Anesthesia Pharmacology Chapter 29 Diabetes Management Practice Questions

Type II diabetes management: Thiozolidinediones
1. Activate peroxisome proliferator-activated receptors (PPARγ)
2. PPAR mostly expressed in adipose tissue
3. Both
4. Neither
Endogenous ligands interacting with PPARγ:
1. Small lipophilic molecules for example arachidonic acid, linoleic acid, prostaglandin 15d-PGJ2.
2. Primary physiological response to PPAR gamma activation is adipocyte differentiation.
3. PPARγ activity is associated with uptake into fat cells of circulating fatty acids as well as lipid storage shifts.
4. A & B
5. B & C
6. A & C
7. A, B & C
Thiozolidinediones/Thiozolidinediones currently available for treating patients with type II diabetes:
1. Troglitazone
2. Rosiglitazone
3. Pioglitazone
4. A & B
5. B & C
6. A & C
7. A, B & C
Cellular responses to PPARγ activation includes enhancement of responsiveness of tissue to insulin.
1. True
2. False
Rosiglitazone and pioglitazone:
1. Insulin sensitizers
2. Administration results in promoting insulin-mediated glucose uptake by about 40% range: 30%-50%) in type II diabetic patients
3. Both
4. Neither
Thiozolidinediones less likely to influence plasma triglyceride levels:
1. Rosiglitazone
2. Pioglitazone
3. Both equally likely to alter plasma triglyceride levels
Thiozolidinediones increase the expression of glucose transporters (GLUT 1 and GLUT 4).
1. True
2. False
Thiozolidinediones effect/effects:
1. Increased adiponectin
2. Reduced resistin release from the adipocytes
3. Reduced hepatic glucose output
4. Reduced free fatty acid plasma levels
5. A & B
6. B & C
7. A & C
8. D only
9. A, B, C & D
Rosiglitazone and pioglitazone:
1. May each be used as monotherapy
2. May each be combined with sulfonylureas, insulin, or metformin.
3. Both
4. Neither
Administration of biguanides (e.g. metformin) or thiozolidinediones (rosiglitazone and pioglitazone) is likely to cause hypoglycemia.
1. True
2. False
Pioglitazone:
1. Exhibits PPARγ and some PPARα activity.
2. Absorbed within a couple hours of ingestion; however, food delays uptake.
3. Both
4. Neither
Pioglitazone is metabolized by the cytochrome P450 drug metabolizing system utilizing mainly CYP2C8 and CYP3A4 isoforms resulting in active metabolites.
1. True
2. Falls
Rosiglitazone:
1. Highly protein bound, rapidly absorbed.
2. Metabolized by the cytochrome P450 drug metabolizing system, especially utilizing CYP2C8 and CYP3A4, resulting in minimally active metabolites.
3. Both
4. Neither