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Gastrointestinal Module > Pharmaco Antidiabetics Agents > Flashcards

Pharmaco Antidiabetics Agents Flashcards

1
Q

Common feature if all type of diabetes mellitus

A

Hyperglycemia

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2
Q

Classification of diabetes mellitus

A

Insulin dependent diabetes mellitus (type I)

Non insulin dependent diabetes mellitus (type II)

Gestational diabetes

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3
Q

Clinical symptoms of type I

A

Polydipsia
Polyuria
Polyphagia

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4
Q

Clinical management

A

Diet
Exercise
Treatment

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5
Q

Treatment types

A

Exogenous insulin

Oral Hypoglycemic drugs

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6
Q

In what case if exogenous insulin used

A

Type I diabetes mellitus

Sometimes in type II

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7
Q

Goal of exogenous insulin therapies

A

Maintain glucose level close to normal

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8
Q

Why is diabetes treatment individualized

A

Spectrum of patients with diabetes

Symptoms may exist or not , may vary

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9
Q

Classification of exogenous insulin

A

Rapid acting

Short acting

Intermediate acting

Long acting

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10
Q

Onset of action of rapid acting insulin

A

5-10 min

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11
Q

Examples of rapid acting insulin

A

Lispro

Insulin aspart

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12
Q

Insulin aspart can bind to

A

Insulin receptors

IGF-1

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13
Q

Short acting / regular insulin examples

A

Humulin R

Novolin R

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14
Q

Short acting insulin onset of action.

A

30mins

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15
Q

When do you administer regular insulin

A

Administered several minutes before a meal

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16
Q

What type of diabetes is controlled by regular insulin

A

Postprandial hyperglycemia

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17
Q

When should you use regular insulin

A

Surgery
Trauma
Shock
Diabetic ketoacidosis

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18
Q

How many times do you administer rapid and short acting insulin per day

A

2/3 times a day

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19
Q

Intermediate acting insulin names

A

Isophane insulin suspension(NPH)

Insulin zinc suspension (lente insulin)

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20
Q

Onset of action of intermediate acting insulin

A

1-2h

Long duration of action too

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21
Q

What can be combined with intermediate acting insulin to prolong duration of action

A

Zinc

Protamine

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22
Q

Can you use intermediate acting insulinin case of emergency

A

No

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23
Q

How many times a day do you give intermediate acting insulin

A

Once or twice a day

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24
Q

What compound it sounds in high quantity in long acting insulin

A

Protamine and zinc

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25
Examples of long acting insulin
Protamine zinc | extended insulin zinc suspension (ultralente)
26
Duration of action of long acting insulin
36 hours
27
Onset of action of long acting insulin
Two or more hours
28
Factors influencing insulin regimen
``` Diet lifestyle physical activity type of diabetes Work schedule meal times ```
29
In insulin regimen what form of combinations of insulin preparations are made
Intermediates and short acting insulin combination 70:30 ratio or 50:50 for NPH/regular 70: 30 Humilin 70: 30 Novolin 50: 50 Humulin
30
Adverse effects of insulin therapy
Hypoglycemia with CNS Symptoms ( tremor , lethargy, sensory deficits seizures, loss of consciousness) Weight gain ( increased caloric storage by insulin) Allergic rxns for animal derived insulin Hypokalemia ( Na-K-ATPase stimulation) Local lipodystrophy (repeated insulin SC injection)
31
If Hypoglycemia due to insulin therapy what can you do
Oral carbohydrates (fruit juice, glucose tablets) When severe IV glucose or IM glucagon
32
When are oral hypoglycemic agents used
In type two diabetes
33
Why is compliance for type two diabetes better
Because therapy is not injected
34
Type of drugs in oral hypoglycemic agents
``` Sulfonylureas Biguanides Thiazolidinediones A-glucosidase inhibitors Meglitinides ```
35
Most widely prescribed drugs in treatment of type two diabetes mellitus
Sulfonylureas
36
Classification of sulfonylureas
First generation second generation third generation
37
First generation sulfonylureas
Chlorpropamide Tolbutamide
38
Second generation sulfonylureas
Glyburide Glipizide
39
Third generation sulfonylureas
Glimepiride
40
Why are first generation sulfonylureas not frequently used in modern management of diabetes mellitus
Delay in time of onset occasional long duration of action side effects More drug interactions
41
Chlorpropamide pk
Slow onset of action maximal Hypoglycemic potential reached at one or two weeks several weeks to be eliminated
42
Chlorpropamide side effects
Flushing especially with alcohol intake
43
Tolbutamide pk
Short acting compounds | good for likely to be hypoglycemic patient
44
Why are second generation sulfonylureas better agent than the first
More predictable time of onset and duration of action | fewer side effects
45
Potency of glyburide
150 more times potent than tolbutamide
46
Duration of action of glyburide
24h
47
MOA of sulfonylureas
Stimulation of insulin release from pancreatic b-cell
48
Why are sulfonylureas not used in management of type one diabetes
Low number available B cells in that form of diabetes
49
Why do obese diabetics respond poorly to sulfonylureas
Because Obesity must be associated with insulin resistance
50
Where are sulfonylureas absorbed
Git
51
Sulfonylureas excretion
Renal or biliary route
52
Does of sulfonylureas
Low to intermediate dose at first | gradual increase until dose results in normoglycemia
53
Adverse effects of sulfonylureas
Hypoglycemia weight gain cross-reactivity when sensitivity to sulfa-containing antibiotics
54
Main biguanides
Metmorfin
55
First line treatment of mild to moderate type 2 overweight diabetic’s with insulin resistance
Metformin
56
2 formulations a metformin
Glucovance | Glucophage XR
57
Glycovance composition
Metformin + glyburide
58
Why is glucophage XR better tolerated in patients who are prone to GIT side effects
Because it’s extended release product
59
Are biguanides hypoglycemic
Not necessarily
60
Do biguanides have effects on secretion or glucagon or somatostatin
No
61
Effects of biguanides
Decrease intestinal absorption of carbohydrates Increase glucose uptake (GLUT4) Increase glycolysis via anaerobic pathway (lactic acidosis) Increase glucose utilization (glycogenesis) Decrease gluconeogenesis
62
What can you combine biguanides with
Sulfonylureas | Insulin
63
Side effects of biguanides
``` 20-25% of patients Diarrhea Abdominal discomfort Nausea Metallic Taste Decreased absorption of B12 ```
64
Thiazolidinediones effect
Insulin sensitizing properties Decrease insulin resistance Enhance insulin in target tissues
65
Name of Thiazolidinediones
Rosiglitazone | Pioglitazone
66
What can you associate rosiglitazone with
Metformin Can also be combined with insulin and sulfonylureas
67
Rosiglitazone action
Modest increase in low density lipoprotein And TAGs
68
Thiazolidinediones absorption.
From GIT | Metabolized by liver
69
Plasma elimination of Thiazolidinediones
2-3h | Urine mostly and then stool
70
Why is Thiazolidinediones dosage gradual
Risk of hypoglycemia because effects takes weeks to develop
71
Thiazolidinediones adverse effects
Edema Weight gain Hypoglycemia (rare)
72
a glucosidase inhibitors action
Decrease postprandial hyperglycemia Decrease carbohydrates absorption from GIT Inhibit a-glucosidase (glycoamylase, sucrase, maltase, dextranase)
73
How can you make a glucosidase more effective
Take it before or with meal
74
In which people are a glucosidase more effective
Patients with type II diabetes with 50% carbohydrates diet
75
Can you use a glucosidase in type 1
No prohibited
76
Name of a glucosidase
Acarbose (low systemic absorption) | Miglitol (high systemic absorption)
77
Adverse effects of a glucosidase
GIT disturbances ( loose stool, flatulence, abdominal cramping)
78
Can you have weight gain with a glucosidase inhibitors
No weight gain
79
What can you combine a glucosidase inhibitors with
Metformin Sulfonylureas Insulin
80
Meglitinides moa
Augment release of insulin in presence of glucose
81
Name of meglitinides
Repaglinide | Nateglinide
82
What can you associate meglitinides with
Metformin
83
When is the only situation where meglitinides is used over sulfonylureas
Allergy to sulfa drugs
84
Nateglinide compared to repaglinide
Faster onset and shorter duration

Gastrointestinal Module (15 decks)

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