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37 Cards in this Set

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How do sulfonylureas work?
MOA?
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
What is a primary treatment failure?

What is a secondary treatment failure?
Primary- not enough insulin produced due to more widespread destruction of beta cells

Secondary- loss of efficacy, reduction of insulin
Do sulfonylureas work right away?
No, full effect in 7-10 days. Titrate after 1-2 weeks
Adverse effects of sulfonylureas
Hypoglycemia, weight gain, GI effects, hepatotoxicity, hematologic effects, skin rash
Preferred sulfonylurea for patients with renal problems. Why?
Glipizide. Even though most of the excretion is renal, it is excretion of an inactive hepatic metabolite.
What agents increase SU side effects?

Decrease SU side effects?
Increase- cimetidine, alcohol, warfarin, NSAIDs, salicylates

Decrease, rifampin, diuretics, beta blockers, estrogens, corticosteroids
Biguanides- MOA? Examples?
Decrease hepatic gluconeogenesis, reducing peripheral insulin resistance

Metformin
Biguanides are indicated for what patients?
Obese patients, patients with hypoglycemia from sulfonylurea use, patients with PCOS
Benefits of biguanides?
Decreased triglycerides and LDL, increase HDL, weight loss
Adverse effects of biguanides? Contraindications
GI- NVD, lactic acidosis

Contra- renal impairment, hepatic disease, CHF, EtOH use
Drugs which increase metformin effect? Where do they act?
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)
Thiazolinediones- MOA, uses
Decreases peripheral insulin resistance, increases Glut4 receptors

Use thiazolinediones for insulin resistance/PCOS
What drug interacts with AMP kinase? What are the effects?
Metformin interacts with metformin and downregulates gluconeogenesis by liver cells.
Are thiazolinediones effective immediately?
Effects seen in 2 weeks (max effect in 6-8)
Titrate dose after 6-12 weeks
Thiazolinedione SEs
BLACK BOX- myocardial ischemic effects, increase LFTs, edema, plasma volume increase, CHF, weight gain, anemia, ovulation,
Thiazolinedione- examples

Which is used more often
Rosiglitazone, pioglitazone

Pioglitazone
Meglitinides- MOA
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
Are meglitinides effective immediately?
Rapid absorption, short half life, titrate dose after 1 week
Meglitinides- SEs
hypoglycemia, headache
alpha glucosidease inhibitors- MOA, Uses
Slows the breakdown of complex CHO in GI tract, decreased absorption of CHO

Postprandial hyperglycemia, sever hypoglycemia with small dose SU
Adverse effects of alpha glucosidase inhibitors
GI effects, flatulence (titrate slowly, take with meals)

Decreased carbohydrate abso
What should be used in the event of hypoglycemia in a patient taking alpha glucosidase inhibitors?
Glucose tablets (must be a simple sugar or it wont be absorbed
What is the role of amylin? Where is it produced?
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).
What is the role of pramlintide? Uses. When is it taken
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
Pramlintide SEs
Nausea, hypoglycemia (esp type 1 dm)
What is the role of glucagon like peptide? When is it used
GLP MOA is pramlintide + Beta cell stimulation (increased insulin)

Used for T2DM with SU, Metform, TZD
GLP-1 examples

SE, contraindications?
Exenatide & liraglutide

SEs- nausea, hypoglycemia, pancreatitis

Contra- kidney disease, gastroparesis, pancreatitis
GLP-1 dosing, when is it given
Exenatide- BID or weekly
Liraglutide- daily elections
Inject 60 min before a meal
Sitagliptin and saxagliptin
Dipeptidyl peptidase 4 inhibitor

Prolongs action of GLP-1 (exenatide, liraglutide)
Side effects of DPP4 inihibtors
Urticaria, Steven Johnson syndrome, URI, headache,
Best sugar control can be seen with what type of insulin regimen? When are doses given?
1 long lasting basal insulin dose given each day with 3 rapid acting insulin doses given with every meal
Main types of insulin (5)
Aspart- Levels peak early & last 4-6 hr
Regular- last 6-10
NPH- last 12-20
Ultralente- last 18-24
Glargine- peakless 20-24
Adverse effects of insulin?
Hypoglycemia, local skin reactions, hypersensitivity, lipodystrophy, weigh tgain, hyperinsulinemia
Which drugs are contraindicated in renal insufficiency?
Metformin (lactic acidosis) & glyburide (hypoglycemia)
Which drugs are contraindicated with CHF?
Metformin- lactic acidosis
TZD- edema, exacerbate CHF
Best drugs for pts with history of hypoglycemia?
Metformin
TZDs
Good add on drug for patients on insulin therapy
Pramlintide