TRH's diabetic drugs; 3.18

Question 1

What are the rapid acting insulin drugs?

Answer 1

Lispro insulin
Aspart insulin
Glulisine insulin

(Think LAG, there is no LAG)

Question 2

What is a short acting insulin drug?

Answer 2

Regular insulin

Question 3

When should rapid/short acting insulin drugs be used?

Answer 3

Bolus/meal time

Question 4

What is an intermediate acting insulin drug?

Answer 4

NPH insulin

Question 5

What are examples of long acting insulin drugs?

Answer 5

Glargine insulin

Detemir insulin

Question 6

What are some side effects of using insulin drugs?

Answer 6

Hypoglycemia
Weight gain (no longer leaking calories)
Allergic reaction
Atrophy/hypertrophy of subcutaneous fat at injection site
Insulin resistance

Question 7

What is the mechanism of biguanides (metformin)?

Answer 7

Inhibit hepatic enzymes and uptake of gluconeogenic substrates (like lactate)

Question 8

Is metformin metabolized?

Answer 8

No…excreted unchanged

Question 9

What are some potential side effects of biguanides?

Answer 9

Diarrhea (with initial high dose)
Lactic acidosis (liver doesn't take up lactate)

Question 10

What drugs increase skeletal muscle uptake of insulin and increase cell responsiveness?

Answer 10

PPAR agonists (thiazolidinedione) (they have glitazone in the name). Sensitize cells to insulin so more GLUT 4 synth and transport

Question 11

What do TZD and glitzazones require to be functional?

Answer 11

The presence of insulin

Question 12

Besides increased muscular uptake of glucose, what is another effect of PPAR agonists?

Answer 12

Activate insulin responsive genes in the liver that regulate carb and lipid metabolism

Question 13

What drugs increase insulin secretion by closing potassium channels?

Answer 13

Sulfonylureas (glimepiride)

Meglitinides (repaglinid, nateglinide)

Question 14

How does glimepiride work?

Answer 14

Binds to SUR1 subunit of the ATP-sensitive K channel

Question 15

Where are sulfonylureas metabolized? Excreted?

Answer 15

Sulfonylureas are metabolized in the liver and excreted by the kidneys (urine)

Question 16

What is a major difference b/w first and second generation sulfonylureas?

Answer 16

Second generation have shorter half lives (more potent & fewer side effects)

Question 17

Besides the typical hypoglycemia and weight gain, what other adverse effects can happen with meglitinides?

Answer 17

Tremor, GI symptoms, dizziness

Question 18

What drugs increase insulin secretion by activating adenylate cyclase?

Answer 18

GLP analogs (exenatide)
Dipeptidase IV inhibitors (increase GLP (end in GLiPtin))

Question 19

Which of the drugs that activates AC is administered SQ? Oral?

Answer 19

Exenatide is given SQ before meals

Dipeptidase IV inhibitors are orally effective

Question 20

What class of drugs slows intestinal digestion/absorption of carbs?

Answer 20

Alpha-glucosidase inhibitors. Delayed sugar hydrolisys and absorption

Question 21

What are examples of alpha-glucosidase inhibitors?

Answer 21

Acarbose (latin for without carbose) and miglitol (no mnemonic, just remember it)

Question 22

What is the normal function of alpha-glucosidase?

Answer 22

Breaks down disaccharides to monosaccharides

Question 23

What drug delays gastric emptying and inhibits glucagon secretion?

Answer 23

Amylin analog (pramlintide [more like prAMYLINtide))

Question 24

What is the effect pramlintide?

Answer 24

Inhibits glucagon synthesis
Inhibits glucose synthesis in liver
Delays gastric emptying
Increases satiety

Question 25

How is pramlintide administered?

Answer 25

Subcutaneous administration before meals

Question 26

What are some side effects of amylin analogs?

Answer 26

GI symptoms

Severe hypoglycemia in combo with insulin