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30 Cards in this Set
- Front
- Back
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What are the newer agents of diabetes drugs?
LESS EFFECTIVE MORE $$ Long term satiety unknown |
Exenatide
Sitagliptin Saxagliptin Pramlintide |
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synthetic analog of human glucagon like peptide 1 (GLP-1)
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Exenatide
(1st incretin mimetic) |
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Function of Exenatide
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stimulates insulin secretion, lowers serum glucagon, slows gastric emptyping, increases satiety
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Pros/Cons Effects of Exenatide
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subq injection 2x/day before meals;
GI sx/ Weight Loss For pts who fail with metformin/sulfonylurea |
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inhibitor of DPP-4 (not PPARs)
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Sitagliptin
Saxagliptin |
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mechanism of Sitagliptin and Saxagliptin
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oral hypoglycemics
inhibtor DPP-4 which digests GLP-1; increases GLP which stimulates insulin secretion suppresses glucagon levels, slows gastric emptying |
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Recommendations for DPP-4 inhibitors
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equal/less effective than Type 1 drugs
Add to metformin or thiazolidinedione |
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amylin analog
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Pramlitntide
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Mechanism of Pramlitnide
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slows gastric emptying
increases satiety suppresses post prandial plasma glucagon and hepatic glucose output |
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Pros/Cons Effects of Pramlintide
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GI, anorexia, headache, weight loss
fxn: for pts who can't achieve glucose levels on other drugs |
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Long acting human insulin analog that gives flat peakless profile
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detemir
glargine ultralente (not basal) |
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Intermediate insulin
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Lint on Window Pane
Lente Isophane |
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Very Short Insulin
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GAL
Glulisme Aspart Lispro |
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Major side effects of metformin
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GI sx
Decreased B12 absorption |
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Metabolic Management of Type 2
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tier 1 = older diabetic drugs
tier 2 = new antidiabetic drugs initiall: lifestyle and metformin |
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INSULIN SECRETOGOGUES
sulfonylureas meglitidines D-Phenylalanine Derivative |
increase insulin secretion
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BIGUANIDES
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increase peripheral glucose utilization
anti-hyperglycemic (NOT hypoglycemic) METFORMIN |
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fxn of biguanide and major SE
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dec. heaptic insulin resistance
dec glucose production by liver lose weight SE lactic acidosis |
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THIAZOLIDINEDIONES
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inc peripheral insulin sensitivity
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Examples of Thiazolidinediones
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rosiglitazone
pioglitazone rosig + metformin (Glitz $$$) |
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Side Effects/Efficacy of Thiazolideiones
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HEPATOTOXICITY! CARDIOTOXICITY
does NOT inc insulin releases p450 metabolized dec fasting plasma gluc [ ] but less than sulfonylurea or metformin $$$ |
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Examples of Sulfonylureas
Class 1 Tolerance BUILDS!!! |
1st class = tool belt
tolbutamide chlorpropamide tolazamide acetohexamide |
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Examples of Sulfonylureas
Class 2 higher potency, less required NOT more efficacious |
glyburide
glitzide glimepride GL ide drugs!! |
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Efficacy/fxn of sulfonylurea
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stimulate insulin release from B cells
chronic therapy = dec glucagon levels CI: liver/renal failure hypoglycemic epidodes occur |
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MEGLITINIDE FXN
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same primary action to sulfonylurea
but different structurally fast and brief stim. of insulin secretion reduce postprandial hyperglycemia |
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D PHENYLALANINE EX
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Nateglinide
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MEGLITINIDES EX
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ex: Repaglinide
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alpha glucosidase inhibitors
ex and fxn |
acarbose
miglitol fxn: reduce glucose absorption bc competitive inhibitors of intestinal glucosidases |
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side effects of alpha glucosidase inhibitors
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GI - gas, diarrhea, CI in pts with GI dx
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How sulfonylurea work?
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potentiate insulin release through binding to a B cell receptor associated with an ATP sensitive potassium channel
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