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DERS Pharm > Anti Diabetics > Flashcards

Anti Diabetics Flashcards

1
Q

Insulin secretion mechanism

A

Glucose in blood increases –> cell depolarizes –> Ca+ triggers insulin secretion

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2
Q

Insulin receptor

A

a subunit for recognition

b subunit tyrosine kinase and phosphorylates tyrosine

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3
Q

Insulin inhibits

A

gluconeogenesis

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4
Q

Insulin causes

A
  • glucose entry in muscle and adipose tissue
  • glycogen synthesis in liver and muscle
  • fatty acid synthesis and storage
  • amino acid uptake
  • glycolysis
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5
Q

Rapid acting insulin is

A

fast onset, short duration

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6
Q

Short acting insulin is

A

rapid onset

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7
Q

Long acting insulin is

A

slow onset, long duration

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8
Q

Rapid acting insulin analogs

A

Insulin Lispro
Insulin Aspart
Insulin Glulisine

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9
Q

Rapid acting insulin analogs mimic ___

A

prandial release of insulin
usually given with long acting insulin
given 15 min before meal

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10
Q

Short acting insulin __

A

soluble crystalline zinc insulin

given 30 minutes before meal

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11
Q

Intermediate acting insulin ___

A

Neutral protamine Hagedorn (NPH)
aka. Isophane insulin

Crystalline zinc + protamine
used for basal control

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12
Q

Long acting insulin analogs

A

Insulin Glargine
Insulin Degludec
Insulin Detemir

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13
Q

Rapid and long acting insulin do?

A
  • improve HbA1C levels

- reduce hypoglycemia

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14
Q

Standard mode of insulin therapy is

A

SC injection

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15
Q

IV insulin is used in

A
  • pt with ketoacidosis
  • perioperative period
  • labor and delivery
  • ICU
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16
Q

Inhaled insulin AE and CI

A
  • cough, throat pain, hypoglycemia

CI:

  • copd
  • asthma
  • smokers
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17
Q

Insulin regimen goals?

A

replace basal insulin and pradnsial insulin

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18
Q

2 methods of insulin release

A
  1. basal bolus insulin regimens

2. insulin pump therapy

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19
Q

Basal bolus insulin regime

A
  • one shot of long acting insulin when fasting

- doses of rapid acting around mealtimes

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20
Q

Insulin pump therapy

A

best way to mimic normal insulin secretion

  • glulisine, lispro, or insulin aspart is used in the insulin pump
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21
Q

The biggest AE of insulin

A

hypoglycemia

  • less risk with rapid than regular
  • less risk with long than NPH
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22
Q

If you have mild hypoglycemia?

A

drink OJ, or have sugar

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23
Q

If you have severe hypoglycemia?

A

IV glucose infusion

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24
Q

Drugs that cause hypoglycemia

A

Ethanol
B blockers
Salicylates

25
Q

Drugs that cause hyperglycemia

A
  • Epinephrine
  • Glucocorticoids
  • Atypical antipsychotics
  • HIV protease inhibitors
  • Phenytoin
  • Clonidine
  • Ca2+-channel blockers
  • Diuretics
26
Q

NON- insulin antidiabetic agents

A
  • Insulin secretagogues
  • Biguanides
  • Thiazolidinediones
  • A glucosidase inhibitors
  • Incretin analogues
  • Inhibitors of DPP-IV
  • Amylin analogs
  • Bile-acid sequestrants
  • SGLT2 inhibitiors
27
Q

Insulin secretagogues

A

Sulfonyureas

Meglitinides

28
Q

Sulfonyureas

A

1st gen and 2nd gen

reduce fasting plasma glucose and HBA1C

  • stimulate insulin release from B cells by binding to SUR1 subunit and blocking K channels

AE:

  • hypoglycemia
  • weight gain
29
Q

First gen sulfonylureas

A

Chlorpropamide

AE:

  • hypoglycemia
  • hyperemic flush when alcohol ingested due to inhibitiono f aldehyde dehydrogenase
  • SIADH

CI:
- old ppl

30
Q

Second gen sulfonylureas

A

Glyburide
Glipizide
Glimepiride

  • more potent than 1st gen
    AE:
  • hypoglycemia
  • weight gain
31
Q

Meglitinides

A

Repaglinide
Nateglinide

  • not as effective as sulfonylureas
  • rapid onset, short duration
  • postprandial glucose regulators
  • take before each meal

AE:
- weight gain

CI:
- pt with sulfur allergy

32
Q

Biguanides

A

Metformin

33
Q

Metformin

A

AE:

  • GI
  • impaired B12 absorption
  • lactic acidosis

CI:

  • renal, hepatic disease
  • hypoxia
  • alcoholism

first line of therapy in type 2 diabetes

34
Q

TZDs

A

promote glucose uptake in adipose tissue

➢ Pioglitazone
➢ Rosiglitazone

slow onset

MOA: gene regulation 
AE:
- fluid retention, edema
- weight gain
- CHF

CI:
- heart failure

liver function monitoring required

35
Q

a-Glucosidase Inhibitors

A

Acarbose

36
Q

Acarbose

A

MOA:

  • reduces postprandial digestion of starch
  • reduces absorption
  • drop HBA1C and FPG lvl

AE:

  • GI effects
  • hepatic. enzyme elevation

CI:
- IBS

liver function monitoring required

37
Q

Incretin analogs

A

Exenatide (injectable)

38
Q

Exenatide

A

analog of Glucagon like polypeptide 1
agonist of GLP-1 receptor

resistant to dipeptidyl peptidase IV (DPP-IV)

MOA:
• Enhances glucose-dependent insulin secretion.
• Suppresses postprandial glucagon release.
• Slows gastric emptying.
• Decreases appetite.
• May stimulate β-cell proliferation

AE:

  • nausea, vomiting
  • acute pancreatitis

CI:
- pt with gasteroparesis

39
Q

Inhibitors of DPP-IV

A

Sitagliptin

40
Q

Sitagliptin

A

MOA:

  • inhibitor of DPP-IV
  • increase GLP1 and insulin

AE:

  • pancreatitis
  • hypersensitivity reactions
41
Q

Amylin analogs

A

Pramlintide

42
Q

Pramlintide

A

MOA:

  • analog of amylin
  • inhibits food intake, gastric emptying and glucagon secretion
43
Q

BIle acid sequestrants

A

Colesevelam

44
Q

Colesevelam

A

MOA: lower LDL cholesterol used for type 2 DM

45
Q

SGL2 inhibitors

A

Canagliflozin

46
Q

Canagliflozin

A

MOA:

  • blocks glucose reabsorption
  • increased glucose excretion and decreased blood glucose lvls

AE:

  • UTI
  • hyperkalemia, hypermagnesmia

CI:
- pt with GFR < 45

47
Q

type 2 DM inital drug therapy

A

metformin

monotherapy reduce HBA1C by 1%

48
Q

Dual combination therapy

A

after 3 months if monotherpay doesnt help add second oral agent

GLP1 agonist or insulin

49
Q

Triple combination therapy

A

if 2 drug doesnt help add 3rd agent might need to get –> insulin if HBA1C > 8.5%

50
Q

GLP1 receptor agonist vs. Insulin

A

GLP1 RA is better injectable option because minimize hypoglycemia and weight gain

51
Q

When is insulin initial therapy for type 2 DM

A
  • ongoing catabolism (weight loss)
  • hyperglycemic syndromes
  • ketonuria
  • HbA1C > 10%
  • random glucose > 300
52
Q

Gestational DM (preganancy)

A

NPH insulin single dose and id postprandial glucose control needed then add insulin lispro or aspart

53
Q

DM with CVD

A
  • ACEI/ARB
  • Statins
  • Aspirin
54
Q

DM with nephropathy

A
  • ACEI/ARB
55
Q

DM with gastroparesis

A

prokinetic agents: metoclopramide or erythromycin

56
Q

DM with erectile dysfunction

A

phosphodiesterase type 5 inhibitors

57
Q

Glucagon

A

secreated by pacreatic a cells

increases: glycogen degradation, gluconeogenesis, fatty acid oxiziation, insulin release
decreases: glycolysis

58
Q

Glucagon uses:

A
  • severe hypoglycemia
  • radiology of bowel
  • B blocker poisoning
  • C peptide test

DERS Pharm (2 decks)

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