17. Dm Drugs

Front 1

How do sulfonylureas work?
MOA?

Back 1

Increase insulin secretion
Sulfonylurea receptors on panc. beta cells --> keeps K from leaving the cell --> increased K leads to calcium entry into the cell --> insulin release

Front 2

What is a primary treatment failure?

What is a secondary treatment failure?

Back 2

Primary- not enough insulin produced due to more widespread destruction of beta cells

Secondary- loss of efficacy, reduction of insulin

Front 3

Do sulfonylureas work right away?

Back 3

No, full effect in 7-10 days. Titrate after 1-2 weeks

Front 4

Adverse effects of sulfonylureas

Back 4

Hypoglycemia, weight gain, GI effects, hepatotoxicity, hematologic effects, skin rash

Front 5

Preferred sulfonylurea for patients with renal problems. Why?

Back 5

Glipizide. Even though most of the excretion is renal, it is excretion of an inactive hepatic metabolite.

Front 6

What agents increase SU side effects?

Decrease SU side effects?

Back 6

Increase- cimetidine, alcohol, warfarin, NSAIDs, salicylates

Decrease, rifampin, diuretics, beta blockers, estrogens, corticosteroids

Front 7

Biguanides- MOA? Examples?

Back 7

Decrease hepatic gluconeogenesis, reducing peripheral insulin resistance

Metformin

Front 8

Biguanides are indicated for what patients?

Back 8

Obese patients, patients with hypoglycemia from sulfonylurea use, patients with PCOS

Front 9

Benefits of biguanides?

Back 9

Decreased triglycerides and LDL, increase HDL, weight loss

Front 10

Adverse effects of biguanides? Contraindications

Back 10

GI- NVD, lactic acidosis

Contra- renal impairment, hepatic disease, CHF, EtOH use

Front 11

Drugs which increase metformin effect? Where do they act?

Back 11

Furosemide, cimetidine, digoxin

Furosemide- loop diuretic
Cimetidine- histamine 2 R antag (decreases stomach acid)
Digoxin- for arrhythmias (decreases Ca levels and also slows HR at AV node)

Front 12

Thiazolinediones- MOA, uses

Back 12

Decreases peripheral insulin resistance, increases Glut4 receptors

Use thiazolinediones for insulin resistance/PCOS

Front 13

What drug interacts with AMP kinase? What are the effects?

Back 13

Metformin interacts with metformin and downregulates gluconeogenesis by liver cells.

Front 14

Are thiazolinediones effective immediately?

Back 14

Effects seen in 2 weeks (max effect in 6-8)
Titrate dose after 6-12 weeks

Front 15

Thiazolinedione SEs

Back 15

BLACK BOX- myocardial ischemic effects, increase LFTs, edema, plasma volume increase, CHF, weight gain, anemia, ovulation,

Front 16

Thiazolinedione- examples

Which is used more often

Back 16

Rosiglitazone, pioglitazone

Pioglitazone

Front 17

Meglitinides- MOA

Back 17

Increase insulin secretion when glucose exceeds threshold level
GLUCOSE DEPENDENT

Behaves like sulfonylureas, binds receptor increases intracellular K, IN THE PRESENCE OF GLUCOSE increased Ca and insulin is released

Front 18

Are meglitinides effective immediately?

Back 18

Rapid absorption, short half life, titrate dose after 1 week

Front 19

Meglitinides- SEs

Back 19

hypoglycemia, headache

Front 20

alpha glucosidease inhibitors- MOA, Uses

Back 20

Slows the breakdown of complex CHO in GI tract, decreased absorption of CHO

Postprandial hyperglycemia, sever hypoglycemia with small dose SU

Front 21

Adverse effects of alpha glucosidase inhibitors

Back 21

GI effects, flatulence (titrate slowly, take with meals)

Decreased carbohydrate abso

Front 22

What should be used in the event of hypoglycemia in a patient taking alpha glucosidase inhibitors?

Back 22

Glucose tablets (must be a simple sugar or it wont be absorbed

Front 23

What is the role of amylin? Where is it produced?

Back 23

Amylin is produced in the pancreas. It is cosecreted with insulin and feeds back on the brain to inhibit hyperglycemia (inhibits food intake, gastric emptying and glucagon).

Front 24

What is the role of pramlintide? Uses. When is it taken

Back 24

It is an amylin analog. Regulates post prandial glucose, inhibits glucagon secretion, slows gastric emptying and promotes satiety.

It is used for T1 & T2 DM. Injected right before meals

Front 25

Pramlintide SEs

Back 25

Nausea, hypoglycemia (esp type 1 dm)

Front 26

What is the role of glucagon like peptide? When is it used

Back 26

GLP MOA is pramlintide + Beta cell stimulation (increased insulin)

Used for T2DM with SU, Metform, TZD

Front 27

GLP-1 examples

SE, contraindications?

Back 27

Exenatide & liraglutide

SEs- nausea, hypoglycemia, pancreatitis

Contra- kidney disease, gastroparesis, pancreatitis

Front 28

GLP-1 dosing, when is it given

Back 28

Exenatide- BID or weekly
Liraglutide- daily elections
Inject 60 min before a meal

Front 29

Sitagliptin and saxagliptin

Back 29

Dipeptidyl peptidase 4 inhibitor

Prolongs action of GLP-1 (exenatide, liraglutide)

Front 30

Side effects of DPP4 inihibtors

Back 30

Urticaria, Steven Johnson syndrome, URI, headache,

Front 31

Best sugar control can be seen with what type of insulin regimen? When are doses given?

Back 31

1 long lasting basal insulin dose given each day with 3 rapid acting insulin doses given with every meal

Front 32

Main types of insulin (5)

Back 32

Aspart- Levels peak early & last 4-6 hr
Regular- last 6-10
NPH- last 12-20
Ultralente- last 18-24
Glargine- peakless 20-24

Front 33

Adverse effects of insulin?

Back 33

Hypoglycemia, local skin reactions, hypersensitivity, lipodystrophy, weigh tgain, hyperinsulinemia

Front 34

Which drugs are contraindicated in renal insufficiency?

Back 34

Metformin (lactic acidosis) & glyburide (hypoglycemia)

Front 35

Which drugs are contraindicated with CHF?

Back 35

Metformin- lactic acidosis
TZD- edema, exacerbate CHF

Front 36

Best drugs for pts with history of hypoglycemia?

Back 36

Metformin
TZDs

Front 37

Good add on drug for patients on insulin therapy

Back 37

Pramlintide