Pharm Final: DM (PPT)

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Pharm Final: DM (PPT)
2013-04-06 09:00:49

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  1. Which drugs address glucose influx?
  2. Which drugs target insulin resistance?
    • 1. TZDs
    • 2. Metformin
    • 3. Dopamine agonist
  3. Which drugs target glucagon secretion?
    • 1. GLP 1 Mimetic
    • 2. Symlin (amlyn)
    • 3. DPP4 Inhibitor
  4. Which drugs target insulin supply (ACUTE beta cell function)?
    • 1. Sulfonylureas (Glipizide, Glyburide)
    • 2. Glinides (Prandin)
  5. Which drugs target Insulin supply (Chronic B-cell function)?
  6. T or F. Glinides are short-acting and target post-prandial well.
    True (Prandin)--> TID 30-45min before meal
  7. What is the MOA of SFU & nonSFU?
    BIND to ATP-dependent K+ channel of B-cell --> stopping K efflux increasing depolarization of cell--> causing increased insulin secretion
  8. Why is SFU NOT considered first line therapy?
    • High secondary failure rate
    • -Glyburide (non-selective 1st gen) is NOT heart friendly b/c effect K+channels in heart as well and has increased risk for hypoglycemia (esp at night in older people).
  9. T or F. Metformin does NOT causes hypoglycemia or wt gain.
    True (works on liver and targets how much glucose put out by liver)
  10. MOA: Metformin
    • Activates 5AMPK (enhances GLP1 effects
    • -Decrease glyconeogensis & increase sk-muscle glucose uptake
  11. T or F. Metformin has a risk of causing kidney damage.
    False--> just needs functioning kidneys, doesn't actually cause damage
  12. What supplements should be considered for people taking metformin?
    Vit B12
  13. MOA: TZDs
    • -Involved in gene expression
    • -PPAR seletive agonist--> to increase GLUT-4 transport
  14. What are some S/E of TZD?
    • -Wt gain
    • -Edema
    • -CHF
    • -Acts on lipids
  15. What patients should NOT receive TZDs?
    CHF (Actos/Avandia--> Black Box Warning)
  16. MOA: Alpha Glucosidase Inhibitors
    • -Inhibits pancreatic & intestinal enzymes found in small intestine
    • -Prevents breakdown of complex starch
    • -Defers digestion & absorption distally
  17. What is a common S/E of a-glucosidase inhibitor?
    • Flatulence
    • -Contraindicating in IBD, cirrhosis
  18. T or F. Orange juice should NOT be used in hypoglycemia from AGIs.
  19. Discuss Incretins
    • -Hormones in gut
    • -Nutrient entry in stomach-->release incretins--> stim insulin secretion
  20. Glucagon is made by which cells?
    Alpha cells
  21. What are 5 effects GLP-1?
    • 1. Reduce appetite
    • 2. Alpha cells: decrease postprandial glucagon secretion
    • 3. Liver: Decrease glucagon reduces output of sugar
    • 4. Stomach: Slows stomach emptying
    • 5. Beta cells: Enhances insulin secretion
  22. MOA: GLP-1 Analogs
    • Mimic GLP-1
    • -Glucagon suppression
    • -Enhances insulin/amylin secretion (only during hyperglycemia)
    • -Delays gastric empything
    • -Enhances satiety
    • **OK to miss a meal
  23. What is the Black Box Warning of GLP-1 (Victoza)?
    Risk of Thyroid C-Cell Tumor
  24. MOA: DPP-IV Inhibitors
    • -DDP-IV is an enzyme that breaks down GLP-1 so inhibitors block the enzyme, increasing GLP-1
    • -Tumor inhibition enzyme
  25. What are some SE of DPP-IV Inhibitor?
    • -weight NEUTRAL
    • -Rare GI
    • -H/A
    • -Nasopharyngitis
    • -URI
    • **suppressing immunity??
  26. What are 2 major concerns for DPP-IV Inhibitors?
    • 1. Hemorrhagic/necrotizing pancreatitis (watch for abd pain w/ vomiting)
    • 2. Cancer concern
  27. What hormone is co-secreted with insulin from Beta cell?
    Amylin (in response to food)
  28. What are 3 effects of Amylin?
    • 1. Inhibits glucagon secretion
    • 2. Delays gastric emptying
    • 3. Satiety agent
  29. T or F. Amylin should NOT be taken with insulin.
    F--> Take TID before meals WITH prandial insulin
  30. What are 2 contraindications for Amylin Analog?
    • 1. Gastroparesis
    • 2. Hypoglycemia unawareness
  31. What is the Black Box Warning for Symlin?
    Increased risk of insulin-induced severe hypoglycemia, particularly in Type 1 diabetes
  32. Amlin causes weigh gain or weight loss?
    • -weight LOSS
    • -reduces meal-time insulin dose
    • -hypoglycemia
    • -GI: N/V, anorexia
  33. MOA: dopamine agonist?
    • Unknown
    • -NON-insulin mediated glucose disposal
  34. What are S/E of Dopamine Agonists?
    • -Hypotension
    • -Somnolence
    • -Rhinitis
    • -H/A
  35. What are 2 precautions for dopamine agonists?
    • -Liver impairment
    • -Nursing mothers
  36. How is BAS best used?
    In combo with either SFU or metformin
  37. What is a precaution for BAS?
    Increase TG
  38. What are examples of Basal Insulins?
    • Intermediate--> Novolin/Humulin N
    • Long acting--> Lantus (glargine) & Levemir (Detemir)
  39. What are examples of Bolus insulin?
    • -Short acting--> Humulin/Novolin R
    • -Rapid acting--> Humulog (Lispro), Novolog (aspart) & Apidra (glulisine)
  40. Should pregnant women receive lantus?
  41. What needs to be considered with regular insulin?
    -Need to take 30min before meal, can last up to 6-8hrs so can overlap with sequential doses
  42. What are 2 concerns w/ Insulin?
    • 1. Hypoglycemia
    • 2. Hypertrophy of subQ fat (rotate sites)