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CAM > 4. Chrissobolis - DM Drugs > Flashcards

4. Chrissobolis - DM Drugs Flashcards

1
Q

What drug class does Metformin belong to?

A

Biguanides

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2
Q

What is the main function of Metformin?

A

Reduce hepatic glucose production

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3
Q

What are 2 the minor functions of Metformin?

A
  1. Increase glucose uptake and utilization in skeletal muscle and adipose
  2. Decrease glucose absorption in the GI tract
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4
Q

What is the main reason for Metformin therapy? - two things

A
  1. Lower glucose levels

2. Improve insulin sensitivity

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5
Q

What does Metformin do at the cellular level?

A

Increases AMP, causing an increase in insulin sensitivity and a decrease in gluconeogenic pathways

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6
Q

What are the 5 brand name available formulations of Metformin? What 3 are extended release?

A
  1. Glucophage
  2. Rio met
  3. Fortamet - ER
  4. Glucophage XR - ER
  5. Glumetza - ER
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7
Q

What is the black box warning for Metformin?

A

Lactic acidosis

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8
Q

What 3 conditions is Metformin not indicated for?

A
  1. T1DM
  2. Diabetic ketoacidosis
  3. Heart Failure
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9
Q

What is the main action of TZDs?

A

Decrease insulin resistance

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10
Q

What is TZDs MOA?

A

Selective ligand for PPAR-y receptor

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11
Q

What is TZDs action in adipose tissue?

A

Increase FFA uptake and storage

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12
Q

What is TZDs action in the liver?

A

Enhances insulin signaling

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13
Q

What is TZDs action in macrophages?

A

Affects M2 and M1, promotes anti-inflammatory macrophages and protects against pro-inflammatory macrophages

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14
Q

What is the brand name of Pioglitazone? What class does it belong to?

A

Actos - TZD

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15
Q

What is the brand name of rosiglitazone? What class does it belong to?

A

Avandia - TZD

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16
Q

What are the three main side effects of TZDs?

A
  1. Fractures in bones
  2. HTN and edema
  3. HF and MI
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17
Q

What is the brand name (hint, there’s 2) of Exenatide? What drug class does it belong in?

A

Bydureon and Byetta - Short Acting GLP-1Ra

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18
Q

Why are long acting GLP-1Ra better than short acting GLP-1Ras?

A

Better overall glycemic control due to higher fasting insulin levels

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19
Q

What is the brand name (hint there’s 2) for liraglutide? What drug class does it belong it?

A

Saxenda, Victoza - long acting GLP-1Ra

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20
Q

What is the brand name for albiglutide? What drug class does it belong to?

A

Tanzeum - long acting GLP-1Ra

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21
Q

What is the brand name for dulaglutide? What drug class does it belong to?

A

Trulicity - long acting GLP-1Ra

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22
Q

Where is metformin’s main site of action?

A

In the liver

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23
Q

What is the MOA of DPP4i?

A

Inhibit the breakdown of GLP-1 and GIP by DPP4.

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24
Q

What is the brand name for sitaglpitin? What drug class does it belong to?

A

Januvia - DPP4i

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25
What is the brand name for saxagliptin? What drug class does it belong to?
Onglyza - DPP4i
26
What is the brand name for linagliptin? What drug class does it belong to?
Trajenta - DPP4i
27
What is the brand name for alogliptin? What drug class does it belong to?
Nesina - DPP4i
28
What are the main SE of DPP4is?
Severe joint pain and increased risk of acute pancreatitis
29
What is the MOA of sulfonylureas?
Increase insulin release by biding to SUR1 receptor on pancreatic beta cells
30
What are the three brand names of glipizide? What drug class do they belong to?
Glipizide XL, glucotrol, glucotrol XL - Sulfonylureas
31
What is the brand name of glimepiride? What drug class does it belong to?
Amaryl - sulfonylureas
32
What are the 2 brand names of glyburide? What drug class do they belong to?
Diabeta, glynase PresTab - sulfonylureas
33
What can happen from chronic administration of sulfonylureas?
Desentization, circulating insulin levels decline
34
What is the main side effect of sulfonylureas?
Hypoglycemia, including coma
35
What is the MOA of SGLT-2i?
Inhibit the reabsorption of glucose from urine back into circulation
36
What is the brand name of canagliflozin? What drug class does it belong to?
Invokana - SGLT2i
37
What is the brand name of dapagliflozin? What drug class does it belong to?
Farxiga - SGLT2i
38
What is the brand name of empagliflozin? What drug class does it belong to?
Jardiance - SGLT2i
39
What is the major side effect of all SGLT2 inhibitors?
Genetourinary infection
40
What is the goal of insulin therapy?
Replicate normal, physiological insulin secretion
41
What are the 4 types of injectable insulins?
1. Rapid acting 2. Short acting 3. Intermediate acting 4. Long acting
42
What type of insulin is preferred for continuous sc insulin infusion devices (aka insulin pumps)
Rapid acting insulins
43
What is the advantage of rapid acting insulin?
Take insulin immediately before a meal
44
When should short acting insulin be given and why?
Given 30-45 minutes before the meal because blood glucose rises faster than insulin
45
What are the 2 main side effects for all insulin therapy?
Hypoglycemia and weight gain (more insulin = more weight)
46
What concentration is available for insulin?
100 U/mL (100u)
47
What are the three delivery methods of insulin?
1. SubQ injection 2. Portable pen injectors 3. Inhaled insulin
48
What is the MOA of alpha-glucosidase inhibitors?
Competitively inhibit enzymes in the small intestine, delaying the breakdown/absorption of carbs
49
What is the net effect of alpha-glucosidase inhibitors?
Reduction in postprandial blood glucose rise
50
What is the brand name of acarbose? What drug class does it belong to?
Precose - alpha-glucosidase inhibitors
51
What is the brand name of miglitol? What drug class does it belong to?
Glyset - alpha-glucosidase inhibitors
52
What is the MOA of a bile acid sequestrant?
Competes for the reabsorption of bile acids, thought to also compete with the absorption of glucose from the gut
53
How does a dopamine agonist work?
Binds in the hypothalamus, alters the circadian rhythms and reverses insulin resistance
54
What is the brand name of colesevelam? What drug class does it belong to?
Welchol - bile acid sequestrant
55
What is the brand name of bromocriptine? What drug class does it belong to?
Cycloset - dopamine agonist
56
What is the MOA of amylin?
Secreted along w/ insulin to reduce the amount of glucagon secreted after a meal
57
What is the main effect of amylin?
Decreased plasma glucose
58
What is the brand name of pramlintide? What drug class does it belong to?
SymlinPen (120 &60) - amylin
59
What is pramlintide?
An amylin agent for use in T1 and T2 DM for pts currently treated w/ insulin
60
What is the black box warning for pramlintide?
Insulin/glucose lower agents
61
What is the MOA of meglitinides?
Same as sulfonylureas, binds to SUR receptor and increases the amount of insulin released
62
What is the brand name of repaglinide? What drug class does it belong to?
Prandin - Meglitinides
63
What is the brand name of nateglinide? What drug class does it belong to?
Starlix - meglitinides
64
What is the A1C goal for a diabetic pt?
7%
65
What is the goal for preprandial plasma glucose?
80-130 mg/dL
66
What is the goal for postprandial plasma glucose?
67
When adding another non-insulin drug onto therapy how much dose it lower a pts A1C?
~0.9-1.1%
68
What can be used when Metformin can't be used?
Any of the other 6 medications
69
When Metformin can't be used because of renal insufficiency, when can and cannot be used?
Can: DPP4 inhibitors | Can't sulfonylureas
70
When an A1C is >9% what should be considered for initial therapy?
Duel therapy including insulin
71
In gestational diabetes, what is the most effective treatment?
Lifestyle changes

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