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Endocrine Pharm
Endocrine Pharm lecture
34
Anatomy
Graduate
07/31/2011

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Term
Diagnosis of diabetes: classic diabetes symptoms (poly's) and weight loss, and a __ __ glucose of greater than or equal to __.
Definition
- random plasma glucose of greater than or equal to 200 mg/dl
Term
Prediabetes is diagnosed by an __ __ __ __ of between _ and __, or an __ __ __ __ of between __ and __.
Definition
- Impaired Fasting Glucose Tolerance of greater than 100 and below 126
- Oral Glucose Tolerance Test (OGTT)of greater than 140 and below 200
Term
A __ __ _ _of greater than or equal to 126 is diagnostic for DM.
Definition
- Fasting Plasma Glucose (FPG)
Term
OGTT greater than or equal to __ is diagnostic of DM.
Definition
200 mg/dl
Term
Diagnostic for DM:
- random palsma glucose greater than or equal to ___
- FPG of greater than or equal to ___
- OGGT of greater than or equal to __
Definition
- 200 mg/dl
- 126 mg/dl
- 200 mg/dl

you can also use HbA1C to diagnose diabetes
Term
Type I DM treatment:
Definition
insulin
Term
TIIDM tmts:
Definition
- PO medications: Sulfonylureas, Meglitides, Biguanides, Thiazolidinediones, alpha-Glucosidase inhibitors, Dipeptidyl Peptidase-4 Inhibitors (DPP-4)
- Incretin mimetics
- Insulin
Term
Don’t forget about lifestyle modifications in the treatment plan:
Diet, exercise, weight control
Regular checkups/blood tests
Regular eye/dental exams
Tobacco cessation
Limit EtOH consumption
Foot care/protection
Definition
Term
Secretagogues are po meds for diabetics and include ___ and ___.
Definition
- Sulfonylureas (Glyburide, Glipizide, Gilmepiride)
- Meglitinides (Repaglinide, Nateglinide)
Term
Glyburide:
Definition
- 2nd generation sulfonylurea secretagogue
- trade names: Micronase, DiaBeta, Glynase
- half life of 1-2 hours, but has active metabolite so has 24 hour action
- 2.5 mg/d
Term
Glipizide:
Definition
- sulfonylurea secretagogue second generation
- trade name: Glucotrol
- 5-40 mg/d
- t1/2= 2-4 hours
Term
Glimepiride:
Definition
- sulfonylurea secretagogue second generation
- trade name: Amaryl 1 mg/d
Term
Contraindications to Sulfonylureas:
Definition
- Ketoacidosis/diabetic coma
- hypersensitivity to the med
Term
Black box warning on sulfonylureas:
Definition
1st generation may increase risk of cardiovascular mortality
Term
Caution use of sulfonylureas with what health issues?
Definition
- renal disease
- hepatic disease
- hypoglycemia
- metabolic stress
Term
Non-sulfonylurea secretagogues bind to sulfonylurea receptor and have same action as sulfonylureas. If sulfonylureas have been tried and did not work, these probably will not work either.
Definition
Term
2 non-sulfonylurea secretagogues:
Definition
- Meglitinide= Repaglinide= Prandin
- D-phenylalanine derivative= Nateglinide= Starlix
Term
Non-sulfonylurea secretagogues are __ acting so they must be taken __ times a day.
Definition
short
3
Term
SE of non-sulfonylurea secretagogues:
Definition
- hypoglycemia
- weight gain
- GI disturbance
- arthralgia
Term
Contraindications to non-sulfonylurea secretagogues :
Definition
- Type I DM
- DKA
Term
what enzyme is involved with metabolism of Repaglinide?
Definition
Cytochrome P450- CYP3A4
Term
Enzyme involved in metabolism of Nateglinide:
Definition
Cytochrome P450- CYP2C9
Term
Big advantage of Biguanides (i.e. Metformin):
Definition
DOES NOT CAUSE HYPOGLYCEMIA OR WEIGHT GAIN
Term
__ is often first line drug for DM. It can be given to __ y/o and older. It requires multiple dosing regimens. It works by decreasing __ __, decreasing __ __ of glucose, and ___ glucose uptake by skeletal muscle cells.
Definition
- Metformin
- 10 y/o and older
- decreasing hepatic gluconeogenesis
- decreasing GI absorption of glucose
- increasing glucose uptake by skeletal muscle cells
Term
SE of Metformin:
Definition
- GI disturbance (doe related)
- weight loss
- metallic taste
Term
Contraindications to Metformin:
Definition
- renal dysfunction (creatinine greater than 1.4) or abnormal creatinine clearance
- CHF
- acute or chronic metabolic acidosis
Term
Black box warning for Biguanides (Metformin):
Definition
lactic acidosis: rare but deadly 50% of the time

MONITOR CREATNINE IN ALL PATIENTS, CHECK GFR IN ELDERLY
Term
What do you need to check in all patients on Metformin?
Definition
- creatinine
- check GFR in elderly
Term
2 types of drugs for DM that do NOT cause hypoglycemia:
Definition
- Biguanides (Metformin)
- Thiazolidinediones (TZDs)
Term
2 drugs that are often first line for DM:
Definition
-Biguanides (Metformin)
- Thiazolidinediones
Term
TZDs are often first line of therapy as monotherapy or combined with __, __ (but not Avandia), or sulfonylureas.
Definition
- Metformin, insulin
Term
TZD mechanism of action:
Definition
- increase insulin sensitivity in muscle, liver, and adipose tissue
- decrease insulin resistance
Term
Black Box for TZDs:
Definition
- contraindicated for NYHA class III and IV, myocardial ischemia
Term
SEs of TZDs;
Definition
- CHANGE IN SERUM LIPIDS (LDL AND HDL)
- MACULAR EDEMA
- weight gain (fluid retention)
- anemia (dilutional)
- ovulation (beware in perimenopausal women)
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