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Questions and Answers
Which of the following is NOT a known effect of metformin?
Which of the following is NOT a known effect of metformin?
- Reduction of serum glucose levels
- Fluid retention
- Increased insulin release from the pancreas (correct)
- Reduced transcription of leptin
What is the main mechanism of action of GLP-1 Agonists (Incretinmimetics)?
What is the main mechanism of action of GLP-1 Agonists (Incretinmimetics)?
- Enhancement of insulin secretion in the presence of glucose (correct)
- Inhibition of insulin secretion
- Enhancement of fatty acid utilization
- Stimulation of glucagon release
Which of the following is a side effect associated with pioglitazone?
Which of the following is a side effect associated with pioglitazone?
- Reduced subcutaneous fat
- Increased risk of bladder cancer (correct)
- Decreased risk of bone fractures
- Enhanced leptin transcription
How does metformin affect fatty acid utilization in cells?
How does metformin affect fatty acid utilization in cells?
Which antidiabetic medication is contraindicated in pregnancy and breastfeeding?
Which antidiabetic medication is contraindicated in pregnancy and breastfeeding?
Which medication can lower HbA1c by approximately 0.8% when used as monotherapy?
Which medication can lower HbA1c by approximately 0.8% when used as monotherapy?
Which medication prevents sucrose breakdown into glucose, making only glucose or dextrose usable during a hypoglycemic episode?
Which medication prevents sucrose breakdown into glucose, making only glucose or dextrose usable during a hypoglycemic episode?
Which medication is contraindicated in patients with irritable bowel syndrome (IBS) and obstruction?
Which medication is contraindicated in patients with irritable bowel syndrome (IBS) and obstruction?
Which medication increases the effectiveness of insulin and can reduce the amount of external insulin required by 30%?
Which medication increases the effectiveness of insulin and can reduce the amount of external insulin required by 30%?
Which medication has a slow onset of approximately 2 months for maximum effect and requires regular liver function tests?
Which medication has a slow onset of approximately 2 months for maximum effect and requires regular liver function tests?
What is the main mechanism of action of Biguanides like metformin?
What is the main mechanism of action of Biguanides like metformin?
Which insulin has a peakless duration of action greater than 42 hours?
Which insulin has a peakless duration of action greater than 42 hours?
Which of the following hypoglycemic agents is suitable for patients with sulfa allergy?
Which of the following hypoglycemic agents is suitable for patients with sulfa allergy?
What is the main adverse effect associated with Nateglinide (Starlix) use?
What is the main adverse effect associated with Nateglinide (Starlix) use?
Which of the following medications can be mixed with rapid-acting insulins without altering kinetics?
Which of the following medications can be mixed with rapid-acting insulins without altering kinetics?
Which enzyme do Dipeptidyl-peptidase-4 (DPP4) Inhibitors inhibit?
Which enzyme do Dipeptidyl-peptidase-4 (DPP4) Inhibitors inhibit?
What is the primary effect of Saxagliptin (Onglyza)?
What is the primary effect of Saxagliptin (Onglyza)?
What side effect is NOT commonly associated with DPP-4 inhibitors?
What side effect is NOT commonly associated with DPP-4 inhibitors?
Which DPP-4 inhibitor can be used in all stages of renal impairment without dose adjustment?
Which DPP-4 inhibitor can be used in all stages of renal impairment without dose adjustment?
What is the mechanism of action of SGLT2 inhibitors?
What is the mechanism of action of SGLT2 inhibitors?
Why is it important to take other drugs at least 1 hour before or 2 hours after the administration of Linagliptin (Tradjenta)?
Why is it important to take other drugs at least 1 hour before or 2 hours after the administration of Linagliptin (Tradjenta)?
Which adverse effect is NOT associated with SGLT2 inhibitors use?
Which adverse effect is NOT associated with SGLT2 inhibitors use?
Which GLP-1 agonist drug is eliminated hepatically?
Which GLP-1 agonist drug is eliminated hepatically?
Which drug acts by slowing gastric emptying, suppressing post-prandial glucagon concentration, and increasing satiety?
Which drug acts by slowing gastric emptying, suppressing post-prandial glucagon concentration, and increasing satiety?
Which GLP-1 agonist is available as an oral formulation?
Which GLP-1 agonist is available as an oral formulation?
What is the main indication for Pramlintide (Symlin) use?
What is the main indication for Pramlintide (Symlin) use?
Which GLP-1 receptor agonist is specifically marketed as a treatment for obesity?
Which GLP-1 receptor agonist is specifically marketed as a treatment for obesity?
Which drug class is associated with an increased risk of heart failure, particularly in patients with preexisting heart or kidney disease?
Which drug class is associated with an increased risk of heart failure, particularly in patients with preexisting heart or kidney disease?
Which adverse effect is a common side effect of GLP-1 agonist drugs?
Which adverse effect is a common side effect of GLP-1 agonist drugs?
In which CKD stages are liraglutide, albiglutide, and dulaglutide contraindicated?
In which CKD stages are liraglutide, albiglutide, and dulaglutide contraindicated?
What is the key difference between insulin detemir (Levemir) and glargine in terms of duration of action?
What is the key difference between insulin detemir (Levemir) and glargine in terms of duration of action?
What is the mechanism of action for sulfonylureas like glyburide (Micronase)?
What is the mechanism of action for sulfonylureas like glyburide (Micronase)?
Which medication should not be used in patients with renal or liver failure due to its metabolism and excretion profile?
Which medication should not be used in patients with renal or liver failure due to its metabolism and excretion profile?
What is the main adverse effect associated with sulfonylureas like glyburide?
What is the main adverse effect associated with sulfonylureas like glyburide?
How does insulin degludec (Tresiba) differ from insulin detemir (Levemir) in terms of dosing?
How does insulin degludec (Tresiba) differ from insulin detemir (Levemir) in terms of dosing?
What is the primary difference between the mechanism of action of biguanides like metformin and sulfonylureas like glyburide?
What is the primary difference between the mechanism of action of biguanides like metformin and sulfonylureas like glyburide?
Which medication is 100 times more potent than 1st generation agents in terms of hypoglycemic effects?
Which medication is 100 times more potent than 1st generation agents in terms of hypoglycemic effects?
What side effect is common to both 1st and 2nd generation sulfonylureas?
What side effect is common to both 1st and 2nd generation sulfonylureas?
What adverse reactions are rarely associated with sulfonylureas?
What adverse reactions are rarely associated with sulfonylureas?
Which medication's weakly active metabolites are excreted by the kidney, leading to a higher incidence of hypoglycemia in elderly patients with kidney disease?
Which medication's weakly active metabolites are excreted by the kidney, leading to a higher incidence of hypoglycemia in elderly patients with kidney disease?
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Study Notes
Thiazolidinediones (TZDs)
- Also known as "glitazones"
- Examples: Rosiglitazone (Avandia), Pioglitazone (Actos)
- Increase tissue insulin sensitivity
- Enhance insulin-dependent uptake of fatty acids and glucose from plasma into fat/muscle
- Can cause weight gain (2-10 lbs), fluid retention, and increased incidence of CHF
- May increase risk of bladder cancer with pioglitazone
- Can cause GI disturbances, fatigue, headache, and increased risk of bone fractures in women
- Contraindicated in pregnancy and breast-feeding
GLP-1 Agonists (Incretin Mimetics)
- Examples: Exenatide (Byetta), Liraglutide (Victoza), Dulaglutide (Trulicity), Lixisenatide (Adlyxin), Semaglutide (Ozempic), Tirzepatide (Mounjaro)
- Enhance secretion of insulin in the presence of glucose
- Slow the rate of absorption of glucose and other nutrients by delaying gastric emptying
- Reduce appetite and inhibit glucagon release
- Stimulate beta cell differentiation and proliferation
- Do not affect glucose, lactose, or fructose absorption
Biguanides
- Example: Metformin
- Decrease hepatic glucose production by inhibiting gluconeogenesis
- Activate AMP-dependent kinase (AMPK) which inhibits the expression of hepatic gluconeogenic genes
- Used orally, QD, for diabetes treatment
- Can cause GI upset, diarrhea, and lactic acidosis in rare cases
Meglitinides
- Examples: Repaglinide (Prandin), Nateglinide (Starlix)
- Hypoglycemic agents that stimulate insulin release by closing K+ ATP channel
- Used before meals to reduce post-prandial glucose levels
- Can cause weight gain, GI upset, headache, and hypoglycemia
Dipeptidyl-Peptidase-4 (DPP-4) Inhibitors
- Examples: Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina)
- Inhibit the metabolism of endogenous GLP-1 and GIP, increasing their duration of effectiveness
- Used as add-on therapy for type 2 diabetes
- Can cause angioedema, urticaria, localized skin exfoliation, bronchial hyperreactivity, and runny nose
Insulin
- Examples: Detemir (Levemir), Degludec (Tresiba), Glipizide (Glucotrol), Glimepiride (Amaryl)
- Hypoglycemic agents that stimulate insulin release by closing K+ ATP channel
- Used for diabetes treatment, can cause weight gain, hypoglycemia, and hypersensitivity reactions
SGLT2 Inhibitors
- Examples: Canagliflozin (Invokana), Ertugliflozin (Steglatro), Dapagliflozin (Farxiga), Empagliflozin (Jardiance), Bexagliflozin (Brenzavvy)
- Inhibit the sodium-glucose transporter type 2 (SGLT2) in the proximal tubule of the kidney
- Increase urinary glucose excretion, causing weight loss and reducing HbA1c
- Can cause genital yeast infections, urinary tract infections, and volume depletion
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