DM

Question 1

primary defect in T1DM

Answer 1

pancreatic beta cells due to autoimmune process

Question 2

defects in T2DM

Answer 2

• Insulin resistance and impaired insulin secretion
• Hyperinsulinemia- relatively new T2DM bc pancreas is releasing insulin but cells are resistant
• Insulin resistance

Question 3

insulin lispro

Answer 3

onset- 15-30 minutes
peak 30 minutes - 2- 2.5 hrs
duration 3-6 hrs

Question 4

insulin lispro peak

Answer 4

30 minutes- 2.5 hrs

Question 5

insulin lispro duration

Answer 5

3-6 hours

Question 6

insulin aspart (novolog) onset

Answer 6

10-20 minutes
peak 1-3 hrs
duration 3-5 hrs

Question 7

insulin aspart - novolog- peak

Answer 7

1-3hours

Question 8

insulin aspart-novolog- duration

Answer 8

3-5 hrs

Question 9

insulin glulisine-aprida onset

Answer 9

10-15 minutes
peak 1 - 1.5 hrs
duration 3-5 hrs

Question 10

insulin glulisine aprida peak

Answer 10

1 - 1.5 hrs

Question 11

insulin glulisine - aprida- duration

Answer 11

3-5 hrs

Question 12

regular insulin onset, peak, duration

Answer 12

onset- 30 - 60 mins
peak 1 -5 hrs
duration 6-10 hrs

Question 13

NPH

Answer 13

onset 60-120 minutes
peak 6-14 hrs
duration 18-24 hrs

Question 14

insulin glargine

Answer 14

onset 70 min
peak none
duration 18-24 hrs

Question 15

insulin detemir

Answer 15

onset 60 - 120 min
peak 12 - 24 hrs
duration varies

Question 16

insulin degludec

Answer 16

onset 60 min
peak none
duration 42 hrs

Question 17

metformin MOA

Answer 17

lowers BG and improves glucose tolerance in 3 ways
1- Inhibits glucose production in the liver
2- Reduces (slightly) glucose absorption in gut
3- Sensitizes insulin receptors in target tissues (fat and muscle) and thereby increases glucose uptake in response to whatever insulin may be available

Question 18

Metformin metabolized where

Answer 18

none, absorbed in small intestine

Question 19

metformin excretion

Answer 19

kidneys

Question 20

metformin AE

Answer 20

• most common GI- decreased appetite, nausea, diarrhea (subside w/time)
• does not cause wt gain, wt neutral drug
• BLACK BOX- lactic acidosis
o Avoid in ppl w/ liver disease, severe infection, hx of lactic acidosis, renal insufficiency, etoh excess, show and conditions that can result in hypoxemia, HF (predisposes)

Question 21

sulfonylurea MOA

Answer 21

stimulating release of insulin and increasing cell sensitivity

Question 22

sulfonylurea AE

Answer 22

hypoglycemia

wt gain

Question 23

metaglindines aka glidines

Answer 23

nateglidine, repaglinide

• Same MOA of sulfonylureas- stimulation of pancreatic insulin release
• Difference between sulfonylureas and glinides is that glinides are shorter acting and taken w/ each meal
• AE- hypoglycemia

Question 24

Thiazolidinediones (glitazones)

Answer 24

• Reduce glucose levels primarily by decreasing insulin resistance
• Rosiglitazone [Avandia]: Restricted use
• Pioglitazone [Actos

Question 25

Pioglitazone [Actos] black box

Answer 25

associated with HF d/t renal retention of fluid. If HF dx, drug should be dc or dose reduced

Question 26

Alpha-glucosidase inhibitors acarbose

Answer 26

• Act in intestine to delay the absorption of carbohydrates and thereby reduces rise in post prandial rise in BGL

Question 27

Alpha-glucosidase inhibitors acarbose AE

Answer 27

Frequently causes flatulence, cramps, abdominal distention, borborygmus, diarrhea, and liver dysfunction

Question 28

[dipeptidyl peptidase-4 inhibitor] gliptin moa

Answer 28

• Promote glycemic control by enhancing the actions of incretin hormones 1- Stimulate glucose-dependent release of insulin 2- Suppress postprandial release of glucagon (hormone that decreases glucose production in liver)

Question 29

dipeptidyl peptidase-4 inhibitor] gliptin excretion

Answer 29

kidneys renal dosing

Question 30

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors MOA

Answer 30

* Block reabsorption of filtered glucose in the kidney, leading to glucosuria * Work by lowering threshold for glucose excretion from kidney, excretes glucose out of urine

Question 31

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors AE

Answer 31

• Side effects: Genital fungal infections in female patients, urinary tract infections, increased urination

Question 32

Glucon-Like Peptide -1 (GLP-1 mimetics)

Answer 32

• Incretin mimetics, augments effects of incretin hormone GLP1

Question 33

Glucon-Like Peptide -1 (GLP-1 mimetics) MOA

Answer 33

• Slow gastric emptying, stimulate glucose-dependent release of insulin, inhibit postprandial release of glucagon, and suppress appetite

Question 34

Amylin mimetics

Answer 34

 Pramlintide [Symlin]  Reduces postprandial bgl by delaying gastric emptying and suppressing glucagon secretion  Adverse effects: Hypoglycemia and nausea, injection site reactions

Question 35

Glucon-Like Peptide -1 (GLP-1 mimetics)

Answer 35

• Exenatide [Byetta] o Adverse effects: Hypoglycemia and gastrointestinal effects, including pancreatitis • Liraglutide [Victoza] o May cause medullary thyroid carcinoma (MTC)