Anti-Diabetic Flashcards
DM I pathophys
beta cell failure, genetic autoimmune destruction
insulin dependent due to insulin deficiency
DM II pathophys
gradual beta cell deterioration leading to resistance to insulin
symptoms of DM
increased thirst, slow healing, fatigue, blurred vision, frequent urination, unexplained weight loss
insulin MOA
bind insulin receptors to activate tyrosine kinase to adipose, liver, skeletal muscle and promote storage
lispro insulin features
3-5 hours duration
IV/prick
onset 15 min
regular crystalline insulin features
7-10 hour duration
IV/prick
most common
neutral protamine hagedorn features
duration
16-20 hour duration
can be used with regular
insulin!
oral antidiabetic drugs include
sulfonylureas
metformin
thiazolidinediones
acarbose/miglitol
effect of sulfonylureas on blood sugar
reduce by stimulating pancreatic insulin release
effect of metformin/biguanides on blood sugar
reduce biosynthesis of glucose in the liver
effect of thiazolidinediones on blood sugar
reduce by increasing sensitivity of target cells to insulin
combat insulin resistance
effect of acarbose/miglitol on blood sugar
reduce by retarding the absorption of sugars from the GI tract
sulfonylureas MOA
inhibit K+ channels to increase intracellular Ca+, increase insulin release from pancreatic beta cells
are sulfonylureas commonly used now?
No, there are 3 generations of these drugs but they are not commonly prescribed now due to better alternatives
sulfonylureas side effects
hypoglycemia
cholestatic jaundice
weight gain
cross placenta/fetal hypoglycemia
meglitinides pros and cons
pros: rapidly acting insulin enhancers with shorter duration than sulfonylureas
less weight gain
minimal renal excretion so safe for patients with impaired renal function
cons: adverse effect of hypoglycemia, cannot be taken without food/meal
metformin MOA
decrease hepatic glucose production by inhibiting GnG
increases muscle and liver sensitivity to insulin
pros of metformin
modest weight loss
no hypoglycemia
decreases triglycerides and LDL
increases HDL
side effects of metformin
GI effects
lactic acidosis, esp if kidney disease present
first line medication for diabetes
metformin
additional medications added if needed
thiazolidinediones MOA
enhance GLC/lipid metabolism with PPAR action to increase sensitvity to insulin
increases GLUT 4 GLC transporters
pros of thiazolidinediones
decrease triglycerides and increase HDL
side effects of thiazolidinediones
edema
alpha glucosidase inhibitors MOA
inhibit alpha glucosidase that converts starch and complex carbs into simple sugars, decreasing absorption of GLC after meals
