PHARM: DIABETES

Question 1

what drugs can cause dysglycemia?

Answer 1

• beta blockers (end in olol)
• corticosteriods
• HMG-CoA reductase inhibitors (statins)
• thiazide or loop diuretics
• protease antivirals
• 2nd gen anti-psychotics (olanzapine, quetiapine)

Question 2

what are rapid onset insulin preparations useful for?

Answer 2

post prandial insulin injections or use with an insulin pump

Question 3

what are long-acting insulin preparations useful for?

Answer 3

basal insulin infusion

Question 4

what are the adverse effects of insulin?

Answer 4

hypoglycemia is the most common and usually due to missed meal or increase in exercise

localized fat hypertrophy

allergic

Question 5

what class of drug is metformin? How does it work?

Answer 5

Biguanides

decreases hepatic glucose production. Also makes muscle tissue more sensitive to insulin so it can absorb glucose for energy.

Question 6

what is considered the first choice for patients with new and uncomplicated diagnosis of T2DM?

Answer 6

metformin

(no weight gain, lowers HbA1c by. 1-1.5%)

Question 7

adverse effects of metformin?

Answer 7

nausea, diarrhea, abdominal discomfort, anorexia, metallic taste.

may cause lactic acidosis in patients with existing hepatic or renal disease

Vitamin B12 deficiency

Question 8

what drug class is Acarbose? how does it work?

Answer 8

alpha-glucosidase inhibitors

inhibits intestinal alpha-glucosidases resulting in delayed digestion of starches and disaccharides
- reduces postprandial glucose levels

Question 9

what does Acarbose NOT significantly inhibit?

Answer 9

intestinal lactase

Question 10

How to take Acarbose?

Answer 10

TID dosing WITH a meal

Question 11

hypoglycemia patients taking acarbose should be treated with ______?

Answer 11

glucose rather than sucrose

Question 12

adverse effects of Acarbose?

Answer 12

flatulence, diarrhea, abdominal pain, cramps, nausea

may reduce metformin bioavailabillity

contraindicated in IBS and IBD

Question 13

what drug class is Sitagliptin and how does it work?

Answer 13

dipetidyl peptidase-4 inhibitors (enzyme that breaks down GLP-1)

so GLP-1 naturally reduces blood glucose levels, but it normally breaks down and stops working quickly. By interfering DPP4 inhibitors allow GLP-1 to remain active in body longer.
INDIRECTLY acting as an incretin mimetic

lowers HbA1c by 1% or less and also doesn’t help with CV risks

Question 14

adverse effects of sitagliptin

Answer 14

nasopharyngitis, hypersensitivity reactions.

rare: pancreatitis, joint pain

Question 15

what are some pros of sitaliptin?

Answer 15

low risk of hypoglycemia

does not inhibit cytochrome P450 isoymzes so low potential for drug interactions

weight neutral

Question 16

how do glucagon-like peptide-1 receptor agonists work

Answer 16

they are direct incretin mimetics

increase insulin secretion, suppress postprandial glucagon secretion, slow gastric emptying, increase satiety

Question 17

what drugs may help prevent CV events in primary and secondary patients?

Answer 17

GLP-1 agonists like liraglutide and semaglutide (ozempic)

Question 18

what class of drug is Glyburide and how does it work?

Answer 18

sulfonylureas (generic name often begins with gly or gli)

insulin secretagogue - stimulates pancreas to release more insulin (basal and post prandial insulin release)

lower HbA1c by 1-1.5%

Question 19

is Glyburide used alone as monotherapy?

Answer 19

generally an add on therapy to metformin

Question 20

adverse effects of glyburide?

Answer 20

higher risk of hypoglycemia and more weight gain
Can interact with alcohol
beta-blockers can mask hypoglycaemic symptoms

Question 21

what drug is in the class Meglitindes? How does it work

Answer 21

Repaglinide

this is a different class of insulin secretagogues. it stimulates insulin release but activity is shorter than sulfonylureas so only post prandial not basal insulin.

Question 22

adverse effects of Repaglinide?

Answer 22

similar to sulfonylureas with more extensive metabolic drug interactions.

Question 23

what drug and its class work by preventing glucose reabsorption in the kidneys, leading to more glucose excretion?

Answer 23

Drug: Canagliflozin
class: sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors)

Question 24

What are the adverse effects of Canagliflozin?

Answer 24

risk of genitourinary infections
hypotension (increased with use of loop diuretics)
hyperkalemia
risk of diabetic ketoacidosis

Question 25

what drugs may reduce the risk of cardiovascular complications?

Answer 25

Canagliflozin
liraglutide and semaglutide (ozempic)

Question 26

what drugs do not alter CV risks?

Answer 26

sitaglipin (DPP-4 inhibitor)

glyburide (Sulfonylureas) - uncertain lack of evidence

Question 27

what drugs can cause weight loss?

Answer 27

GLP-1 agnoists (semaglutide and liraglutide)

Question 28

what drugs are not associated with weight gain?

Answer 28

metformin
Acarbose
Sitaglipin (DPP-4 inhibitor)

Question 29

what drug could cause weight gain?

Answer 29

Glyburide (class: Sulfonylureas)
note: big difference b/t drugs in this class and terms of effectivness, risk of hypoglycemia, and weight gain.
Thiazolidinediones (Pioglitazone)

Question 30

what drugs lower HbA1c by 1-1.5%?

Answer 30

Sulfonylureas (glyburide)
metformin
Thiazolidinediones (Pioglitazone)

Question 31

How do Thiazolidinediones work?

Answer 31

agonist at PPARG receptors located at cell nucleus in adipose tissue.
this upregulates GLUT4 transporters and lipoprotein lipase
enhancing glucose reabsorption and hydrolysis of TGs

So they increase sensitivity to insulin in muscles and fat tissue. They also reduce glucose production in liver.

Question 32

what do thiazolidinediones do?

Answer 32

increase peripheral glucose uptake

enhance fat cell sensitivity to insulin

decrease hepatic glucose output

Question 33

adverse effects of Pioglitazone?

Answer 33

increased risk of heart failure (fluid retention and edema)

increase risk of fractures

worsen macular edema

(TZDs can cause water retention and increase risk of heart failure in some)

Question 34

What drug do you need to obtain written consent for?

Answer 34

new and renewed rosiglitazone (thiazolidinediones)