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49 Cards in this Set
- Front
- Back
What is the treatment strategy for patients with T1DM? |
- Low-sugar diet
- Insulin replacement |
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What is the treatment strategy for patients with T2DM?
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- Dietary modification and exercise for weight loss
- Oral agents, non-insulin injectables, insulin replacement |
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What is the treatment strategy for patients with gestational diabetes mellitus?
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- Dietary modifications
- Exercise - Insulin replacement if lifestyle modification fails |
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What is the mechanism of insulin and effect on different tissues?
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Rapid-acting forms of insulin |
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What are the possible side effects of the different insulin formulations?
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- Hypoglycemia
- Rare hypersensitivity reactions |
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What are the types of rapid acting insulin?
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- Lispro
- Aspart - Glulisine |
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What are the clinical uses of Lispro, Aspart, and Glulisine?
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Rapid-acting forms of insulin:
- DM1, DM2, and GDM * Used for post-prandial glucose control |
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What are the types of short acting insulin?
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Regular insulin
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What are the clinical uses of regular insulin?
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Short-acting form of insulin:
- DM1, DM2, GDM, and DKA - Administered w/ IV - Hyperkalemia (+ glucose) - Stress hyperglycemia |
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What are the types of intermediate acting insulin?
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NPH Insulin
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What are the clinical uses of NPH insulin?
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Intermediate acting insulin:
- DM1, DM2, GDM |
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What are the types of long acting insulin?
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- Glargine
- Detemir |
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What are the clinical uses of Glargine and Detemir?
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Long-acting forms of insulin:
- DM1, DM2, GDM - Basal glucose control |
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What type of diabetes drug is a "biguanide"?
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Metformin
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What kind of drug is Metformin? Mechanism?
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- Biguanide
- Exact mechanism is unknown - ↓ Gluconeogenesis, ↑ Glycolysis, ↑ Peripheral glucose uptake (↑ insulin sensitivity) |
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When is Metformin used? When is it contraindicated?
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- 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) |
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How is Metformin administered? Toxicities?
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- Oral
- May cause GI upset - Most serious adverse effect is lactic acidosis (thus contraindicated in renal failure) |
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What are the first-generation sulfonylureas?
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- Tolbutamide
- Chlorpropamide |
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What are the second-generation sulfonylureas?
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- Glyburide
- Glimepiride - Glipizide |
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What is the mechanism of the sulfonylureas (tolbutamide, chlorpropamide, glyburide, glimepiride, glipizide)?
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- Closes K+ channels in β-cell membrane
- Depolarizes → triggering insulin release via ↑ Ca2+ influx |
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What are the uses of sulfonylureas (tolbutamide, chlorpropamide, glyburide, glimepiride, glipizide)?
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- Stimulates release of endogenous insulin in T2DM
- Not effective in T1DM because it requires some islet function |
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What are the possible side effects of sulfonylureas (tolbutamide, chlorpropamide)?
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- Risk of hypoglycemia ↑ in renal failure
- Disulfiram-like effects (only in 1st generation) |
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What are the possible side effects of sulfonylureas (glyburide, glimepiride, glipizide)?
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Risk of hypoglycemia ↑ in renal failure
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What are the glitazone / thiazolidinedione drugs?
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- Pioglitazone
- Rosiglitazone |
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What is the mechanism of the glitazone / thiazolidinedione drugs (Pioglitazone and Rosiglitazone)?
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- ↑ 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) |
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What are the uses of glitazone / thiazolidinedione drugs (Pioglitazone and Rosiglitazone)?
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Used as monotherapy in T2DM or combined with:
- Insulin - Metformin (biguanide) - Sulfonylureas (tolbutamide, chlorpropamide, glyburide, glimepiride, and glipizide) |
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What are the possible side effects of glitazone / thiazolidinedione drugs (Pioglitazone and Rosiglitazone)?
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- Weight gain
- Edema - Hepatotoxicity - Heart failure |
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What are the α-glucosidase inhibitor drugs for diabetes?
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- Acarbose |
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What is the mechanism of Acarbose and Miglitol?
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- Inhibits intestinal brush-border α-glucosidases
- Delayed sugar hydrolysis and glucose absorption → ↓ post-prandial hyperglycemia |
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What are the uses of the α-glucosidase inhibitors (Acarbose and Miglitol)?
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Used as monotherapy in T2DM or in combination with:
- Insulin - Metformin (biguanide) - Sulfonylureas (tolbutamide, chlorpropamide, glyburide, glimepiride, and glipizide) - Glitazones / Thiazolidinediones (pioglitazone and rosiglitazone) |
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What are the possible side effects of the α-glucosidase inhibitors (Acarbose and Miglitol)?
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GI disturbances (farting)
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What drug for diabetes is an analog of amylin?
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Pramlinitide
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What is the mechanism and uses of Pramlinitide?
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- Amylin analog |
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What are the potential side effects of Pramlinitide?
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- Hypoglycemia
- Nausea - Diarrhea |
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What are the GLP-1 analogs?
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- Exenatide
- Liraglutide |
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What are the actions and uses of Exenatide and Liraglutide?
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GLP-1 analogs:
- ↑ insulin - ↓ glucagon release - Used for T2DM only |
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What are the potential side effects of Exenatide and Liraglutide?
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Nausea, vomiting, pancreatitis
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What diabetes drugs are DPP-4 inhibitors?
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- Linagliptin
- Saxagliptin - Sitagliptin |
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What are the actions and uses of Linagliptin, Saxagliptin, and Sitagliptin?
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DPP-4 inhibitors
- ↑ insulin - ↓ glucagon release - Used for T2DM only |
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What are the possible side effects of Linagliptin, Saxagliptin, and Sitagliptin?
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Mild urinary or respiratory infections
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What diabetes drugs can cause hypersensitivity reactions?
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Types of insulin
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What diabetes drugs can cause lactic acidosis?
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Metformin (biguanide)
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What diabetes drugs can cause a disulfiram like effect?
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First generation Sulfonylureas:
- Tolbutamide - Chlorpropamide |
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What diabetes drugs can cause hepatotoxicity?
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Glitazones / Thiazolidinediones:
- Pioglitazone - Rosiglitazone |
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What diabetes drugs can cause GI disturbances (farting)?
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α-glucosidase inhibitors:
- Acarbose - Miglitol |
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What diabetes drugs can cause weight gain?
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Glitazones / Thiazolidinediones:
- Pioglitazone - Rosiglitazone |
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What diabetes drugs can cause heart failure?
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Glitazones / Thiazolidinediones:
- Pioglitazone - Rosiglitazone |
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What diabetes drugs can cause pancreatitis?
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GLP-1 analogs:
- Exenatide - Liraglutide |
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What diabetes drugs can cause mild urinary or respiratory infections?
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DPP-4 inhibitors:
- Linagliptin - Saxagliptin - Sitagliptin |