module 15

Question 1

what is a biguanide?

Answer 1

-drug of choice for treating type 2 diabetes

Question 2

how does biguanides lower blood gluocse in 3 seperate ways?

Answer 2

1. increases the sensitvitiy and number of insulin receptors

2.decreases hepatic gluconeogenesis

3. reduces intestinal glucose absorption

Question 3

what is the major advantage of biguanides?

Answer 3

they dont increase insulin levels so they dont pose a risk for hypoglycemia

Question 4

what are the adverse effects of biguanides?

Answer 4

nausea
decreased appetite
diarrhea
decreased absorption of b12 and folic acid
lactic acidosis (fatal in 50% of patients)

Question 5

how do sulfonylureas work?

Answer 5

1. act by stimulating release of insulin from the pancreas
2. inhibit glycoenolys

Question 6

what is the difference between 1st and 2nd generation sulfonylureas?

Answer 6

second generation are much more potent and cause fewer drug interactions

Question 7

what are the risks of sulfonylureas?

Answer 7

hypoglycemia
prolonged use may lead to pancreatic burnout

Question 8

how do meglitinides work?

Answer 8

stimulate insulin release from the pancreas

Question 9

how do meglitinides differ from sulfonylurea?

Answer 9

-have a short half life so are effective for postprandial rises in glucose

• less likely to cause hypoglycemia

-less likely to cause pancreatic burnout

Question 10

what are thiazonlidinediones also known as?

Answer 10

glitadones

Question 11

how do thiazolidinediones work?

Answer 11

-increase insulin sensitivity in target tissues

-decrease hepatic gluconeogenesis

• increase HDL and decrease triglyceride levels via activation of PPARa

glitazones activate the pprary receptor, which is an intracellular receptor. Activation of this receptor turns on genes that regulate carbohydrate metabolism - the result is increased sensitivity to insulin by increases in the glucose transporters

Question 12

how do alpha glucosidase inhibitors work?

Answer 12

• act in the intestine to delay carb absorption (in order for carbs to be absorbed they must be broken down into monosaccarides - this process is mediated by alpha glucosidase)— there the agi block the enzyme and cause a decrease in complex carbs metabolism and reduces the rise of post prandial metabolism

Question 13

what are the adverse affects of alpha glucoside inhibitors?

Answer 13

• limited to the intestine since they are poorly absorbed
  -flatulence
  -cramps
  -abdominal distention
  -diarrhea
  -decreased iron absorption

Question 14

how do gliptins work?

Answer 14

-act to inhibit an enzyme called dipeptidyl peptidase (DPP-4) - DPP4 breaks down the incretin hormones GLP and GIP. GLP and GIP are released from the GI tract after a meal and cause increased release of insulin and decreased release of glucagon— by inhibting DPP-4, gliptins allow more GIP and GLP to reach the pancreas, therefore causing increased insulin release and suppresssion of glucagon release

Question 15

what are the side effects of gliptins?

Answer 15

no known major side effects

Question 16

how do incretin mimetics work?

Answer 16

• synthetic analogs that mimic the actions of incretin hormones (incretin hormones cause the increase of insulin release and decrease of glucagon release)

Question 17

how are incretin mimetics administered?

Answer 17

subcutaneous injection

Question 18

are incretin mimetics used alone or adjunctively?

Answer 18

adjunctive with biguanides or sulfonylareas

Question 19

what are the side effects of incretin mimetics?

Answer 19

-hypoglycemia
-pancreatitis