Fa: Endocrine - Pharmacology - 1

Front 1

What is the treatment strategy for patients with T1DM?

Back 1

- Low-sugar diet
- Insulin replacement

Front 2

What is the treatment strategy for patients with T2DM?

Back 2

- Dietary modification and exercise for weight loss
- Oral agents, non-insulin injectables, insulin replacement

Front 3

What is the treatment strategy for patients with gestational diabetes mellitus?

Back 3

- Dietary modifications
- Exercise
- Insulin replacement if lifestyle modification fails

Front 4

What is the mechanism of insulin and effect on different tissues?

Back 4

Rapid-acting forms of insulin
- Bind insulin receptor (tyrosine kinase activity)
- Liver: ↑ glucose stored as glycogen
- Muscle: ↑ glycogen, protein synthesis, ↑ K+ uptake
- Fat: ↑ TG storage

Front 5

What are the possible side effects of the different insulin formulations?

Back 5

- Hypoglycemia
- Rare hypersensitivity reactions

Front 6

What are the types of rapid acting insulin?

Back 6

- Lispro
- Aspart
- Glulisine

Front 7

What are the clinical uses of Lispro, Aspart, and Glulisine?

Back 7

Rapid-acting forms of insulin:
- DM1, DM2, and GDM
* Used for post-prandial glucose control

Front 8

What are the types of short acting insulin?

Back 8

Regular insulin

Front 9

What are the clinical uses of regular insulin?

Back 9

Short-acting form of insulin:
- DM1, DM2, GDM, and DKA
- Administered w/ IV
- Hyperkalemia (+ glucose)
- Stress hyperglycemia

Front 10

What are the types of intermediate acting insulin?

Back 10

NPH Insulin

Front 11

What are the clinical uses of NPH insulin?

Back 11

Intermediate acting insulin:
- DM1, DM2, GDM

Front 12

What are the types of long acting insulin?

Back 12

- Glargine
- Detemir

Front 13

What are the clinical uses of Glargine and Detemir?

Back 13

Long-acting forms of insulin:
- DM1, DM2, GDM
- Basal glucose control

Front 14

What type of diabetes drug is a "biguanide"?

Back 14

Metformin

Front 15

What kind of drug is Metformin? Mechanism?

Back 15

- Biguanide
- Exact mechanism is unknown
- ↓ Gluconeogenesis, ↑ Glycolysis, ↑ Peripheral glucose uptake (↑ insulin sensitivity)

Front 16

When is Metformin used? When is it contraindicated?

Back 16

- First-line therapy for T2DM
- Can be used in patients without islet function (T1DM)

- Contraindicated in renal failure patients (because it can cause lactic acidosis)

Front 17

How is Metformin administered? Toxicities?

Back 17

- Oral
- May cause GI upset
- Most serious adverse effect is lactic acidosis (thus contraindicated in renal failure)

Front 18

What are the first-generation sulfonylureas?

Back 18

- Tolbutamide
- Chlorpropamide

Front 19

What are the second-generation sulfonylureas?

Back 19

- Glyburide
- Glimepiride
- Glipizide

Front 20

What is the mechanism of the sulfonylureas (tolbutamide, chlorpropamide, glyburide, glimepiride, glipizide)?

Back 20

- Closes K+ channels in β-cell membrane
- Depolarizes → triggering insulin release via ↑ Ca2+ influx

Front 21

What are the uses of sulfonylureas (tolbutamide, chlorpropamide, glyburide, glimepiride, glipizide)?

Back 21

- Stimulates release of endogenous insulin in T2DM
- Not effective in T1DM because it requires some islet function

Front 22

What are the possible side effects of sulfonylureas (tolbutamide, chlorpropamide)?

Back 22

- Risk of hypoglycemia ↑ in renal failure
- Disulfiram-like effects (only in 1st generation)

Front 23

What are the possible side effects of sulfonylureas (glyburide, glimepiride, glipizide)?

Back 23

Risk of hypoglycemia ↑ in renal failure

Front 24

What are the glitazone / thiazolidinedione drugs?

Back 24

- Pioglitazone
- Rosiglitazone

Front 25

What is the mechanism of the glitazone / thiazolidinedione drugs (Pioglitazone and Rosiglitazone)?

Back 25

- ↑ Insulin sensitivity in peripheral tissue
- Binds to PPAR-γ nuclear transcription regulator (genes activated by PPAR-γ regulate FA storage and glucose metabolism; this ↑ insulin sensitivity and levels of adiponectin)

Front 26

What are the uses of glitazone / thiazolidinedione drugs (Pioglitazone and Rosiglitazone)?

Back 26

Used as monotherapy in T2DM or combined with:
- Insulin
- Metformin (biguanide)
- Sulfonylureas (tolbutamide, chlorpropamide, glyburide, glimepiride, and glipizide)

Front 27

What are the possible side effects of glitazone / thiazolidinedione drugs (Pioglitazone and Rosiglitazone)?

Back 27

- Weight gain
- Edema
- Hepatotoxicity
- Heart failure

Front 28

What are the α-glucosidase inhibitor drugs for diabetes?

Back 28

- Acarbose
- Miglitol

Front 29

What is the mechanism of Acarbose and Miglitol?

Back 29

- Inhibits intestinal brush-border α-glucosidases
- Delayed sugar hydrolysis and glucose absorption → ↓ post-prandial hyperglycemia

Front 30

What are the uses of the α-glucosidase inhibitors (Acarbose and Miglitol)?

Back 30

Used as monotherapy in T2DM or in combination with:
- Insulin
- Metformin (biguanide)
- Sulfonylureas (tolbutamide, chlorpropamide, glyburide, glimepiride, and glipizide)
- Glitazones / Thiazolidinediones (pioglitazone and rosiglitazone)

Front 31

What are the possible side effects of the α-glucosidase inhibitors (Acarbose and Miglitol)?

Back 31

GI disturbances (farting)

Front 32

What drug for diabetes is an analog of amylin?

Back 32

Pramlinitide

Front 33

What is the mechanism and uses of Pramlinitide?

Back 33

- Amylin analog
- ↓ Gastric emptying
- ↓ Glucagon

- Used for T1DM and T2DM

Front 34

What are the potential side effects of Pramlinitide?

Back 34

- Hypoglycemia
- Nausea
- Diarrhea

Front 35

What are the GLP-1 analogs?

Back 35

- Exenatide
- Liraglutide

Front 36

What are the actions and uses of Exenatide and Liraglutide?

Back 36

GLP-1 analogs:
- ↑ insulin
- ↓ glucagon release

- Used for T2DM only

Front 37

What are the potential side effects of Exenatide and Liraglutide?

Back 37

Nausea, vomiting, pancreatitis

Front 38

What diabetes drugs are DPP-4 inhibitors?

Back 38

- Linagliptin
- Saxagliptin
- Sitagliptin

Front 39

What are the actions and uses of Linagliptin, Saxagliptin, and Sitagliptin?

Back 39

DPP-4 inhibitors
- ↑ insulin
- ↓ glucagon release

- Used for T2DM only

Front 40

What are the possible side effects of Linagliptin, Saxagliptin, and Sitagliptin?

Back 40

Mild urinary or respiratory infections

Front 41

What diabetes drugs can cause hypersensitivity reactions?

Back 41

Types of insulin

Front 42

What diabetes drugs can cause lactic acidosis?

Back 42

Metformin (biguanide)

Front 43

What diabetes drugs can cause a disulfiram like effect?

Back 43

First generation Sulfonylureas:
- Tolbutamide
- Chlorpropamide

Front 44

What diabetes drugs can cause hepatotoxicity?

Back 44

Glitazones / Thiazolidinediones:
- Pioglitazone
- Rosiglitazone

Front 45

What diabetes drugs can cause GI disturbances (farting)?

Back 45

α-glucosidase inhibitors:
- Acarbose
- Miglitol

Front 46

What diabetes drugs can cause weight gain?

Back 46

Glitazones / Thiazolidinediones:
- Pioglitazone
- Rosiglitazone

Front 47

What diabetes drugs can cause heart failure?

Back 47

Glitazones / Thiazolidinediones:
- Pioglitazone
- Rosiglitazone

Front 48

What diabetes drugs can cause pancreatitis?

Back 48

GLP-1 analogs:
- Exenatide
- Liraglutide

Front 49

What diabetes drugs can cause mild urinary or respiratory infections?

Back 49

DPP-4 inhibitors:
- Linagliptin
- Saxagliptin
- Sitagliptin