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15 Cards in this Set

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How do sulfonylureas work?
First generation: tolbutamide, chlorpropamide.
Second generation: glyburide, glimepiride, glipizide
Close K+ channel in beta cell membrane --> depolarization --> insulin release via increased calcium influx. Basically, they stimulate the release of endogenous insulin in type 2 DM (require some islet fxn, so useless in type 1 DM).
What are the side effects of the sulfonylureas?
First gen (tobutamide, chlorpropamide): disulfiram-like
Second gen (glyburide, glimepiride, glipizide): hypoglycemia

SULFONYLUREAS, LIKE INSULIN, CAN CAUSE WEIGHT GAIN AND HYPOGLYCEMIA.
How do biguanides like Metformin work?
decrease gluconeogenesis,
acts as insulin sensitizer.

can be used in pts w/out islet fxn, as oral hypoglycemic
WHat is the worst adverse effect of a biguanide like metformin?
Lactic acidosis.
How do the glitazones work (pioglitazone, rosiglitazone)?
increase target cell response to insulin.
what are some side effects of pioglitazone and rosiglitazone?
weight gain, edema, hepatotoxicity, CV toxicity
how do the alpha-glucosidase inhibitors work?
what are the names of two alpha glucosidase inhibitors?
Acarbose, Miglitol.
Both inhibit intestinal brush-border alpha glucosidases --> delayed sugar hydrolysis and glucose absorption --> decreased postprandial hyperglycemia.
What are the main side effects of acarbose and miglitol (alpha glucosidase inhibitors)
GI effects, especially FLATULENCE!
How does pramlintide work? what are its side effects?
Pramlintide is an amylin analogue that slows gastric emptying and decrease glucagon. used in type 2 DM

AE's: hypoglycemia, nausea, diarrhea
how does exenatide work? what are its side effects?
it is a GLP-1 mimetic, which increases insulin secretion and decreases glucagon release. used in type 2 DM

AE's: nausea, vomiting, pancreatitis.
What is the mechanism of orlistat, and what are its main side effects?
alters fat metabolism by inhibiting pancreatic lipases. main ae's include steatorrhea, GI discomfort, reduced absorption of fat soluble vitamins, HA.
used for long-term obesity management.
How does sibutramine work, and what are its toxicities?
Used for short and long-term obesity management; sympathomimetic serotonin and NE reuptake inhibitor.

Toxicities: HTN, tachycardia
How do propylthiouracil and methimazole work? What are their toxicities?
propylthiouracil and methimazole inhibit the peroxidase enzymes responsible for the organification and coupling of thyroid hormone synthesis. propylthiouracil also decreases synthesis of T3 from T4 peripherally. Toxicities include skin rash, agranulocytosis, and aplastic anemia.
Should you use methimazole or PTU for a pregnant woman w/ hyperthyroidism? Why?
Use PTU, because it's more extensively protein bound, and thus less likely to cross the placenta.
What 4 conditions can somatostatin (octreotide) be used to treat?
acromegaly, carcinoid, gastrinoma, glucagonoma