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Pharmacology 5334 Module 6 Exam Questions And Correct Answers
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Pharmacology 5334 Module 6 Exam QuestionsAnd Correct Answers
Complications of diabetes-Answer Hyperglycemia; ketoacidosis (only occurs with type
I); hypoglycemia (can occur from treatments)
Long-term complications of DM-Answer Macrovascular damage (heart disease, HTN,
stroke, hyperglycemia, altered lipid metabolism); microvascular damage (retinopathy;
nephropathy; sensory and motor neuropathy; gastroparesis; amputation secondary to
infection; ED in males)
Diagnosis of DM - Answer Hemoglobin A1C: 6.5 or higher - diabetes; 5.7-6.4 -
prediabetes; less than 5.7 - normal. Fasting plasma glucose: greater than 126 - diabetes.
Casual plasma glucose test: greater than 200 - diabetes. Oral glucose tolerance test:
2-hour levels are greater than 200
Type 2 Diabetes treatment steps - Answer Step 1: lifestyle changes + metformin
Step 2: continue step 1 and add 2nd drug
Step 3 : progress to 3 drug combination (one of which is metformin)
Step4: intensively complex insulin regime
Target values for blood glucose - Response 70-130 mg/dL before meals; 100-140 mg/dL
at bedtime
Insulin Lispro (Humalog) - Response Short-duration (3-5 hours), rapid acting (10-20
minutes); analog of human insulin. Take immediately before or after eating
Insulin Aspart (Novolog) - The action of insulin aspart is short-duration, 3-6 hours, and
rapid acting, 15-30 minutes after subQ injection. It is a rapid-acting analog of regular
insulin. It acts more quickly than regular insulin but has a shorter duration of action. It
,should be injected 5-10 minutes before meals.
Insulin Glulisine (Apidra) - The action of insulin glulisine is short-duration, 3-5 hours, and
rapid acting, 10-15 minutes. Synthetic analog of natural human insulin. Should be given
close to the time of eating
Regular insulin (Humulin R, Novolin R) Short-acting, slower-onset insulin. Unmodified
human insulin. Routes: subQ, subQ infusion, IM, and oral. Onset: 30-60 min; peaks in 1-5
h; duration up to 10 hr. CLEAR solution.
NPH Insulin (Humulin N, Novolin N) - Answer Intermediate-duration insulin. Given 2-3
times daily to provide glycemic control between meals and during the night. Only one
suitable for mixing with short-acting. CLOUDY suspensions. Given subQ.
Insulin Glargine (Lantus) - Answer Long-duration insulin. Modified human insulin.
Prolonged duration of action (up to 24 hours). Once-daily subQ. CLEAR solution - do not
mix with other insulins.
Insulin detemir (Levemir) Long-acting insulin. Human insulin analogue. Slower onset,
dosedependent duration of action. Basal glycemic control is achieved with it. It is NOT
given with meals as a means to control post-prandial hyperglycemia. CLEAR, colorless
solution. Dosage: 1-2 times daily subQ. Do not mix with other insulins.
Afrezza - Inhalation insulin. Used for mealtime insulin. Provides good glycemic control
with relatively low incidents of hypoglycemia. Little to no effect on the pulmonary
function, but can cause bronchospasm so us with caution in patients with chronic lung
disease.
Complications of insulin treatment - Hypoglycemia (blood glucose below 70 mg/dL);
lipohypertrophy (rotate sites); allergic reactions; hypokalemia. Drug interactions:
hypoglycemia agents; hyperglycemic agents; beta-adrenergic blocking agents (impair
glycogenolysis)
Metformin -Answer Drug of choice for initial therapy in most pts with T2DM. Most
, common side effects: GI disturbances; lactic acidosis (be cautious in pts with CKD).
Inhibits glucose production in liver; reduces glucose absorption in gut; sensitizes insulin
receptors in target tissues such as fat and skeletal muscle and increases the glucose
uptake and response to whatever insulin is available. Drug interactions: alcohol,
cimetidine, iodinated radio contrast (d/c drug 2-3 days before dye)
Sulfonylureas - Answer First generation: Chlorpropamide, Tolbutamide
Second: Glimepiride, Glipizide, Glyburide.
Promote insulin release; only to be used for T2DM. Major side effects: hypoglycemia,
weight gain. Drug interactions: alcohol, NSAIDs, cimetidine, beta blockers
Meglitindies - Answer Repaglinide and Nateglinide. Same MOA as Sulfonylureas;
stimulate the pancreatic insulin release. Adverse effect: hypoglycemia. Drug
interactions: gemfibrozil
Thiazolidinediones Glitazones - Answer Decrease glucose levels primarily by
decreasing insulin resistance; only indicated for T2DM add-on to metformin.
Rosiglitazone; pioglitazone. Do not give to patients with HF.
Pioglitazone - Answer Decreases insulin resistance and may also decrease glucose
production. Adverse effects: URI, headache, sinusitis, and myalgia. Drug interactions:
insulin; drugs that induce or inhibit the CYP2C8 system
Alpha-glucosidase inhibitors- Act in the intestine to delay absorption of carbohydrates.
T2DM Acarbose ADE: frequently produce flatulence, cramps, abdominal distention,
borborygmus, diarrhea, liver dysfunction Miglitol: especially effective in Latinos and
African Americans; ADE: flatulence, abdominal discomfort and other GI effects.
DPP-4 inhibitors (gliptins) - Action and Uses Increase the action of incretin hormones to
enhance glycemic control; stimulate glucose-dependent secretion of insulin; decrease
postprandial glucagon secretion. Sitagliptin. Saxagliptin. Linagliptin. Alogliptin.
SGLT-2 inhibitors - Block reabsorption of filtered glucose in the kidney resulting in
glucosuria Canaglifozin: ADE - genital fungal infections in female pts., UTI, increased
urination Dapagliflozin: Use in caution with loop diuretics because of risk of dehydration
and hypotension Empagliflozin Ertugliflozin
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