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65 Cards in this Set
- Front
- Back
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First line therapy in DM?
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lifestyle changes
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Drugs that stimulate pancreas to make more insulin
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Sulfonylureas
Meglitinides |
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Drugs that sensitize body to insulin
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TZDs
Biguanides |
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Drugs that slow absorption of starches?
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Alpha-glucosidase inhibitors
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Drugs that suppress glucagon, decrease gastric emptying
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Incretins
DPP4 inhibitors |
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Which three drugs change A1c by 1 to 2 %?
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SU
Biguanides Meglitinide |
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1st generation SUs
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Acetohexamide
Chlorpropamide Tolazamide Tolbutamide |
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2nd Generation SUs
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Glimepiride
Glipizide Glyburide |
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SU MOA?
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block ATP-dependent K channel on beta cells to increase insulin release, decrease basal hepatic glucose production, increase insulin receptor number, decrease glucagon
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SU broken down by?
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extensively metabolized in liver and excreted in urine
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SU Caution in ?
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Hepatic and renal insuff
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Chlorpropamide may see?
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Disulfuram like rxn, avoided in elderly
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Which two SUs most likely to cause hypoglycemia:
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Clorpropamide and glyburide
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Glimepiride MOA?
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Enhance sensitivity of peripheral tissues to insulin
more rapid glucose control QD |
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Glyburide often causes?
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Hypoglycemia
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Glipizide taken when? see what?
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30 minutes before a meal, see less hypoglycemia
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SU S/E?
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Hypoglycemia
Weight gain Constipation, N/D Rash Leucopenia, thrombocytopenia Resistance may develop May increase CV risk |
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SU Contraindications
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Diabetic ketoacidosis
Type 1 DM Pregnancy |
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SU interactions
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protein binding
disulfuram reactions |
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Meglitinides MOA?
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K channel modulators
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Meglitinides drugs?
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Repaglinide
Nateglinide |
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Meglitinides insulin release is?
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increase relative to glucose level
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Take meglitinides when?
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before meals, peak effectiveness in 1 hour
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Meglitinides S/E?
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Upper respiratory tract
Hypoglycemia (less freq) Weight gain HA Nausea Joint pain |
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Biguanides:
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Metformin
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Metformin MOA?
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decrease hepatic glucose production
increase fatty acid oxidation increase peripheral glucose uptake decrease glucose absorption from GI |
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Metformin does not?
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increase insulin release
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Metformin elim via?
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excreted unchanged by kidneys
***NOT metabolized by liver |
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Metformin CI in hepatic disease because?
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Lactic acid build up
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Metformin S/E?
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GI problems
lactic acidosis Rash megaloblastic anemia |
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Metformins CI
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Heart failure
Renal disease Metabolic acidosis Hepatic disease Cationic drugs |
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Metformin + surgery?
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should be stopped before surgery and radiographic procedures with contrast dyes
and withold for 48 hours post op |
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TZD drugs?
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Rosiglitazone
Pioglitazone |
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TZD definition?
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potent agonist for Peroxisome Proliferator Activated Receptor Gamma which regulates transcription of insulin responsive genes
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TZD moa?
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increase peripheral glucose uptake and increase tissue insulin sensitivity and decrease hepatic glucose production
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TZD elim?
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liver metabolism (2C8, 3A4, 2C9)
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TZDs S/E?
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Weight gain
edema infections headache fatigue muscle pain increase HDL/LDL |
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Monitor what with TZDs?
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liver enzymes
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risk of what with TZDs?
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risk of MI with rosiglitazone
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2 peptides involved in glucose?
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Glucagon-like-peptide-1
Glucose-dependent insulinotropic polypeptide GLP-1, GIP |
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Which peptide useful in type 2 DM?
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GLP-1
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Incretins do what?
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when sense glucose, increase glucose-dependent insulin release, decrease gastric emptying and food intake
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GLP-1 metabolized by?
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Dipeptidyl peptidase 4
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DM2 effects on GLP-1?
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have decreased postprandial GLP-1 induced insulin secretion
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Exenatide indications?
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DM2 taking Metformin + SU and not controlled
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May see what with exenatide?
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weight loss
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Exenatide S/E?
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N/V
Hypoglycemia with SU |
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Liraglutide is?
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Human GLP-1 analog linked to fatty acid that is released slowly
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Concerns with liraglutide?
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Small thyroid tumors
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Liraglutide S/E?
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N/V
Hypoglycemia Panceatitis Headache Dizziness Thyroid tumors |
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GLP-1 agonists undergoing clinical trials?
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Albiglutide
Taspoglutide Lixisenatide |
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DPP4 involved in?
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breakdown of GLP-1, peptide YY, neuropeptide Y, growth hormone releasing hormone, T cell activation
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DPP4 inhibitors:
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Sitagliptin
Saxagliptin |
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DPP4 Inhibitors S/E?
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Diarrhea
Headache Angioedema Rash |
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Could see what with DPP4 inhibitors?
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Stevens Johnson Syndrome
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Could see antibodies formed with?
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GLP-1 agonists
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Alpha-glucosidease inhibitors drugs? MOA?
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Acarbose
Miglitol MOA: Competitive inhibitors or alpha-amylase and alpha-glucosidase enzymes in intestinal brush border |
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AG inhibitors taken?
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with first bite of each meal
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AG inhibitors S/E?
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Abdominal pain
Diarrhea Flatulence |
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AG Inhibitors CI in?
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IBD
GI obstgruction Ulceration |
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Pramlintide MOA?
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Islet amyloid polypeptide binds to amylin receptor in CNS to decrease stomach emptying, decrease glucagon release, decrease satiety
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Pramlintide taken?
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SubQ before meals
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Pramlintide S/E?
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Nausea
Hypoglycemia |
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SGLT2 inhibitors:
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Dapagliflozin
Canagliflozin both in trials |
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SGLT2 inhibitors moa?
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sodium glucose transporter in proximal tubule responsible for glucose reabsorption
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