

Question 34

what are TZDs used for (thiazolidinediones)

Answer 34

poorly controlled DM II

Question 35

what must you do if Tx patient with TZD

Answer 35

liver function tests every 3 mo

Question 36

how do TZDs work

Answer 36

bind nuclear transcription factors PPAR-gamma site that resensitize target tissue to insulin

Question 37

effects of pioglitazone TZD

Answer 37

reduce insulin R improve peripheral action insulin reduce hyperglycemia by inc glucose uptake reduce hepatic glucose production take several weeks to produce a clinical effect

Question 38

pioglitazone is approved for regimen with what

Answer 38

monotherapy insulin sulfonylureas or metformin

Question 39

side effects pioglitazone

Answer 39

moderate weight gain, edema, mild anemia | fluid retention

Question 40

risk with rosiglitazone

Answer 40

MI

Question 41

What is pramlintide

Answer 41

maylin analog

Question 42

how is pramlinitide administered

Answer 42

SQ injection before meals

Question 43

advserse effects pramlinitide

Answer 43

increased risk hypoglycemia, nausea | decreased appetite, comiting, stomach pain, tiredness, dizziness or indigestion

Question 44

what secretes glucagon like peptide

Answer 44

intestinal L cells

Question 45

what is the GLP analog

Answer 45

exenatide

Question 46

effects of GLP-1 agonists

Answer 46

glucose dependent enhancement of endogenous insulin secretion inhbition of endogenous glucagon secretion appetite suppression reduction in speed of gastric emptying stimualte islet growth

Question 47

most common adverse effects GLP-1 agonists

Answer 47

nausea, vomiting, diarrhea and upper resp Sx

Question 48

biggest drawback to GLP-1 agonists

Answer 48

need 2x SQ injection

Question 49

adverse effects of the Na glucose co transporter 2 inhibitors

Answer 49

genital mycotic infections and UTIs diuretic effects sometimes bladder cancer

Question 50

which drug class in DM causes increased risk for acute pancreatitis and severe HS reactions

Answer 50

DPP-4 inhibitors