Diabetes Drugs

Front 1

What are the common symptoms of diabetes

Back 1

1.Polyuria

2. Polydispia

3. Polyphagia

Front 2

What is the Fasting Glucose and the Post Meal Glucose levels for diabetics

Back 2

Fasting Glucose = ≥7

Post Meal Glucose = ≥11

Front 3

What is a normal glucose level

Back 3

4.4-6.1 mmol/L

Front 4

What is Type 1 Diabetes

Back 4

Autoimmune destroys beta cells

Insulin dependent/Juvenile onset

Front 5

What is type 2 diabetes

Back 5

Insulin resistant

Non insulin dependent/maturity onset

Front 6

What are 4 things Diabetes is caused by

Back 6

1. Decreased insulin secretion

2. Insulin resistance

3. Excess glucagon & corticosteroids

4. Anti-insulin Antibody

Front 7

Which 6 tissues are insulin sensitive

Back 7

1. Skeletal, Cardiac, Smooth Muscle

2. Adipose

3. Leukocytes

4. Pituitary

Front 8

Which 5 tissues are non insulin senstivie

Back 8

1. Brain

2. Kidney

3. Intestinal

4. RBC

5. Endothelium

Front 9

What are 3 defects you see in diabetes

Back 9

1. Increased Extracellular glucose

2. Decreases Intracellular glucose (insulin sensitive)

3. Increase Intracellular glucose (non insulin sensitive)

Front 10

What are the 4 long term complications of Diabetes

Back 10

1. Micro and macro vessel disease

2. Retinopathy

3. Nephropathy

4. Neuropathy

Front 11

What are the goals of therapy for type 2 diabetes

Back 11

1. Get normal blood glucose

2. Delay/prevent mobility/mortality from long term complications

Front 12

What is the Insulin Synthesis Pathway

Back 12

Preproinsulin => signal sequence removed => proinsulin => chain C removed => insulin (2 chains linked by disulfied bridge)

Front 13

What does 1 Unit of Insulin equal

Back 13

1 Unit = amount of insulin needed to reduce fasting glucose of a rabbit to 45 mg/dL (2.5mM)

Front 14

What is the Short Acting Insulin Medication

Back 14

Insulin Lispro

Front 15

1. What is Insulin Lispro an analog of

2. What is its duration

3. What is its impact on Pharmacodynamics

Back 15

1.Insulin (Amino acid 28 & 29 in beta chain reversed)

2. Rapid absorption and short action

3. No impact on pharmacodynamics

Front 16

1.When do you use Insulin Lispro

2. Which type of diabetes is it used in

Back 16

1. 15 min before a meal (typical insulin 30-45 min before meal)

2. Type 1 and late stage Type 2

Front 17

What are the benefits of Insulin Lispro

Back 17

Decrease incidence and risk of hypoglycaemia

Front 18

1.What are the 2 long acting insulin medications

2. When are they good to use

Back 18

1. a. insulin Glargine

b. insulin Detemir

2. Good for bedtime

Front 19

What are the 3 benefits of using long acting insulin medication

Back 19

1. Slowly absorbed

2. Long duration (20.5 hours)

3. Loss of nocturnal hypoglycemia

Front 20

What are the 3 adverse effects of Glargine

Back 20

1. Pain at injection site

2. Possible tumor growth

3. Can not be diluted or mixed with any other insulins

Front 21

What are 3 new types of technology for insulin administrations

Back 21

1. Nasal spray

2. Insulin inhaler

3. Insulin pump (juvennile diabetes research fund)

Front 22

What 5 things decrease the actions of Insulin

Back 22

1. Glucocorticoids

2. Glucagon

3. Epinephrine

4. Growth Hormone

5. Thyroid Hormone

Front 23

What 5 things increase the actions of Insulin

Back 23

1. ACEi

2. Alcohol

3. Salicylates

4. Beta Blocker

5. MAO inhibitor

Front 24

What are the side effects of Insulin

Back 24

1. Hypoglycemia (Hunger, sweating, blurred vision, death, be careful in elderly)

2. Lipotrophy (loss of fat)

3. Allergy

Front 25

What are the 2 Sulfonylureas

Back 25

1. Gilburide

2. Tolbutamine

Front 26

What are the MOA of the Sulfonylureas

Back 26

1. Release insulin from beta cells

2. Reduce Glucagon from blood

3. Potentiate the action of insulin

Front 27

What are the adverse effects of the Sulfonylureas

Back 27

1.Hypoglycemia

2.Secondary failure (don't work as well as time goes on)

3.Skin rash, photosensitivity, GI, intolerance to alcohol

Front 28

What is the meglitinide

Back 28

Repaglinide

Front 29

What is the MOA of Repalglinide

Back 29

1. Increase insulin secretion by binding to ATP sensitive K+ channels at a distinct site from that of sulphonylurea

Front 30

What are the adverse effects of Repalglinide

Back 30

1. Weight gain

Front 31

What medication is in the Biguanide class

Back 31

Metformin

Front 32

What is the MOA of metformin

Back 32

Not fully understood

Activated cylic AMP activated protein kinase which reduces glucose release from the liver

Front 33

What are the uses for Metformin

Back 33

1. Euglycemic rather than hypoglycaemic

2. Mild weight loss

Front 34

What is the metabolism of metformin

Back 34

Not metabolized therefore excreted through kidneys as active form

(less secondary failure)

Front 35

What is the adverse effects of the early forms of metformin (i.e. phenformin)

Back 35

Killed patients from lactic acidosis

Front 36

What are the 2 Glitazones

Back 36

1. Rosglitazone

2. Pioglitazone

Front 37

What is the MOA of the Glitazones

Back 37

1. Decrease insulin resistance by binding nuclear receptors that regulate genes responsible for lipid metabolism

2. Decrease gluconeogenesis, glucose output and TG synthesis in liver

3. Increase glucose uptake in skeletal muscle and adipose

Front 38

What is the metabolism of Glitazones

Back 38

Liver (CYP)

Better absorbed with food

Front 39

What are Glitazones used for

Back 39

1. Type 2 diabetes (not 1st line more adjunct with metformin) (need > 30 units of insulin a day and HgbA1C > 8.5%)

Front 40

What is the Glucosidase inhibitor

Back 40

Acarbose

Front 41

Who does Acarbose work well with

Back 41

Elderly

Front 42

What is the MOA of Acarbose

Back 42

Acts ONLY on gut and slows CHO breakdown

Front 43

What do you use Acarbose for

Back 43

Type 2 diabetes

Front 44

What are the side effects of Acarbose

Back 44

Bloating and farting

Front 45

What is the MOA of Orlistat

Back 45

Blocks intestinal lipase

Reduce absorption of dietary fat

Front 46

When is Orlistat effective

Back 46

Only at meal time

Front 47

What is the use of Orlistat

Back 47

Improve insulin sensitivity

Front 48

What are the side effects of Orlistat

Back 48

Fatty stool, nausea, diarrhea

Front 49

What is Pramlintide

Back 49

Synthetic analog of Amylin

(amylin = hormone co-secreted with insulin from beta cells)

Front 50

What is the MOA of Pramlintide

Back 50

Suppresses glucagon secretion

Decreases glucose absorption from gut

Front 51

What are the uses of Pramlintide

Back 51

Mixed with regular insulin just before injecting

Good for type 1 and 2

Front 52

What are incretins

Back 52

Glucagon like peptides (GLP-1)

Front 53

What are the function of incretins

Back 53

Mimics effects of insulin

Front 54

When are incretins secreted

Back 54

after a meal

Front 55

What are the 2 types of DPP-4 Inhibitors

Back 55

1. Sitagliptin-PO4

2. Saxagliptin

Front 56

What is the function of DDP-4

Back 56

breaks down GLP-1

Front 57

What type of diabetes do you use the DPP-4 inhibitors

Back 57

Type 2 diabetes

Front 58

What is the side effect of DDP-4 inhibitors

Back 58

anaphylaxis

Front 59

What are the two types of GLP-1 Analoges

Back 59

1. Exenatide

2. Liraglutide

Front 60

What is the function of the GLP-1 Analoges

Back 60

1.Enhances insulin secretion

2.Suppresses Glucagon secretion during hyperglycemia

3.Decreases food intake and slows gastric emptying

Front 61

Can you use Exenatide alone

Back 61

No, used in adjunct with metformin or sulphonylurea

Front 62

What is Exenatide

Back 62

Synthetic version of Extendin-4

Front 63

Is Exenatide hyper, hypo, or euglycemic on its own

Back 63

Euglycemic

Front 64

What are the side effects of exenatide

Back 64

1. Pancreatitis

2. Renal dysfunction

Front 65

What is Dapaglifozin

Back 65

Sodium Glucose Transport Protein 2 inhibitor (SGLT-2)

Front 66

What is the MOA of Dapagliflozin

Back 66

Works in kidney to prevent reabsorption of glucose

Front 67

What are the side effects of Dapaglaiflozin

Back 67

Glycosuria

Hypotension, UTI, bladder infection

Front 68

What is the treatment option for Type 1 (insulin dependent) Diabetes

Back 68

Control blood glucose with insulin and diet

Front 69

What are the treatment options for type 2 (non insulin dependent) diabetes

Back 69

1. Diet (exercise does not work)

2. Mild = oral hypoglycemic as 1st line

3. Oral combination therapy and diet

4. Insulin

5. Reduce hypertension (to prevent complications)

Front 70

What are some future therapies of Diabetes

Back 70

1. CGM + insulin pump

2. Beta cell transplantation

3. Aldose reductase inhibitors

4. Dapagliflozin

Front 71

How do you treat diabetes in the elderly

Back 71

1. Oral agent

2. Sulfonylurea used with causation because of hypoglycemia

3. Doses should be halved and increased slowly

Front 72

What are the steps for type 2 diabetes

Back 72

1. Nonpharmacotherapy

2. Oral agent monotherapy

3. Oral combination therapy

4. Bedtime insulin +/- oral agent

5. Insulin injections 1-4 days