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pharm 2 > anti DM tables > Flashcards

anti DM tables Flashcards

1
Q

Biguanides

A

metformin

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2
Q

Biguanides Moa

A

Liver (primary) – decreases glucose production
Muscle/adipose tissue - decreases insulin resistance

metoformin moa

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3
Q

Metformin comments

 risk hypoglycemia?
 Weight ?
 first line??
 role with insulin?
 Beneficial in the treatment of?
 vitamin deficiency risk?
 ADRs common in what system
 metabolic adr? rare in?

A

 Low risk of hypoglycemia when used as monotherapy
 Weight neutral
 One of the first line drug therapy options added to diet and exercise
 Ameliorates insulin- associated weight gain
 Beneficial in the treatment of prediabetes
 B12 deficiency risk
 GI ADRs (e.g., diarrhea, nausea, cramping)
 Lactic acidosis (rare) in patients with cardiovascular, renal, or hepatic dysfunction

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4
Q

Glucagon-like peptide-receptor agonists (GLP1-RA)

A

dulaglutide
exenatide
liraglutide
lixisenatide
semaglutide

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5
Q

Glucagon-like peptide-receptor agonists (GLP1-RA) moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying

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6
Q

dulaglutide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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7
Q

exenatide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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8
Q

liraglutide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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9
Q

lixisenatide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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10
Q

semaglutide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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11
Q

Glucagon-like peptide-receptor agonists (GLP1- RA)

 risk of hypoglycemia
 nausea?
 Weight?
 CV/ renal? agents?
 Injection site?
 Pancreatitis (rare)
 May be associated with dx of what GI organ?
 Risk of tumors where?

A

 Low risk of hypoglycemia when used as monotherapy
 Nausea
 Weight loss
 CV benefit (albiglutide, dulaglutide, liraglutide, semaglutide) and renal
benefit (liraglutide, semaglutide)
 Injection site reactions
 Pancreatitis (rare)
 May be associated with gallbladder disease
 Risk of Thyroid-C cell tumors

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12
Q

Glucagon-like, peptide-1 (GLP-1) agonist and glucose- dependent insulinotropic polypeptide (GIP) agonist (a “twincretin”):

A

tirzepatide

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13
Q

Glucagon-like, peptide-1 (GLP-1) agonist and glucose- dependent insulinotropic polypeptide (GIP) agonist moa

A

increases insulin secretion in response to elevated glucose, decreases glucagon
secretion, slows gastric emptying

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14
Q

tirzepatide moa

A

increases insulin secretion in response to elevated glucose, decreases glucagon
secretion, slows gastric emptying

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15
Q

tirzepatide

 risk of hypoglycemia?
 weight?
 A1c reduction?
 CV/renal?
 May delay absorption of?

A

 Low risk of hypoglycemia
 More weight loss than GLP-1 agonists
 More A1c reduction than most GLP-1 agonists.
 No CV or kidney outcomes data yet.
 May delay oral contraceptive absorption

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16
Q

Sodium glucose cotransporter-2 inhibitors (SGLT-2

A

bexagliflozin
canagliflozin
dapagliflozin
empagliflozin
ertugliflozin

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17
Q

Sodium glucose cotransporter-2 inhibitors (SGLT-2) moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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18
Q

bexagliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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19
Q

canagliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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20
Q

dapagliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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21
Q

empagliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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22
Q

ertugliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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23
Q

Sodium glucose cotransporter-2 inhibitors (SGLT-2)

risk of hypoglycemia?
 Weight?
 CV and renal? agents?
 Genital side effects?
 BP?
 lipid profile?
 urine?
 pancreas?
 May be associated with rare? agent?
 bones?
 Increased risk of what gangrene?

A

 Low risk of hypoglycemia
 Weight loss
 CV and renal benefit (canagliflozin, dapagliflozin, empagliflozin)
 Genital fungal (yeast) infections (male/female)
 UTI
 Dizziness, hypotension,
 Increased LDL
 Increased urination
 Acute pancreatitis (rare)
 May be associated with rare amputations (canagliflozin
 Increases fracture risk (rare)
 Increased risk of Fournier’s gangrene - infection in the scrotum (which includes the testicles), penis, or perineum (rare)

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24
Q

Dipeptidyl-
Peptidase-4
Inhibitors (DPP-4

A

alogliptin
linagliptin
saxagliptin
sitagliptin

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25
Q

Dipeptidyl- Peptidase-4 Inhibitors (DPP-4 )moa

A

Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like
peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels

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26
Q

alogliptin moa

A

Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like
peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels

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27
Q

linagliptin moa

A

Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like
peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels

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28
Q

saxagliptin moa

A

Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like
peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels

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29
Q

sitagliptin moa

A

Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like
peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels

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30
Q

DPP-4 inhibitors

 risk of hypoglycemia?
 Weight?
 May be associated with?
 CV?
 joints?

A

 Low risk of hypoglycemia when used as monotherapy
 Weight neutral
 May be associated with pancreatitis
 New or worsening heart failure
 May cause severe joint pain

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31
Q

Thiazolidinedione
(TZD)

A

pioglitazone
rosiglitazone

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32
Q

TZD moa

A

Muscle and adipose – peroxisome proliferator- activated receptor γ(gamma) - (PPARγ) agonist, makes tissues more sensitive to endogenous insulin and enhances glucose uptake into the tissues. Does not increase pancreatic insulin secretion

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33
Q

rosiglitazone moa

A

Muscle and adipose – peroxisome proliferator- activated receptor γ(gamma) - (PPARγ) agonist, makes tissues more sensitive to endogenous insulin and enhances glucose uptake into the tissues. Does not increase pancreatic insulin secretion

34
Q

pioglitazone moa

A

Muscle and adipose – peroxisome proliferator- activated receptor γ(gamma) - (PPARγ) agonist, makes tissues more sensitive to endogenous insulin and enhances glucose uptake into the tissues. Does not increase pancreatic insulin secretion

35
Q

Thiazolidinedione

 risk of hypoglycemia?
 peripheral tissues?
 Weight ?
 CV?
bones?

A

 Low risk of hypoglycemia when used as monotherapy
 Edema
 Weight gain
 Heart failure. Avoid in patient with symptomatic heart failure
 Increased fracture risk

36
Q

Sulfonylureas (SU)

Note: 1st generation not included since not commonly used in practice

A

glimepiride (2nd Gen)
glipizide (2nd Gen)
glyburide(2nd Gen)

Start with ”g” and end in “ide” - glipizide, glyburide, glimepiride

37
Q

Sulfonylureas (SU) moa

A

Secretagogue
Pancreas - Stimulates beta cells causing insulin secretion

38
Q

glimepiride moa

A

Secretagogue
Pancreas - Stimulates beta cells causing insulin secretion

39
Q

glipizide moa

A

Secretagogue
Pancreas - Stimulates beta cells causing insulin secretion

40
Q

glyburide moa

A

Secretagogue
Pancreas - Stimulates beta cells causing insulin secretion

41
Q

Sulfonylureas (SU)

 Hypoglycemia?
 Weight?
 “Durability”

A

 Hypoglycemia, especially with renal dysfunction (usually discontinue with use of insulin)
 Weight gain
 “Durability” declines over time

42
Q

metformin

A

Biguanides

43
Q

Liver (primary) – decreases glucose production
Muscle/adipose tissue - decreases insulin resistance

A

Biguanides Moa

44
Q

dulaglutide
exenatide
liraglutide
lixisenatide
semaglutide

A

Glucagon-like peptide-receptor agonists (GLP1-RA)

45
Q

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

A

Glucagon-like peptide-receptor agonists (GLP1-RA) moa

46
Q

tirzepatide

A

Glucagon-like, peptide-1 (GLP-1) agonist and glucose- dependent insulinotropic polypeptide (GIP) agonist (a “twincretin”):

47
Q

increases insulin secretion in response to elevated glucose, decreases glucagon
secretion, slows gastric emptying

A

Glucagon-like, peptide-1 (GLP-1) agonist and glucose- dependent insulinotropic polypeptide (GIP) agonist moa

48
Q

bexagliflozin
canagliflozin
dapagliflozin
empagliflozin
ertugliflozin

A

Sodium glucose cotransporter-2 inhibitors (SGLT-2

49
Q

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

A

Sodium glucose cotransporter-2 inhibitors (SGLT-2) moa

50
Q

alogliptin
linagliptin
saxagliptin
sitagliptin

A

Dipeptidyl-
Peptidase-4
Inhibitors (DPP-4

51
Q

Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like
peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels

A

Dipeptidyl- Peptidase-4 Inhibitors (DPP-4 )moa

52
Q

pioglitazone
rosiglitazone

A

Thiazolidinedione
(TZD)

53
Q

Muscle and adipose – peroxisome proliferator- activated receptor γ(gamma) - (PPARγ) agonist, makes tissues more sensitive to endogenous insulin and enhances glucose uptake into the tissues. Does not increase pancreatic insulin secretion

A

TZD moa

54
Q

glimepiride
glipizide
glyburide

A

Sulfonylureas (SU)

Note: 1st generation not included since not commonly used in practice

55
Q

Secretagogue
Pancreas - Stimulates beta cells causing insulin secretion

A

Sulfonylureas (SU) moa

56
Q

rapid acting insulins

A

Humalog,
Amelog,
Lyumjev (insulin lispro)
NovoLog,
Fiasp* (insulin aspart)
Apidra (insulin glulisine)

57
Q

use of rapid acting insulins

A

Bolus dosing(meals) and insulin
pumps (administration ranges 5-15
minutes before meals –see specific
product information)

58
Q

short acting insulins

A

Humulin R or Novolin R - Regular
insulin -

59
Q

use of short acting insulins

A

Bolus dosing(meals)
(administration ranges 15-30
minutes before meals –see specific
product information)

60
Q

intermeadiate acting insulins

A

Humulin N or Novolin N - NPH

61
Q

intermeadiate acting insulins use

A

~ “Basal-like” (administration Q
day to BID)

62
Q

long acting insulins

A

Lantus, Basaglar* Rezvoglar,
Semglee, (insulin glargine) – 100
units/mL

Toujeo (insulin glargine) – 300
unitls/mL

Levemir (insulin detemir) – to be
discontinued in 2024

63
Q

long acting insulin uses

A

Basal (administration Q day)

64
Q

ultra long acting insulins

A

Tresiba (insulin degludec)

65
Q

ultra long acting insulins use

A

Basal (administration Q day,
anytime of day)

66
Q

Humalog,
Amelog,
Lyumjev (insulin lispro)
NovoLog,
Fiasp* (insulin aspart)
Apidra (insulin glulisine)

A

rapid acting insulins

67
Q

Bolus dosing(meals) and insulin
pumps (administration ranges 5-15
minutes before meals –see specific
product information)

A

use of rapid acting insulins

68
Q

Humulin R or Novolin R - Regular
insulin -

A

short acting insulins

69
Q

Bolus dosing(meals)
(administration ranges 15-30
minutes before meals –see specific
product information)

A

use of short acting insulins

70
Q

Humulin N or Novolin N - NPH

A

intermeadiate acting insulins

71
Q

~ “Basal-like” (administration Q
day to BID)

A

intermeadiate acting insulins use

72
Q

Lantus, Basaglar* Rezvoglar,
Semglee, (insulin glargine) – 100
units/mL

Toujeo (insulin glargine) – 300
unitls/mL

Levemir (insulin detemir) – to be
discontinued in 2024

A

long acting insulins

73
Q

Basal (administration Q day)

A

long acting insulin uses

74
Q

Tresiba (insulin degludec)

A

ultra long acting insulins

75
Q

Basal (administration Q day,
anytime of day)

A

ultra long acting insulins use

ultra long lasting insulin

76
Q

which DM rx have CV benefits

A

GLP-RA and SGLT-2 inhib

77
Q

which DM rx have renal benefits

A

SGLT-2 inhib

78
Q

which DM rx have risk of hypoglycemia

A

SU and insulins

79
Q

which DM Rx cause weight gain

A

SU and TZD

80
Q

which DM Rx cause weight loss

A

SGLT2 inhib
trizepatide
GLP1RA

81
Q

which DM rx can cause new/worse HF

A

DPP4 inhib and TZD

pharm 2 (20 decks)

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