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56 Cards in this Set
- Front
- Back
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When are oral hypoglycemics used?
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Primarily for type 2 diabetes
Sometimes an adjunct role to insulin for type 1 diabetes |
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What does it mean for the patient if you are using oral hypoglycemics?
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Means that the patient has beta cell function and you're trying to modulate it
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Describe the course of type 2 diabetes.
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Insulin resistance
Delayed insulin release Impaired glucose tolerance Beta cell failure |
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Sulfonylureas: class? mechanism?
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Oral hyperglycemic
Pancreatic - potassium channel blocker. Enhances insulin release to change in glucose level. |
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Contrast first and second generation sulfonylureas.
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First generation: less potent, variety of half life, more odd reactions
Second: more potent, longer half life, most commonly used |
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What is the issue with chlorpropamide? What class is it in?
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Could cause severe toxicity with renal dysfunction
Sulfonylurea |
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Name the sulfonylureas.
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Glimeperide
Glipizide Glyburide |
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What are the side effects of sulfonylurea?
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Hypoglycemia
Weight gain (from food) Rash Hyponatremia Marrow toxicity Drug interactions |
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What are the contraindications of sulfonylureas?
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Type 1 diabetes
Pregnancy Lactation Allergy Hypoglycemia |
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How is sulfonylurea dosed?
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Start at the lowest possible dose and go up slowly
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When is sulfonylurea the preferred drug?
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Neonatal diabetes
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What is neonatal diabetes?
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Onset of DM by age 6 months, have a mutation of beta cell sulfonylurea receptor (potassium channel)
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Meglitinides: MOA? Name?
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Potassium channel blockers (not a sulfonylurea)
Repaglinide, Nateglinide |
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When are meglitinides given?
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Given before meals
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Metformin: structure? clearance?
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Derived from guanidine
Renal clearance |
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What is the MOA of metformin?
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Suppresses liver glucose output.
Affects AMP kinase, bild acids Increased insulin action in fat, muscle No effect on insulin secretion |
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What are the other effects of metformin?
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Decreased LDL, triglyceride
Increase serum HDL Lack of weight gain |
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What are the adverse effects of metformin?
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Lactic acidosis
Dyspepsia, diarrhea Hypoglycemia Inhibit B12 absorption |
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What are the risk factors for lactic acidosis for metformin?
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Renal disease
Hepatic disease Alcohol abuse CHF Hypoxemia Dehydration IV dye |
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How to you treat lactic acidosis from metformin?
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Hemodialysis
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What are the indications for metformin therapy?
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Alone in type 2 diabetes
Add to potassium channel blocker, but do not substitute |
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Describe the dosing for metformin. What do you have to monitor?
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Start low, go slow
Take with meals to reduce GI effect Monitor creatinine, B12 level |
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What are the absorption targets for oral therapy?
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Alpha-glucosidase (breaks down starch)
Lipase (breaks down fat) |
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Name the alpha-glucosidase inhibitors.
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Acarbose, miglitol
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Describe the effects of alpha-glucosidase inhibitors.
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Delay digestion and absorption
No effect on lactase |
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What are the side effects of glucosidase inhibitors?
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Flatulance, diarrhea, cramps
No hypoglycemia alone Acarbose - rare liver effect Possible B12 malabsorption |
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Name the lipase inhibitors.
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Orlistat (Rx), Alli (OTC)
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What are the side effects of lipase inhibitors?
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Fatty diarrhea
Rectal incontinence Weight loss |
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Thiazolidinediones: name?
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Pioglitazone (Actos)
Rosiglitazone (Avandia) |
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Thiazolidinediones: mechanism?
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Ligands for peroxisome proliferator activated receptor gamma (PPAR-gamma), increases insulin sensitivity
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How do Thiazolidinediones affect lipids?
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Decreased TG
Increased HDL and LDL |
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Thiazolidinediones: dosing issues?
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Maximum effect not for 8-14 weeks
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Troglitazone: side effects?
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Hepatotoxicity
Induction of CYP450 3A4 (reduced efficacy of oral contraceptives, increased metabolism of cyclosporine and tacrolimus) |
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Thiazolidinediones: describe the use.
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Add to sulfonylurea
Add to insulin Approved monotherapy |
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Thiazolidinediones side effects?
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Weight gain
Hypoglycemia Edema CHF Anemia Wrist fractures Bladder cancer? |
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What is DPP IV?
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A dipeptidyl peptidase
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Name the DPP IV inhibitor.
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Januvia = sitagliptin
Onglyza = saxagliptin |
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DPP IV inhibitor: excretion? given with?
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Renal excretion
With metformin or TZD |
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DPP IV inhibitor: side effects
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N/D
Nasopharyngeal infection |
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How is the dosing of onglyza affected?
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Give lower dose with low CrCl or CYP3A4 inhibitors
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What is DPP IV?
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A dipeptidyl peptidase
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Name the DPP IV inhibitor.
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Januvia = sitagliptin
Onglyza = saxagliptin |
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DPP IV inhibitor: excretion? given with?
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Renal excretion
With metformin or TZD |
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DPP IV inhibitor: side effects
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N/D
Nasopharyngeal infection |
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How is the dosing of onglyza affected?
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Give lower dose with low CrCl or CYP3A4 inhibitors
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What lipid drug can be used in diabetes treatment?
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Bile acid binding resin
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Bild acid binding resin: give the names.
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Welchol = colesevelam
Cholestyramine |
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What are the side effects of bile acid binding resin?
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Constipation, dyspepsia nausea
Bowel obstruction Hyper TG Change levothyroxine replacement dose |
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What are the contraindications for bile acid binding resin?
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Bowel disease, constipation
HyperTG Medicine interactions |
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Bromocriptine: what is it?
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Ergot derivative which binds dopamine receptors. Don't really know how it affects blood glucose.
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Bromocriptine side effects?
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Somnolence
Psychosis Hallucinations Postpartum stroke Fibrosis |
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Bromocriptine clearance?
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Cleared by hepatic CYP3A4
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Contraindications for bromocriptine.
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Ergot sensitivity
Migraine Lactating mother Preexisting psychosis, GI illness |
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Drug for normal weight patient
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K channel blocker
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Overweight patient with only diabetes
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Metformin
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Drug for: high glucose only post-meal?
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Miglitol, meglitinide
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