Pharmacology Diabetic Drugs

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Diabetes goals for treatment?

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FPG= 90-130
2 hour post gpandial PG<180
Glcosylated Hg<7.0%

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Aspart insulin?

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Rapid acting, used for premeal, monomeric, onset 5-15 min

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Lispro Insulin?

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Rapid acting, used for premeal, monomeric, onset 5-15 min

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Glulisine Insulin?

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Rapid acting, used for premeal, monomeric, onset 5-15 min

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Regular insulin?

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Hexamer with zink, used for meals, onset 30-60 min

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NPH insulin?

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Intermediate acting, conjugated with protamine peptide, used for basal insulin

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Lente insulin?

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Intermediate acting, conjugated with protamine peptide, used for basal insulin

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Glargine insulin?

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Long acting, AA substitute, ppt at body pH, no peak

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Detmir insulin?

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Long acting, fatty acid side chain binds to albumin, no peak

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Adverse reactions of Insulin replacement therapy?

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Injection site lipodystrophy

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Conventional Insulin therapy?

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Two injections with regular and NPH, there is a risk of htpoglycemia, and dawn phenomenon(hyperglycemia)

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Intensive/standard therapy?

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Premeal and long acting, decreases diabetes complications, more difficult to comply, more expensive

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Chlorpropamide?

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first generation Sulfonylurea for type 2 diabetes

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Tolbutamide?

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first generation Sulfonylurea for type 2 diabetes

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Glimepiride?

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second generation Sulfonylurea for type 2 diabetes

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glipizide?

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first generation Sulfonylurea for type 2 diabetes, short acting, drug of choice for elderly with renal failure

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Glypuride?

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first generation Sulfonylurea for type 2 diabetes

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Sulfonylurea MOA?

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inhibits beta-cell K+ channels and increases insuline secretion

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Sulfonylurea on Plasma glucose?

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Lowers fasting plasma glucose, not post-prandial

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Sulfonylurea Side Effects?

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Hypoglycemia, weight gain

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Sulfonylurea CI?

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Pregnancy, renal, liver failure, sulfa allergies, type 1, elderly except Glipizide

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Sulfonylurea is indicated for?

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Diabetes for less than 10 years, not overweight, can still secrete insulin

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Repaglinide?

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Meglitinide for diabetes type 2

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Nateglinide?

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Meglitinide for diabetes type 2

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Meglitinides MOA?

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Acts on K+ channels on beta-cells, different spot as Sulfonylurea

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Meglitinides effects on plasma glucose?

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decreases postprandial glucose

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Meglitinides Indicated for?

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people with sulfa allergies and cannot take sulfonylureas

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Meglitinides CI?

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Pregnant and liver disease

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Metformin(biguanides) MOA?

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Activates AMPK which decreases gluconeogenesis and glycolysis, increase glucose utilization and decreas insulin resistance

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Metformin effects on plasma glucose?

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Decreases FPG

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Metformin Indications?

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No weight gain or hypoglycemia, improved lipid profile

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Metformin ADRs?

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GI(take with food), decrease B-12 absorption, lactic acidosis

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Metformin contraindications?

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PRegnars, elderly, renal and liver disease, CHF, shock, iodinized contrast agents

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Pioglitazone and Rosiglitazone?

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Thiazolidediones

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Thiazolidediones MOA?

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PPAR-gama(transcription factors) agonist, causes increase GLUT4, increase adiponectin which increases insulin sensitivity

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Thiazolidediones Effects on Plasm Glucose?

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Decreases FPG, decreases triglycerides

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Thiazolidediones adverse effects?

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Weight gain, fluid retention, CHF

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Thiazolidediones Contraindications?

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Liver disease, CHF, Pregnancy

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Acarbose and Miglitol

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alpha-glucosidase inhibitors

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alpha-glucosidase inhibitors MOA

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inhibits brush boarder enzyme and decreases absorption of glucose

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alpha-glucosidase inhibitors effects on plasma glucose?

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decreases post prandial glucose

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alpha-glucosidase inhibitors CI?

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IBD, ulcers, obstruction

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Pramlinitide MOA?

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Amylin mimetic, decreases postprandial glucagon....

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Pramlinitide Indication?

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Weight loss, decrease postprandial glucose

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Pramlinitide ARDs?

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Nausea, hypoglycemia, injected side effects

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Exenatide MOA?

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GLP-1 analog, potentiates glucose mediated insulin secretion...

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Exanatide Indications?

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Decrease post prandial glucose and weiht loss

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Sitagliptin MOA?

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DPP-IV inhibitor, DPP-IV inactivates GLP-1

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Sitagliptin effects of plasma glucose?

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decreases post-prandial and FPG

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First DOC for Diabetes type 2?

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Metformin, then add Sulfonylureas or thiazolinedione, then try adding insulin

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Diabetes type 2 teatments that lowers FPG?

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Metformin, Sulfonylureas, Thiazolidinediones

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Diabetes type 2 teatments that lowers post-prandial glucose?

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Meglitinides, Alpha-glucosidase inhibitors, Pramlintide