Type II Diabetes

Question 1

Give all classes of Hypoglycemic Agents 5,8

Answer 1

Insulin Sensitizer

• Biguanides
• Thiazolidinedione

Insulin Secretagogue

• Sulfonylureas
• Meglitinides

a-glucosidase inhibitors
- acarbose

Incretin-based Therapy - GIP/GLP1 released after eating, inhibited by DPP4

• DPP4 inhibitor
• GLP1 receptor agonist

SGLT2 inhibitors

Question 2

Biguanides

MOA [4]
- think 4 systems
AE [4]
CI [2]

Answer 2

Metformin - Insulin sensitizer

• Increase Insulin receptors
• decrease intestinal absorb
• decrease liver gluconeogenesis
• increase muscular absorb

Oral, Renal
AE: GI more common, Diarrhea, Flatulence, B12 absorption
– Metformin therapy is associated with increased risk of B12 deficiency and megaloblastic anemia.

CI: Renal, Lactic Acidosis (from blocking gluconeogenesis)

Question 3

Thiazolidinediones

Answer 3

Pioglitazone

PPAR Gamma receptor
- increase insulin sensitivity, increase Glut 1, 4
(through decreasing FFA, hence relying more on glucose)

Oral, Hepatic
AE: Weight gain, Fluid retention - edema, Heart failure risk

Question 4

Wheres Glut 1 2 4 found

Answer 4

Glut 1: all, brain
Glut 4: fat and muscle
Glut 2: intestine and PANCREAS, liver

Question 5

Sulfonylurea

MOA
Different Durations of Action
AE

Answer 5

Secretegogues

• Stimulate B cells release insulin by inhibiting Katp channel
• cell depolarized, Ca open, influx of Ca
• exocytosis of insulin granules

Duration:

Glipizide < Glimepiride, Glicalzide < Glibenclamide

AE: hypoglycemia, Weight Gain

Question 6

Meglitinide

MOA
AE

Answer 6

Repaglinide, Nateglinide;

MOA - close Katp channel using a diff SUR
- GLUCOSE DEPENDENT manner - use w meal times;
Glucose close first and drug potentiates this
-

Oral, Hepatic
AE: Hypoglycemia risk is lower, but high wo regular meals; Weight Gain

Question 7

Compare sulfonylurea and meglitinide

Answer 7

Both weight gain, hypoglycemia

However meglitinide is glucose dependent by binding to a different SUR

Insulin causes weight gain when the cells absorb too much glucose and the body converts this into fat.

TZD-associated weight gain may result mainly from increased fat mass and fluid retention and may be in part congruent to the mechanism of action of TZD.
– recall PPAR GAMMA

Question 8

alpha-glucosidase inhibitor

MOA
AE
CI

Answer 8

Acarbose, Miglitol

MOA: irreversible inhibitor
AE: Gas
CI: Inflammatory Bowel Disease

Question 9

Incretin-Based Therapy

MOA
Names
AE
Special use

Answer 9

GIP/GLP1 released which augments insulin secretion and suppress glucagon release; since released after meals is glucose dependent

• DPP4 inhibitor “gliptins” - Sotagliptin, Vildagliptin, Linagliptin; Linagliptin no dose adjustment for problems

AE: GI, Flu-like symptoms

• GLP1 R agonist - SUBCUTANEOUS “tide” for appetite
• Exenatide, Liraglutide
• MOA - GLP receptor, increase insulin release, decrease appetite by increasing satiety - hence weight loss; insulin release is glucose dependent
• AE: GI
  Special use: CVS, Heart failure

Question 10

SGLT2 inhibitor

Names
AE [4]
Special Uses [3]

Answer 10

Block SGLT2 at PCT; increasing glucose excretion

“gliflozin”
Empagliflozin, Canagliflozin, Dapagliflozin

AE: Vagina thrush, UTI, Nocturnal urination
Diabetic Ketoacidosis - Gliflozins decrease blood glucose levels hence less insulin hence fat metabolism;; also kidney reabsorption of ketone bodies hence euglycaemic DKA;

Special:
decreases major cardiac event w CVD. decrease hospitalization wo CVD
decrease of ESRD for renal patients

so if px has Renal problem + DM - good to help dysfunction but does not help w glucose level excretion

Question 11

Obese ppl cannot give what can give what

Answer 11

Yes 2:
Obese, CVS:
- SGLT2 inhibitor
- GLP1 agonists tides - Exenatide, Liraglutide

No 3:

• both secretagogues Sulfonylureas and Meglitinides;
• Thiazolidinedione - Pioglitazone

Question 12

CVS pts give what and name examples

Answer 12

SGLT2 Inhibitors - gliflozins

• empanadas, dapper up
• empagliflozin, dapagliflozin

GLP1 - appetide - tides

• glutides;
• LIRAGLUTIDE

vs LINAAAAGLIPTIN

Question 13

Renal problem give what

Answer 13

Linagliptin - DPP4 inhibitor

Question 14

Whats Pioglitazone

Answer 14

TZT - PPAR Gamma agonist

Question 15

Whats Biguanides

Answer 15

Insulin sensitizer

Question 16

Whats Glipizide

Answer 16

Shortest DOA Sulfonylurea

Question 17

Whats Linagliptin

Answer 17

DPP4 agonist wo renal AE

Question 18

Whats Nateglinide

Answer 18

Meglitinide - glinides

Question 19

Whats Liraglutide

Answer 19

GLP1 agonist

Question 20

Which classes are glucose dependent

Answer 20

Both Incretin therapies - DPP4 inhibitors and GLP1 agonists

Meglitinides - diff SUR from SU

Question 21

Whats Glibenclamide

Answer 21

Longest DOA of SU

Question 22

Name 2 SU

Answer 22

Glipizide and Gibenclamide

Question 23

Name 3 SGLT2 inhibitors

Answer 23

Empa
Cana
Dapa
gliflozin

Question 24

Whats gliflozins

Answer 24

SGLT2 inhibitors

Question 25

Whats tides

Answer 25

GLP1 agonist | Exenatide, Liraglutide

Question 26

Whats gliptins

Answer 26

DPP4 inhibitors

Question 27

Whats glinide

Answer 27

Meglitinides Nateglinide Repaglinide

Question 28

Meglitinide siblings

Answer 28

Nate, Repa

Question 29

DPP4 aunties

Answer 29

Sita, Lina, Vilda - gliptins

Question 30

GLP1 agonist sisters

Answer 30

Exenatide, Liraglutide

Question 31

SGLT2 ahhhs

Answer 31

Empa, Cana, Dapa - gliflozins;

Question 32

PPAR Alpha vs PPAR Gamma

Answer 32

PPAR Alpha - Fenofibrate, Gemfibrozil - increase beta-oxidation of fats, decrease FAS, decrease VLDL production - lower TG PPAR Gamma - Pioglitazone - increase uptake of FFA, increase insulin sensitivity, increase glucose metab

Question 33

Name 1 impt AE of Metformin and most common AE

Answer 33

Lactic Acidosis - from blocking liver gluconeogenesis Most common is GI

Question 34

What activates PPAR alpha and PPAR gamma receptors

Answer 34

Alpha: Fibrates | Gamma, the one w G in the name: Thiazolidinedione

Question 35

What is special use of GLP1 agonists

Answer 35

CVS