Cuddy - DM drugs Flashcards
Which drug classes increase endogenous insulin secretion?
Sulfonylureas, meglinitides, GLP-1 agonists, and DPP-4 inhibitors
Which drugs drug classes act at peripheral tissues to decrease insulin resistance?
Metformin, TZDs
Which drugs decrease glucose release and absorption?
Metformin
SGLT-2 inhibitors (make your pee sweet)
a-glucosidase inhibitors
-Decrease post-prandial glucose spike
What are the long-acting insulins?
Degludec; Glargine (Lantus)
These control basal insulin levels
What are the long-acting insulins?
Degludec, Glargine (Lantus)
These control basal insulin levels - no peak
What is the MOA of sulfonylurea drugs?
Bind ATP-dependent K+ channels on B-cells
- -> Ca+ influx
- -> release of insulin-containing vesicles
What is the MOA of sulfonylurea drugs?
Bind ATP-dependent K+ channels on B-cells, causing them to close
- -> Ca+ influx
- -> release of insulin-containing vesicles
What class of drugs has the suffix “-ride”?
Glyburide, glimepiride
Sulfonylureas (also included: glipizide)
What class of drugs has the suffix “-glinide”?
Repaglinide, nateglinide
Meglitinides
What are the secretogouges that increase endogenous insulin release WITHOUT sensitivity to [glucose]?
Sulfonylureas and meglitinides
What are the secretogogues that increase endogenous insulin release WITHOUT sensitivity to [glucose]?
Sulfonylureas and meglitinides
*Increased risk of hypoglycemia
What class of drugs has the suffix “-tide”?
Exenatide, liraglutide, dulaglutide, lixisenatide, semaglutide
GLP-1 agonists
Which classes of drugs increase endogenous insulin release dependent on [glucose]?
GLP-1 agonists
dPP-4 inhibitors
What is the MOA of meglinitide drugs?
Bind ATP-dependent K+ channels on B-cells, causing them to close
- -> Ca+ influx
- -> release of insulin-containing vesicles
What is the MOA of GLP-1 agonists?
Bind and activate GLP-1 receptors, which do the following:
- Increases insulin release (dependent on increased glucose levels)
- Decreases inappropriate glucagon release
- Suppresses appetite
- Delays gastric emptying
What is the MOA of DPP-4 inhibitors?
Inhibit the peptide responsible for breaking down endogenous GLP-1.
(Increased activity of GLP-1 = glucose-sensitive insulin secretion, decreased glucagon release, suppressed appetite, and delayed gastric emptying)
What class of drugs has the suffix “-gliptin”?
Sitagliptin, saxagliptin, linagliptin
DPP-4 inhibitors
What are the actions of Metformin?
Via phosphorylation/activation of AMPK:
Decreases hepatic gluconeogenesis
Decreases intestinal glucose absorption
Sensitizes liver and skeletal muscles to insulin (increases glucose uptake in periphery)
Reduces FFA turnover
What are some important adverse effects associated with metformin?
- GI intolerance (N/V/D; metallic taste, anorexia - dose dependent and transient)
- Possibility of lactic acidosis (don’t use in situations that predispose to hypoxia or renal insufficiency)
CONTRAINDICATED in patients with GFR <30 (caution in patients with GFR <45)
What is the class of drugs that has the suffix “-glitazone”?
rosiglitazone, pioglitazone
TZD/thiazolidinediones/PPAR-y agonists
What is the MOA/action of TZD drugs?
Binds to nuclear receptors (PPAR-y) to influence gene transcription.
Increases insulin sensitivity (via increased translocation of GLUT-4 receptors).
Increases glucose utilization and decreases glucose production in adipose tissue, muscle tissue, and liver.
TZDs are contraindicated in patients with ____?
Heart failure
TZDs can cause fluid retention and peripheral edema that can exacerbate HF
Which drug class has the suffix “-flozin”?
Canaglifozin, dapagliflozin, empagliflozin, ertugliflozin
SGLT-2 inhibitors
What is a signature AE associated with SGLT-2 inhibitors?
UTIs
