Podcast
Questions and Answers
Which class of drugs is primarily used as a first-line treatment for patients newly diagnosed with uncomplicated type 2 diabetes?
Which class of drugs is primarily used as a first-line treatment for patients newly diagnosed with uncomplicated type 2 diabetes?
Which of the following adverse effects is most commonly associated with insulin therapy?
Which of the following adverse effects is most commonly associated with insulin therapy?
What is the primary action mechanism of metformin in managing blood glucose levels?
What is the primary action mechanism of metformin in managing blood glucose levels?
Which medication should be used with caution due to the risk of lactic acidosis in patients with renal impairment?
Which medication should be used with caution due to the risk of lactic acidosis in patients with renal impairment?
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In which case should hypoglycemic patients being treated with acarbose use glucose instead of sucrose?
In which case should hypoglycemic patients being treated with acarbose use glucose instead of sucrose?
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What is a common adverse effect associated with the use of alpha-glucosidase inhibitors such as acarbose?
What is a common adverse effect associated with the use of alpha-glucosidase inhibitors such as acarbose?
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Which of the following drugs is considered a DPP4 inhibitor?
Which of the following drugs is considered a DPP4 inhibitor?
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What is a significant contraindication for using metformin?
What is a significant contraindication for using metformin?
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What is a potential risk associated with the use of gliclazide and glimepiride?
What is a potential risk associated with the use of gliclazide and glimepiride?
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What type of insulin is best suited for postprandial glucose management?
What type of insulin is best suited for postprandial glucose management?
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Which of the following drugs can lead to dysglycemia as a common side effect?
Which of the following drugs can lead to dysglycemia as a common side effect?
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Which of the following statements is true regarding meglitinides like repaglinide?
Which of the following statements is true regarding meglitinides like repaglinide?
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What is a key effect of sodium-glucose cotransporter 2 inhibitors like canagliflozin?
What is a key effect of sodium-glucose cotransporter 2 inhibitors like canagliflozin?
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What adverse effect is associated with thiazolidinediones like pioglitazone?
What adverse effect is associated with thiazolidinediones like pioglitazone?
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Which of the following describes a function of thiazolidinediones in managing diabetes?
Which of the following describes a function of thiazolidinediones in managing diabetes?
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What is one of the cardiovascular benefits noted with sodium-glucose cotransporter 2 inhibitors?
What is one of the cardiovascular benefits noted with sodium-glucose cotransporter 2 inhibitors?
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What adverse effect may result from using sodium-glucose cotransporter 2 inhibitors?
What adverse effect may result from using sodium-glucose cotransporter 2 inhibitors?
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What is required before prescribing rosiglitazone, as per regulations?
What is required before prescribing rosiglitazone, as per regulations?
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Which of the following drugs is contraindicated in patients with irritable bowel syndrome?
Which of the following drugs is contraindicated in patients with irritable bowel syndrome?
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What is a primary characteristic of dipeptidyl peptidase-4 inhibitors?
What is a primary characteristic of dipeptidyl peptidase-4 inhibitors?
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Which of the following is true regarding glucagon-like peptide-1 receptor agonists?
Which of the following is true regarding glucagon-like peptide-1 receptor agonists?
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Which adverse effect is most commonly associated with the initiation of glucagon-like peptide-1 receptor agonists?
Which adverse effect is most commonly associated with the initiation of glucagon-like peptide-1 receptor agonists?
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Which sulfonylurea is associated with a higher risk of hypoglycemia?
Which sulfonylurea is associated with a higher risk of hypoglycemia?
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What effect do dipeptidyl peptidase-4 inhibitors have on weight?
What effect do dipeptidyl peptidase-4 inhibitors have on weight?
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What is a concern when using glucagon-like peptide-1 receptor agonists in patients with certain conditions?
What is a concern when using glucagon-like peptide-1 receptor agonists in patients with certain conditions?
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How do sulfonylureas mainly function in relation to insulin?
How do sulfonylureas mainly function in relation to insulin?
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Which of the following adverse effects is shared by both glucagon-like peptide-1 receptor agonists and sulfonylureas?
Which of the following adverse effects is shared by both glucagon-like peptide-1 receptor agonists and sulfonylureas?
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Which medication class is often considered add-on therapy to metformin, rather than used alone?
Which medication class is often considered add-on therapy to metformin, rather than used alone?
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Study Notes
Drugs Affecting Glycemic Control
- Beta-blockers, corticosteroids, HMG-CoA reductase inhibitors, thiazide or loop diuretics, protease antiviral medications, and second-generation antipsychotics can all cause dysglycemia.
- Insulin is a hormone that helps regulate blood glucose levels. Insulin is classified by its onset and duration of action. Rapid-onset insulin is used for postprandial injections and insulin pumps, while long-acting insulin is used for basal infusions.
- The most common adverse effects of insulin are hypoglycemia, localized fat hypertrophy, and allergic reactions.
- Metformin is a biguanide that is generally considered first-line therapy for patients with type 2 diabetes. It decreases hepatic glucose production and is not associated with weight gain.
- Adverse effects of metformin include nausea, diarrhea, abdominal discomfort, anorexia, metallic taste, lactic acidosis, and vitamin B12 deficiency.
- Acarbose is an alpha-glucosidase inhibitor that inhibits intestinal alpha-glucosidases, resulting in delayed digestion of starches and disaccharides.
- Acarbose requires TID dosing and is only effective when taken with meals.
- Adverse effects of acarbose include flatulence, diarrhea, abdominal pain, cramps, and nausea.
- Sitagliptin is a DPP4 inhibitor that inhibits the enzyme responsible for the degradation of GLP-1 and other peptides. It indirectly acts as an incretin mimetic.
- DPP4 inhibitors do not seem to alter cardiovascular risk, lower HbA1c, and do not cause weight gain.
- Adverse effects of DPP4 inhibitors include nasopharyngitis, hypersensitivity reactions, pancreatitis, and severe joint pain.
- Semaglutide and liraglutide are GLP-1 receptor agonists that act on GLP-1 receptors. These medications increase insulin secretion, suppress postprandial glucagon secretion, slow gastric emptying, and increase satiety.
- GLP-1 receptor agonists can be given subcutaneously.
- Adverse effects of GLP-1 receptor agonists include GI adverse effects, injection site reactions, and acute pancreatitis.
- Glyburide is a sulfonylurea that stimulates both basal and meal-stimulated insulin release. It is generally considered add-on therapy to metformin.
- Glyburide is associated with a higher risk of hypoglycemia and weight gain compared to other sulfonylureas.
- Adverse effects of sulfonylureas include weight gain, prolonged hypoglycemia, and beta-blockers may mask hypoglycemic symptoms.
- Repaglinide is a meglitinide that stimulates insulin release but has a much shorter effect than sulfonylureas.
- Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that prevents glucose reabsorption in the kidneys. It leads to enhanced glucose excretion and does not cause weight gain.
- Adverse effects of sodium-glucose cotransporter 2 inhibitors include an increased risk of genitourinary infections, reduced intravascular volume resulting in hypotension, and hyperkalemia.
- Pioglitazone is a thiazolidinedione that acts as an agonist at peroxisome proliferator-activated receptor gamma (PPARG) receptors. This influences gene expression, including upregulation of GLUT4 transporters and lipoprotein lipase.
- Thiazolidinediones cause increased peripheral glucose uptake, enhanced fat cell sensitivity to insulin, decreased hepatic glucose output, and reduce HbA1c. They are associated with weight gain.
- Adverse effects of thiazolidinediones include an increased incidence of heart failure, increased risk of fractures (hip and wrist), and worsening macular edema.
Goals of Therapy
- Control symptoms
- Establish and maintain glycemic control while avoiding hypoglycemia
- Prevent or minimize acute and chronic complications
- Achieve optimal control of risk factors such as hypertension, obesity, and dyslipidemia
Nonpharmacologic Interventions
- Diet, exercise, and self-monitoring are vital for glycemic control.
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Description
Explore the various classes of drugs that can influence glycemic control, including insulin, metformin, and acarbose. Understand the mechanisms, uses, and adverse effects associated with these medications. This quiz aims to enhance your knowledge on managing diabetes pharmacologically.
