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NBME 21 Answers

nbme21/Block 1/Question#21 (25.9 difficulty score)
A 40-year-old man with type 2 diabetes ...
Stimulation of the peroxisome proliferator-activated receptor γ🔍,📺
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 +11 
submitted by sgarzon15(11),
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aknhT oyu terigtl oezn fo hscyetk hpr.am I sllha rnvee trfoge you

cr  why not C?. It´s not supose that it improve the efectivity of insulin? +  
cr  why not C?. It´s not supose that it improve the efectivity of insulin? +  
divya  because insulin uptake by adipose and muscle tissue is not limited to thiazolidinediones but also and mainly by metformin. and glitazones' primary MOA is PPAR gamma stimulation which then increases insulin sensitivity to other tissues. +1  



 +6 
submitted by madojo(177),

Going over the other answer choices:

  • Blocking ATP sensitive potassium channels in the pancreatic beta cells to increase insulin secretion would be drugs like Sulfonylureas or Meglitinides for example like Glyburide.

  • Increasing endogenous GLP1 or GIP levels are drugs like Sitagliptan and Saxagliptan. They have GLP in them

  • Increasing peripheral glucose uptake would be the biguanides like metformin.

  • Stimulating transcription regulator PPAR-gamma decreases insulin resistance and is the MOA of thiazolidenediones like Pioglitazone.




 +0 
submitted by cr(4),
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hyw otn .?C Ist´ nto ousspe taht it imoperv hte tyteveicif of isinnlu?

yb_26  thiazolidinediones (pioglitazone) increase insulin sensitivity (in muscles and liver) through activation of peroxisome proliferator-activated receptor-gamma (PPAR) I think they are asking about primarily mechanism of action, that's why it is E +  
cienfuegos  UW explanation regarding the genes upregulated 1. GLUT4: insulin responsive on adipocytes/skeletal increases G uptake 2. adiponectin: cytokine secreted by adipocytes increases # of insulin responsive adipocytes and stims FA oxidation 3. PPAR family also plays significant role in pathogenesis of metabolic syndrome +2  
poisonivy  Also, I think the word uptake shouldn't be right when speaking about insulin, it does increase insulin sensitivity and therefore glucose uptake +7  
brotherimodu  @poisonivy That's why I didn't choose C and went with E since it was more specific +