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PHARMACOLOGY > CHAPTER 24: DIABETES DRUGS > Flashcards

CHAPTER 24: DIABETES DRUGS Flashcards

1
Q

Amylin
- what is it
- actions

A

hormone co secreted w insulin from pancreatic beta cells

ACTION: delays gastric emptying, dec postprandial (after meal) glucagon secretion, improve satiety

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2
Q

Pramlintide

A
  • synthetic form of amylin
  • SC before major meal
  • combo with insulin and oral agents
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3
Q

Pramlintide: Adverse effects

A

nausea, vomiting, anorexia, hypoglycemia

CANNOT be mixed in same syringe with insulin

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4
Q

Incretin Mimetics/GLP-1 Agonists
- incretin effect
- how does gut regulate it

A

Incretin effect reduced in type 2 diabetes
- gut releases incretin hormones, GLP-1, and GIP, in response to a meal, which are responsible for insulin secretion

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5
Q

Incretin mimetics/GLP-1 receptor agonists: 2 drugs

A

exenatide and liraglutide

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6
Q

Incretin Mimetics: MOA and route

A

mimic incretin hormones (GLP-1 receptor agonists)
- polypeptides–> SC route before meals

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7
Q

Incretin Mimetics: Actions/effects

A
  • improves glucose dep insulin secretion
  • slow gastric emptying time
  • reduce food intake by inc satiety
  • dec postprandial glucagon secretion
  • promote Beta cell proliferation—> post prand hyperglycemia is reduced, HbA1c dec, weight loss
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8
Q

Incretin Mimetics: adverse effects

A

GI: nausea, vomit, diarrhea, constipation
- pancreatitis
-thyroid C-cell tumor (only liraglutide)

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9
Q

Oral Agents
- 3 types of PTs that need oral agents

A
  • PT w type 2 diabetes not controlled w diet
  • PT who develop diabetes after age 40, had it for less than 5 yrs
  • PT with long-standing disease need combo or oral agents to control hyperglycemia
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10
Q

DPP-4 Inhibitors
- name the drugs
- MOA

A
  • Alogliptin, linagliptin, saxagliptin, sitagliptin

MOA: inhibit DPP-4 enzyme that inactivates incretin hormone (GLP-1)–> increases insulin release in response to meal

DDP-4 is what inactives GLP-1 and GIP

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11
Q

DPP-4 Inhibitors: adverse effects

A
  • nasopharyngitis
  • headache
  • pancreatitis
  • dose adjust for renal dysfunction (drug is heavily metab by liver) except linagliptin
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12
Q

DPP-4 Inhibitors: drug-drug interactions

A

Strong liver enzyme inhibitors (antivirus/bacterial drugs) may INCREASE levels of saxagliptin

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13
Q

Sulfonylureas
- names
- use

A
  • glyburide, glipizide, glimepiride
  • insulin secretagogues: they promote insulin release from the B cells of pancreas
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14
Q

Sulfonylureas: MOA

A
  • stim insulin release from B cells of pancreas—> block ATP dep K+ channels—> depolarize, influx Ca2+, insulin exocytosis
  • may REDUCE hepatic glucose production and INC peripheral insulin sensitivity
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15
Q

Sulfonylureas: Adverse Effects

A
  • hyperinsulinemia and hypoglycemia (imbalanced levels gluc and insulin)
  • weight gain
  • Gi distress (nausea, vomit, anorexia)

Glyburide: minimal placenta transfer

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16
Q

which sulfonylurea is best for pregnant patients?

A

glyburide bc it has minimal transfer across the placenta, a better insulin alternative

17
Q

Sulfonylureas: Contraindications and cautions

A
  • diabetes w/ fever, severe infection, trauma, major surgery, ketoacidosis, renal/hepatic disease
  • contraindicate for use in type 1 diabetes
  • pregnancy/lactation
  • not safe/efficient in children
18
Q

Glinides
- names
- actions
- taken when?

A
  • repaglinide, nateglinide

actions: stimulate insulin secretion by blocking ATP dep K+ channels in B cells

take before meal
- rapid onset, short half life

19
Q

why can’t you use glinides in combo with sulfonylureas?

A

due to the overlapping of MOA

20
Q

Glinides: adverse effects

A
  • hypoglycemia and weight gain
  • liver enzyme inducers (ex: barbiturates) may reduce effect
  • liver enzyme inhibitors (ex: antibiotics) may enhance repaglinide gluc lowering effect
21
Q

Glinides: contraindications and cautions

A

caution in PT with hepatic impairment

22
Q

Biguanides: METFORMIN
- actions

A
  • reduce hepatic gluconeogenesis
  • slow intestinal absorption of sugars
  • improve peripheral gluc uptake/utilization
  • weight loss may occur (loss of appetite)
23
Q

Biguanides: METFORMIN
- therapeutic uses

A
  • anti-diabetic APPROVED FOR CHILDREN 10 yrs and older
  • off label for PCOS
24
Q

Biguanides: METFORMIN
- adverse effects

A
  • lactic acidosis
  • GI distress (nausea/vomit)
  • Hypoglycemia if taken w insulin/other agents
  • LONG TERM USE–> b12 deficiency
25
Q

why is hyperinsulinemia not a problem for those taking metformin?

A

bc this drug does NOT affect insulin release, its focus is on reducing liver making glucose

26
Q

Biguanides: METFORMIN
- contraindications and cautions

A
  • renal dysfunc bc of acidosis
  • discontinue if acute MI or worsening HF occurs
27
Q

Thiazolidinediones
- names
- MOA
- insulin sensitizer?

A
  • pioglitazone, rosiglitazone

MOA: dec insulin resistance acting as agonists for PPAR gamma receptors—> transcription of insulin responsive genes–> inc insulin sensitivity in adipose, liver, and skeletal muscle

insulin sensitizers INC glucose uptake (no hyperinsulinemia)

28
Q

Thiazolidinediones: adverse effects

A
  • liver toxicity
  • inc SC fat, cause fluid retention–> weight gain
  • fluid retention–> avoid in PT with HF!!!
  • osteopenia, inc fracture risk in women

pio–> inc bladder cancer risk
rosi–> inc MI and angina risk

29
Q

Alpha Glucosidase Inhibitors
- names
- MOA

A
  • acarbose, miglitol

MOA: inhibit a-glucosidase (enz breaks down carbs into gluc that can be absorbed)
- delay digestion of carbs–> lower postprandial glucose levels

USE IN COMBO w sulfonylureas, metformin, insulin, at start of meal

30
Q

Alpha Glucosidase Inhibitors
- adverse effects and contraindications

A

AE: GI distress

Contraindications:
- PT w bowel disease, colonic ulceration, intestinal obstruction should NOT use these drugs

PHARMACOLOGY (29 decks)

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