5 Written Questions

1. rosiglitazone and pioglitazone
2. absorption + action all similar to other rapid acting insulins
3. decreased effectiveness by barbiturates, rifampin (induce cyp3a4), glucocorticoids, OCPs, thiazides, phenytoin, B-agonists
4. 4 subunits --> possess tyrosine kinase activity
   - insulin binding leads to autophosphorylation + enhancing kinase activity
5. combinations of NPH/regular or neutral protamine lispro/lispro

5 Matching Questions

1. describe the actions of insulin
2. adverse effects of pramlintide
3. what insulin concentrations are typically used?
4. ALPHA GLUCOSIDASE INHIBITORS
5. describe the side effect - hypoglycemia

1. a 100IU/ml is most widely used
   - range from U40-U500
   - with young children, may require the insulin to be diluted
2. b acarbose and miglitol
3. c - signaling cascade leads too glucose transporter translocation to membrane (GLUT4),
   - glucose uptake
   - glycogen synthase
   - increased glycogen formation
   - increase lipogenesis + protein synthesis
   - enhanced DNA synthesis and cell growth (anabolic signals)
4. d nausea, vomitting, headache, anorexia
5. e more common in type 1 with tight control
   - see increased sympathetic activity + parasym
   - sweating, tachycardia, trembling, coma, confusion

5 Multiple Choice Questions

1. lowers blood glucose by stimulating insulin release from B cells
   - blocks inward rectifier K+ channel
   - chronic therapy results in decreased glucagon secretion
   - chronic -->potentiation of insulin action (etiology unknown)
   1. describe premixed insulin preps
   2. describe type 2 diabetes
   3. describe the actions of insulin
   4. describe the MOA of sulfonylureas
2. synthetic analogue of human amylin (islet amyloid polypeptide)
   - slow gastric emptying, increase satiety, suppress postprandial glucagon + hepatic output
   - type I and II pts
   1. describe exanatide
   2. describe detemir
   3. describe pramlintide
   4. describe nateglinide
3. ...
   1. PRE-MIXED INSULIN PREPARATIONS
   2. describe insulin receptor
   3. describe premixed insulin preps
   4. regular insulin (short acting)
4. weight loss (not real adverse effect), nausea, vomitting, diarrhea
   1. what are the adverse effects of metformin
   2. what are the adverse effects of exanatide
   3. what are the adverse reactions to insulin
   4. what are the drug interactions
5. even quicker onset + shorter duration
   - may cause weight gain, but hypoglycemia unlikely
   - inactivated by liver so caution in pts with liver disease
   1. describe pramlintide
   2. describe detemir
   3. describe nateglinide
   4. describe exanatide

5 True/False Questions

1. complications due to diabetes → tissue resistance to insulin + decreased relative insulin secretion
   - usually in adults and obesity is common
   - treat with diet, weight reduction, oral hypoglycemics + insulin

   True        False

2. describe repaglinide → newer secretogogues --> structurally different from sulfonylureas but same MOA
   - rapid absorption + short 1/2 lives (1hr)
   - produces fast + brief insulin secretion

   True        False

3. describe exanatide → synthetic analog of human glucagon like peptide -1
   - stimulates insulin secretion + lowers glucagon levels, slows gastric emptying + increases satiety
   - alternative to metformin + sulfonylureas

   True        False

4. what are the insulin delivery systems are used → basal bolus concept (pump) or intermediate acting +long acting insulin analogue once or twice daily

   True        False

5. What are the side effects of glargine → weight loss (not real adverse effect), nausea, vomitting, diarrhea

   True        False