Anti-Diabetes Flashcards
Insulin of choice in emergent sitautions
IV regular insulin
Low risk of hypoglycemia insulins VRS High risk of hypoglycemia insulins. Name please
rapid acting (lispro, aspart, glulisine) and long acting (glargine, detremir) = low risk VRS higher risk: short acting (regular insulin) and intermediate (NPH)
drugs that can interefere with diabetic meds and make them more prone to hyPOglycemia
beta blockers - stop effects of catecholamines
EtOH - prevents gluconeogenesis
Salicylates - increases insulin secretion and acts a wee bit like insulin @ periphery
drugs that can interfere wtih diabetic meds and make pts more prone to hyPERglycemia
epinephrine, corticosteroids, atypical antipsychotics, HIV protease inhibitors = make tissue less responsive
phenyoin, clonidine, calcium channel blockers = decreased insulin secretion
diuretics = deplete K (alters ability of K to play roel in exocytosis of insulin in response to sugra SUR/KIR channel)
first gen sulfonylureas please
tobutamide - short duration of action
chlorporpamide - longer duration of action
a/se of chlorporpamide
hyperglycemia @ elderly = dont give
hyperemic flush @ OH = dont drink
SIADH = dont pee
DONT GIVE OLD, DONT DRINK LOTS, DONT PEE MUCH
second gen sulfonylureas, now preferred bc better a/se profile = ?
glyburide - hyperglycemia @ 20-30%
glupizine - hyperglycemia @ least DOC***
glimepride - hyperglycemia @ 3-4%
anti-diabetic drugs that cause WEIGHT GAIN
1) sulfonlyureas - tolbutamide, chlorpropamide, glyburide, glipizine, glimepride
2) meglinitides - repaglinide, nateglinide
Please name the Meglitinides
Repaglinide
Nateglinide
Describe kinetics and use of the meglitinides
shorter duration of action and more rapid onset than sulfonylureas –> thefeore used for post pradial (omit if you skip a meal)
A/se of meglitinides
repaglinide and natiglinide: hypoglycemia and weight gain
MOA of meglitinides and sulfonylureas
bind to SUR of ATP-K sensitive –> causes less K+ out of cell –> depolarizes –> opens vg Ca++ channels –> depolarizes –> exocytosis of insulin and increased transcription of insulin –> hurrah
MOA of metformin key words please
no insulin increase (decreases insulin levels due to improved glycemic control)
stops gluconeogen @ liver
increases insulin effects @ muscle and liver
Effects unique to metformin *small group too , high yeild probly
decreases TAG
does not cause weight gain
First line for DMii
metformin (because doesnt cause weight gain and decreases TAG)
When I say metformin, you think of this intracellular protein causeing all its effects
AMPK
A/se of metformin
a) gi messy time
b) B12 deficeincy - bc of gi messy time
c) lactic acidosis - bc liver cant use lactic acid for gluconeogenesis since metformin blocks it via AMPK
Dont use metformin for these 4 types of patients
liver dz
renal dz
OH-ics
hypoxic patients - resp dz
TZDs name them please
pioglitazide
rosiglitazone
MOA TZDs please
pioglitazide, rosiglitazone
a) decrease insulin resistance
b) agonists of PPARgamaa = alter gene expression and therefore take weeks to months to take effect
What does pioglitazone do better than rosiglitazone?
all good things
- decreased LDL particle concentration and size
- increase HDL
- decreased TAG
What blood tests MUST you order if pt is taking TZDs
liver function tests (also perform with alpha glucosidase inhibitors - acarbose)
SHARK STYLE: If you have a diabetic patient with liver problems, dont give these drugs if you can
metformin
TZDs
acarboseo - glucosidase inhibitor
SHARK STYLE: If you have a diabetic patient with a crapy lipid profile, these drugs will help
metform
TZDs (the glitta-zones)
insulin
coveleselam (decreases LDL but icnreases TAG)
SHARK STYLE: if someone drinks alcohol + DM
chronic - no metformin (contraindicated)
once in a while or chronic - no first gen sulfonylureas (tolbutamide, chlorporpramide)
MOA: exenatide
glucagon like polypeptide 1 - an incretin analoug = stimulates insulin secretion
the many effects of exenatide please.
enhances glucose dependent insulin secretion therefore suppresses postprandial glucagon release
slows gastric emptying therefore keeps more food suppresse appetite drive = decreases appeitie
may increase beta cell proliferation
a/se of exenatide
nausea, vomit, diarrhoe,
ACUTE PANCREATITIS
contraindicated in gastroparesis patients (but diabetes can cause gastropareisis :S) - bc causes gastric emptying slowing
how come exenatide doesnt get degraded
resistant to dipeptidyl peptidase IV
Sitagliptin MOA
DDP IV inhibitor –> increases levels of GLP-1 and insulin
a/se of sitagliptin
pancreatitis (just like exenatide - also GLP-1) hypersensitivity reactions (urticaria, angioedema, anaphylaxis, Steven Johnson etc)
Pramlintide MOA
analogue of amyline (cosecreted from beta cells)
- decreased glucagon secretion
- inhibits food intake
- slows gastric emptying
Colesevelam
bile acid sequestrant used to lower LDL via MOA unknown
SHARK STYLE: what drug to not give people with III or IV CHF?
TZDs - glitter-zones
SHARK STYLE: which antidiabetic drugs do NOT cause weight gain
metformin
alpha-glucosidase inhibitiors
sitagliptine
SHARK STYLE: which antidiabetic drug causes weight loss?
exenatide**
SHARK STYLE: list dugs you shouldnt give if someone has issues with the following organ systems: a) heart/cvs b) pancreas c) Renal d) liver e) hyperesensivitiies f) gastroparesis
a) heart/chf - no TZDs
b) pancrease - no exenatide or sitagliptine
c) renal - no metformin
d) liver - no metformin, monitor TZDs and acarbose (alpha glucosidase inhibitors)
e) steven johnson - sitagliptine
f) exenatide - slows gastric emptying
Effective treatment for people with HbA1c < 9%
metformin alone as monotherapy may be effective
If monotheraphy doesnt work over three motnhs
metformin PLUS oral agent, exenatide or insulin
SHARK STYLE: Which anti-diabetics do not cause weight gain
metformin alpha glucosidases exenatide - decreases sitaglitpine plamlitidine
If dual theraphy doesnt work then what would be the most ‘‘robust’’ option be
insuline
~~ What level of HbA1c would favour the transition to insulin?
> 8,5%
What is the most effective of diabetes medications to lower glycemia?
Insulin - has no ceiling
~~~When is insulin warranted as INITIAL THERAPY
DM II use insuline as initial therapy when:
@ significant hyperglycemic symptoms
@ ketonuria
@ HbA1c >10% (>8.5 for tri therapy addition)
@ random glucose > 300 mg/dl
~ If a diabetic has X treat with ? series
HYPERTENSION
ACEi and ARB
~If a diabetic has X treat with ? series
albuminuria
If a diabetic has X treat with ? series
~If a diabetic has X treat with ? series
distal symmetric polyneuropathy
ADGOPVV Amytriptyline Duloxetine Gabapentin Opioids Pregablin Valproate Venlafexin
~If a diabetic has X treat with ? series
gastropareisis
CONTRAINDICATED - exenatide
metoclopramide
erythrmycin
ME
~If a diabetic has X treat with ? series
Erectile dysfunction
PDE5 inhibitor
~ DOC at pregos
regular insulin - short acting
IV (Emerg use of choice as well)
Glucagon uses times four please
1) severe hypoglycemia @ DM pts who o/d insulin
2) radiology of bowel b/c relaxes intestion
3) beta b poisoning - O/D antidote
4) glucagon C peptide test - to assess beta cell function
~ things i think will be super high yield and are bolded in notes
** things i think are high yield hurrah
SHARK - get these before you move on to next card.
15 qs on last years exam.
