Questions and Answers
What is the mechanism of action for sulfonylureas?
Which of the following is a common side effect associated with GLP-1 analogues?
Which medication inhibits the DPP-4 enzyme?
What is a significant contraindication for the use of sulfonylureas?
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What is a side effect of sodium-glucose co-transporter 2 inhibitors?
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Which of the following is NOT a characteristic of DPP-4 inhibitors?
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What is the primary action of GLP-1 analogues related to insulin?
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Which of the following examples is a first-generation sulfonylurea?
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Which of the following is considered an effect of sodium-glucose co-transporter 2 inhibitors?
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Which mechanism of action is associated with thionamides?
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What is a key contraindication for the use of methimazole?
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Which medication is used for mineralocorticoid replacement in primary adrenal insufficiency?
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Which of the following is a common side effect of levothyroxine?
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What condition is cinacalcet primarily used to treat?
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Which of these medications should not be used concurrently with levothyroxine?
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Which statement about propylthiouracil (PTU) is correct?
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What is the primary action of fludrocortisone in the body?
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Which of the following is a side effect associated with cinacalcet?
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Which of the following medications is misused for weight loss?
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Study Notes
Glucose-Lowering Medications
Sulfonylureas and Meglitinides
- Mechanism: Stimulate insulin secretion by closing K+ channels in pancreatic β cells, increasing calcium influx and insulin release.
- Side Effects: Hypoglycemia, weight gain, and disulfiram-like reactions with first-generation sulfonylureas.
- Contraindications: Risk of hypoglycemia increases with renal insufficiency.
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Examples:
- Sulfonylureas (1st Generation): Chlorpropamide, Tolbutamide
- Sulfonylureas (2nd Generation): Glipizide, Glyburide
- Meglitinides: Nateglinide, Repaglinide
GLP-1 Analogues
- Mechanism: Mimics the GLP-1 hormone, decreasing glucagon release, delaying gastric emptying, and enhancing glucose-dependent insulin secretion.
- Side Effects: Nausea, vomiting, pancreatitis, significant weight loss, and increased satiety.
- Examples: Exenatide, Liraglutide, Semaglutide
DPP-4 Inhibitors ("gliptin")
- Mechanism: Inhibit Dipeptidyl peptidase-4 enzyme, prolonging GLP-1 action, leading to decreased glucagon, increased insulin secretion, and delayed gastric emptying.
- Side Effects: Respiratory and urinary infections, no significant weight change, increased satiety.
- Examples: Linagliptin, Saxagliptin, Sitagliptin
Sodium-Glucose Co-transporter 2 Inhibitors
- Mechanism: Block glucose reabsorption in renal proximal convoluted tubules, promoting glucose excretion through urine.
- Side Effects: Increased risk of urinary tract infections (UTIs), vulvovaginal candidiasis, dehydration, and orthostatic hypotension.
Thyroid Hormone Medications
Thionamides
- Mechanism: Inhibit thyroid peroxidase, blocking thyroid hormone synthesis; PTU also inhibits T4 to T3 conversion.
- Clinical Use: Treat hyperthyroidism.
- Side Effects: Skin rash, agranulocytosis, aplastic anemia, hepatotoxicity, teratogenicity potential.
- Examples: Methimazole, Propylthiouracil (PTU)
Levothyroxine and Liothyronine
- Mechanism: Synthetic forms of thyroid hormones (T4 and T3).
- Clinical Use: Treat hypothyroidism, myxedema, and weight loss.
- Side Effects: Tachycardia, heat intolerance, tremors, arrhythmias.
- Contraindications: May be affected by antacids, bile acid resins, and ferrous sulfate.
Fludrocortisone (Aldosterone Analogue)
- Mechanism: Synthetic mineralocorticoid promoting sodium reabsorption in kidneys; mimics aldosterone's effects.
- Clinical Use: Mineralocorticoid replacement in primary adrenal insufficiency.
- Side Effects: Fluid retention (edema), heart failure exacerbation, and hyperpigmentation.
Cinacalcet
- Mechanism: Activates calcium-sensing receptor in the parathyroid gland, reducing parathyroid hormone synthesis.
- Clinical Use: Treats secondary hyperparathyroidism in CKD patients on dialysis and hypercalcemia associated with primary hyperparathyroidism.
Sevelamer
- Mechanism: Non-absorbable phosphate binder that prevents phosphate absorption from the gastrointestinal tract.
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Description
This quiz explores the mechanisms of action, clinical uses, side effects, and contraindications of sulfonylureas and meglitinides. Understand how these medications increase insulin secretion and their implications for treatment. Test your knowledge on examples and adverse reactions associated with these drugs.
