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Pharm Final > Non-Insulin Anti-Diabetics > Flashcards

Non-Insulin Anti-Diabetics Flashcards

1
Q

Name the 4 groups of ORAL hypoglycemics

A

Insulin secretagogues (sulfonylurea and meglitinides)
Biguanides
Thiazolidinediones (TZDs)
Alpha- glucosidase inhibitors

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2
Q

Which non-insulin anti-diabetic drugs (2) produce the biggest drop in fasting plasma glucose AND HbA1c? MOAs?

A

Sulfonylureas: Stimulate insulin release via SUR1 subunit and reduce serum glucagon levels

metformin: inhibits gluconeogenesis

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3
Q

Name the two first generation sulfonylureas

A

Tolbutamide

Chlorpropamide

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4
Q

Which first generation sulfonylurea has a short half life and rarely causes hypoglycemia?

A

Tolbutamide

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5
Q

Which first generation sulfonylurea has a long half life and is contraindicated in patients with hepatic or renal insufficiency?

A

Chlorpropamide

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6
Q

Which sulfonylurea causes jaundice in doses over 500mg?

A

Chlorpropamide

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7
Q

Which sulfonylurea is contraindicated in the elderly? Why?

A

Chlorpropamide

Higher risk of prolonged hypoglycemia

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8
Q

Which sulfonylurea causes a hyperemic flush if taken with alcohol?

A

Chlorpropamide

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9
Q

Which non-insulin anti-diabetic drugs can be used to treat central diabetes insipidus? How?

A

Sulfonylureas esp Chlorpropamide

Can cause SIADH -> hyponatremia

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10
Q

Name the three second generation sulfonylureas

A

Glyburide
Glipizide
Glimepiride

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11
Q

Which sulfonylurea results in hypoglycemia in 20-30% of pts?

A

Glyburide

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12
Q

How do second generation sulfonylureas differ from first?

A

100x more potent and fewer adverse effects

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13
Q

Which sulfonylurea has the shortest half life? Why is this important?

A

Glipizide

Less likely to cause serious hypoglycemia

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14
Q

Which sulfonylurea is approved for once-daily monotherapy or in combo with metformin or insulin?

A

Glimepiride

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15
Q

How are sulfonylureas delivered?

A

Orally

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16
Q

Which oral anti-diabetic agents are associated with wt gain?

A

Sulfonylureas
Meglitinides
Thiazolidinediones (TZDs)

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17
Q

Which group of oral anti-diabetic drugs can lead to tachyphylaxis? (where they initially respond to treatment then regress)

A

Sulfonylureas

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18
Q

Name the two meglitinides. Which is more effective? MOA?

A

Repaglinide - more effective
Nateglinide

Like sulfonylureas, stimulate insulin secretion by binding SUR1 (at different place though)

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19
Q

Which group of oral anti-diabetic drugs have rapid onset, short duration and are used for postprandial glucose regulation? When are they taken?

A

Meglitinides

Taken before each meal

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20
Q

Which class of oral anti-diabetic drugs can safely be given to patients with a sulfa allergy?

A

Meglitinides

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21
Q

Which insulin secretagogue produces fewer incidences of hypoglycemia?

A

Nateglinide

Secretagogues are sulfonylureas and meglitinides

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22
Q

Name the only biguanide. MOA?

A

Metformin

Inhibits gluconeogenesis by reducing gene expression of necessary enzymes

23
Q

Which oral anti-diabetic drug doesn’t cause hypoglycemia even at large doses?

A

Metformin

24
Q

Which oral anti-diabetic drug is associated with a LOSS of weight?

A

Metformin

25
Q

What is the only hypoglycemic drug shown to reduce macro vascular events in type II DM?

A

Metformin

26
Q

What is the first line therapy in type II DM?

A

Metformin + diet and exercise

27
Q

Which oral anti-diabetic drug is not metabolized and excreted in urine?

A

Metformin

28
Q

Which oral anti-diabetic drug used long term can interfere with B12 absorption?

A

Metformin

29
Q

What is metformin’s major adverse effect in 20% of pts?

A

GIT: anorexia, nausea, vomiting, diarrhea

30
Q

Which oral anti-diabetic drug is contraindicated in pts with renal or hepatic disease due to increased risk of lactic acidosis?

A

Metformin

31
Q

What is a major off label use for metformin?

A

It lowers insulin resistance and can lead to ovulation in PCOD and possibly pregnancy

32
Q

Name the two thiazolidinediones (TZDs)

A

Pioglitazone

Rosiglitazone

33
Q

Which oral anti-diabetic drugs act by agonism of PPAR-gamma? How does this decrease insulin resistance?

A

TZDs (-glitazones)

PPAR-gamma is involved in lipid and glucose metabolism and TZDs promote glucose uptake and use in adipose tissue

34
Q

Which class of oral anti-diabetic drugs has a slow onset that can take weeks to months to act? Why?

A

TZDs because they act through gene expression

35
Q

Which TZD increases HDL and decreases TAGs? How does the other affect lipids?

A

Pioglitazone

Rosiglitazone also inc HDL but has no effects on TAGs and also increases LDL

36
Q

Which class of oral anti-diabetic drugs is contraindicated in class III and class IV heart failure?

A

TZDs

37
Q

Which class of oral anti-diabetic drugs requires periodic monitoring of liver function?

A

TZDs (and Acarbose - alpha-glucosidase inhibitor)

38
Q

Name the two alpha-glucosidase inhibitors. MOA?

A

Acarbose
Miglitol

Reduce postprandial digestion and absorption of starch and disaccharides

39
Q

Which class of oral anti-diabetic drugs are associated with increased flatulence and contraindicated in IBD?

A

Alpha-glucosidase inhibitors

40
Q

Pt is using Acarbose and a sulfonylurea and develops hypoglycemia. How should he be treated and why

A

With glucose because breakdown of sucrose is inhibited by Acarbose

41
Q

What must be monitored in patients taking Acarbose?

A

Liver function

42
Q

Which drug is a GLP-1 analog derived from the salivary gland of the Gila monster? MOA?

A

Exenatide

Incretin resistant to DPP-IV (enzyme that degrades incretins) so it enhances glucose-dependent insulin secretion, suppresses glucagon release, slows gastric emptying, and decreases appetite

43
Q

How is exenatide administered? Type of drug?

A

SC injection 2x/day

Incretin analog

44
Q

Which drug is given orally and is a selective inhibitor of DPP-IV? What is DPP-IV?

A

Sitagliptin

DPP-IV degrades incretins

45
Q

Which drug is a synthetic analog of amylin? MOA?

A

Pramlintide

They both inhibit food intake, gastric emptying, and glucagon secretion
Amylin is cosecreted with insulin

46
Q

Which anti-diabetic drug lowers LDL, slightly reduces HbA1c, and can cause constipation, dyspepsia and increase TAGs?

A

Colesevelam

Bile-acid sequestrant

47
Q

What is the only drug approved for use in conjunction with insulin for type II diabetes?

A

Metformin

48
Q

If initial treatment with metformin does not work, what is the next step? How do you choose which drug to give?

A

Either insulin or a sulfonylurea

Give insulin if HbA1c is >8.5%

49
Q

If hypoglycemia is particularly undesirable and weight loss is a major goal, what drug would you prescribe, assuming HbA1c is <8%?

A

Exenatide

50
Q

What is the most effective diabetes medication at lowering glycemia?

A

Insulin

51
Q

When is insulin considered as a first line treatment?

A

When HbA1c is >10%

52
Q

Name two effects glucagon can have on cancers.

A

Causes release of insulin from pancreas, catecholamines from pheochromocytoma, and calcitonin from medullary carcinoma

53
Q

Which anti-diabetic drug is used in radiology of the bowel due to its ability to relax intestine?

A

Glucagon

54
Q

Which type of insulin is used in an insulin pump?

A

Rapid acting

Pharm Final (20 decks)

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