(Endocrine) Treatment For Diabetes

Front 1

Is this amylin or GLP-1 or both:

Causes glucose dependent stimulation of insulin secretion

Back 1

GLP-1

Front 2

Is this amylin or GLP-1 or both:

Reduces gastric emptying

Back 2

Both

Front 3

Is this amylin or GLP-1 or both:

Reduces inappropriate glucagon secretion

Back 3

Both

Front 4

Is this amylin or GLP-1 or both:

Causes weight loss

Back 4

Both

Front 5

Is this amylin or GLP-1 or both:

Can regenerate beta-cells in animals

Back 5

GLP-1

Front 6

Is this amylin or GLP-1 or both:

Is used in Type 1 diabetes and insulin-treated type 2 diabetes

Back 6

Amylin

Front 7

Is this amylin or GLP-1 or both:

Is an oral agent used to treat type 2 diabetes

Back 7

GLP-1

Front 8

Is this amylin or GLP-1 or both:

Pramlintide

Back 8

Amylin

Front 9

Is this amylin or GLP-1 or both:

Exenatide

Back 9

GLP-1

Front 10

Drug Name: Sulfonylureas - Glipizide, Glyburide, Glimepiride
Where applicable list:

Therapeutic Uses:
Mechanism of Action:
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Antidotes or treatment of toxic effects:
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Back 10

"USES: Hyperglycemia
MECHANISM: Directly stimulates release of insulin via ATP potassium receptor closure
SIDE EFFECTS: Won't work in 15% of ""best responders ; Hypoglycemia, weight gain, rashes, GI upset
TOXICITY: May cause beta cell exhaustion, tachypylaxis @ 6 mo
ANTIDOTES:
CONTRAINDICATIONS: Not great for renal failure, especially glyburde; caution with hepatic dysfunction
INTERACTIONS: Chlorpropamide associated w/ disulfiram / hyponatremia
OTHER: Glimepiride is newer, w/ less hypoglyc. Best responders = non obese, early in disease course"

Front 11

Drug Name: Meglitinides - Repaglinide, Nateglinide
Where applicable list:

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Back 11

USES: Hyperglycemia
MECHANISM: Similar to sulfonylureas (ATP K+ channel mediated insulin release) Shorter acting (esp Nateglinide - take 1 min before meal); peak 1 hr
SIDE EFFECTS: Hypoglycemia (though not at night); Weight gain
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS: Careful w/ hepatic and renal imparment
INTERACTIONS:
OTHER:

Front 12

Drug Name: Alpha Glucosidase Inhibitors - Acarbose, Miglitol
Where applicable list:

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Back 12

USES: Hyperglycemia
MECHANISM: Block brush border maltase, isomaltase, glucoamylase, sucrase (hydrolysis of sugars), inhibits pancreatic amylase
SIDE EFFECTS: Flatulence, tummy ache, diarrhea
TOXICITY: Dose related GI complaints (go away with continued use)
ANTIDOTES:
CONTRAINDICATIONS: Type 1 DM or history of DKA, IBD, other digestive disorders, low renal fx
INTERACTIONS:
OTHER: 0.4 - 0.9% reduction A1C, additive effect

Front 13

Drug Name: Metformin
Where applicable list:

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Back 13

USES: Hyperglycemia
MECHANISM: DOES NOT INCR INSULIN SECRETION, (reduces liver glucose output, enhances actions of insulin via incr uptake
SIDE EFFECTS: Weight loss, decr in FFA
, Small incr HDL (These are bad things??) Also, GI problems (can help if taken w/ meal), metallic taste
TOXICITY: Lactic acidosis, decr B-12
ANTIDOTES:
CONTRAINDICATIONS: Renal insufficiency, old age (unless kidneys are great), liver problems, ETOH, Iodinated contrast, surgery
INTERACTIONS:
OTHER: 1.5% reduction A1C,

Front 14

Drug Name: Thiazolidinediones - Rosiglitazone
Where applicable list:

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Back 14

USES: Hyperglycemia
MECHANISM: Pure PPAR-gamma agonist - Receptor in adipocytes which reduces insulin resistance when stimulated
SIDE EFFECTS: Hypoglycemia (not seen in monoRx); Weight gain due to fluid retention / adipocyte prolif
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS: Heart failure; Women w/ osteoperosis risk
INTERACTIONS:
OTHER: Reduces Triglycerides, and raises HDL and LDL - although not as effectively as Pioglitazone

Front 15

Drug Name: Thiazolidinediones - Pioglitazone
Where applicable list:

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Back 15

USES: Hyperglycemia
MECHANISM: PPAR gamma and PPAR alpha agonist. Stimulates adipocytes to reduce insulin resistance.
SIDE EFFECTS: Hypoglycemia (not seen in monoRx); Weight gain due to fluid retention / adipocyte prolif
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS: Heart failure; Women w/ osteoperosis risk
INTERACTIONS:
OTHER: Reduces Triglycerides, and raises HDL and LDL - in a better way than Rosiglitazone

Front 16

Drug Name: Sitagliptin
Where applicable list:

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Back 16

USES: Type 2 diabetes
MECHANISM: Inhibits DPP-IV which breaks down the incretin GLP-1;
SIDE EFFECTS:
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS: Must adjust for renal impairment
INTERACTIONS: Must decrease the sulfonylurea dose as well as short acting insulin
OTHER:

Front 17

Drug Name: Exenatide
Where applicable list:

Therapeutic Uses:
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Back 17

USES: Type 2 diabetes
MECHANISM: Analogue of GLP-1 that is resistant to DPP-IV degradation. Leads to augmentation of insulin in a glucose dependent fashion; Slows gastric emptying
SIDE EFFECTS: Nausea (decr with time);
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS: ESRD, Pregnancy, Type 1 DM, Pancreatitis, Gastroparesis
INTERACTIONS: Hypoglycemia when given w/ sulfonylurea (must adjust dose)
OTHER: 0.8% reduction in A1C; Made from Gila monster saliva; Take w/in 60 min prior to meal

Front 18

Drug Name: Pramlintide
Where applicable list:

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Back 18

USES: Type 1 DM, or insulin dependent DM
MECHANISM: Amylin analog. Administered at mealtime. Decr gastric emptying, and glucagon effects.
SIDE EFFECTS: Nausea, hypoglycemia, weight loss (.5 to 2kg in 2 mo)
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS:
INTERACTIONS:
OTHER: .5 to 1% reduction in A1c. Hypoglycemia is less common in type 2 DM

Front 19

Drug Name: Good old fashioned insulin
Where applicable list:

Therapeutic Uses:
Mechanism of Action:
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Back 19

USES:
MECHANISM: See flow chart for insulin's mechanism of action
SIDE EFFECTS: Hypoglycemia, weight gain
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS:
INTERACTIONS:
OTHER: Short acting or long acting forms