Drug Therapy: Oral Diabetic Agents

Front 1

Drug therapy
Oral Agents

Back 1

Not insulin
Work to improve insulin and glucose prod. and usage
Effective for type 2
3 defects of type 2 diabetes:
1. insulin resistence
2. decreasd insulin prod
3. increased hepatic glucose prod.

Used w/other classes of OA to achieve blood glucose targets

Front 2

Classes

Back 2

Sulfonylureas: 1st & 2nd generation
meglitinides
biguanides
alpha-glucosidase inhibitors
thiazolidinediones
dipeptidyl Peptidase-4 (DDP-4) inhibitor

Front 3

Sulfonylureas "insulin seretagogues"

Back 3

Drug choice for type 2
increased insulin (secretion) prod. from pancreas (primary action)
decrease chance of prolonged hypoglycemia
Examples: 2nd generation
glipizide (glucotrol, glucotrol XL)
glimepride (Amaryl)
glyburide (Micronase, DiBeta)

Front 4

Meglitinides

Back 4

Increase insulin prod from pancrease
less likely to cause hypglycemia
taken 30 min bfore eah meal up to time of meal
should not be takin if meal skipped
Examples:
Repaglinide (Prandin)
Nateglinide (Starlix)

Front 5

Biguanide: 1st choice for type 2

Back 5

reduce glucose production by live
auguments glucose uptake by tissues esp. muscles
doesn't promote weight gain
***lactic acidosis (No alcohol), diarrhea

Front 6

a-glucosidase inhibitors

Back 6

"starch blockers"
slow down absorption of carb in sm. intestine
take w/first bite of each main meal
effective most in lowering postprandial blood glucose
effectivelness checked measured by checking 2hr postprandial glucose levels
monitor liver function (LFTs) & kidney

Example: Acarbonse (precose)
Miglitol (Glyset)

Front 7

Thiazoldinediones: "Insulin sensitizers"

Back 7

Most effetice in those w/insulin resistence. -improves insulin sensitiveity, transport and utilization at target tissues
Will not cause hypoglycemia if used alone, risk increased w/ sulfonylurea/an insulin
improves lipid profiles and blood pressure levels: secondary benefit.
drug alert: edema. DO NOT USE W/PTS. W/HF
Women: effective contraception during therapy: reduces effect of birth control
Monitor LFTs: not recommended for ALT >25 or active liver disease.

Examples: Ploglitazone (Actos)
Rosiglitazone (Avandia)

Front 8

Dipeptidyl peptidase 4 inhibitor

Back 8

inhibit DDP-4 slow inactivation of incretin hormones
glucose dependent
main benefit: absence of weight gain
Example: Sitaglipin (Januvia)
Vildagloipti (Galvus)

Front 9

Amylin analog: Pramlintide (Symlin) BLACK BOX WARNING

Back 9

Hormone secreted by B cells of pancreas
Cosecreted with insulin in response to food intake
for type 1 & type 2 delays gastric emptying
triggering satiety (brain): weight loss & decrease caloric intake
cannot be mixed with insulin
SQ into thigh/abdomen only
Do not mix with insulin

Drug alert:
Can cause severe hypoglycemia when used with insulin
usually ocurs within 3h following injectin
instruct pt. to eat a meal w/at least 250 calories & keep fast acting sugar in event of episode

Front 10

Amylin Analong

Back 10

Teach to injecti different site from insulin injected
N/V/D common
Not for pts. w/gastroparesis
Hypoglycemia risk higher in type 1
Blackbox warns of risk of HYPOGLYCEMIA DURING DRIVING/OPERATING HEAVY MACHINERY: cause severe hypoglycemia when used w/insulin

Front 11

Incretin mimetic BLACK BOX WARNING

Back 11

Sythetic peptide
Stimulates release of insulin from B cells
Subcutaneous injection (pen)
Suppresses glucagon secretion
Known to prod. "weight loss" because of increased satiety (fullness)
Must inject within 1h of breakfast or dinner (BID)
Acute pancreatitis and kidney problems

Front 12

β-Adrenergic blockers

Back 12

mask symptoms of hypoglycema
prolong hypoglycemic effects of insulin

Example: metoprolol (Lopressor)

Front 13

Thiazide/loop diuretics

Back 13

Can potentiate hyperglycemia
By inducing potassium loss
Hydrochlorthiazide (HCTZ)/ furosemide (Lasix)