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Endocrine drugs > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Indications for insulin use

A
  1. DM 1
  2. DM 2 → failure of oral drugs OR stress conditions (pregnancy, infection, surgery)
  3. DKA emergency IV regular insulin
  4. Hyperkalemia - insulin + IV glucose since insulin potassium shift into tissue
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2
Q

Treatment of insulin resistance

A
  1. Underlying cause - stress or infection
  2. Metformin - ↑ insulin sensitivity and ↓ intestinal glucose absorption
  3. Insulin sensitizers thiazolidinediones
  4. Change site of injection local insulin resistance
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3
Q

Adverse effects of insulin

A
  1. Hypoglycemia (most common and dangerous)
  2. Hypokalemia
  3. Insulin resistance
  4. Hypersensitivity reaction - urticaria, angioedema and anaphylactic shock
  5. Local effects
    - Lipodystrophy - atrophy or hypertrophy
    - Allergy at site of injection
    - Local infection
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4
Q

Metabolic syndrome

A

Central obesity + hypercholesterolemia + heart disease + IR + DM 2

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5
Q

Insulin drug interactions

A

Hypoglycemia
Abs FM
1. Alcohol - ethanol inhibtis glucneogeneiss
2. Beta blockers - inhibit glycogensolysis and glucose release from liver and muscle + mask hypoglecmia
3. Salicylates
4. Fenfluramine - SSRI anorexic drugs ↑ serotonin in brain causing ↓ calorie intake + uptake of glucose into striated muscle
5. MAO - inhibit gluconeogenesis

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6
Q

Oral antidiabetic drugs

A

BTS ∝ M
1. Biguanides - metformin
2. Thiazolidinediones - pioglitazone and rosiglitazone
(pio and ros glitazone)
3. Sulfonylurea
4. ∝ glucosidase inhibitors- acarbose - miglitol
5. Meglitinides - repaglinide and nateglinide (me, repa, nate glinide)

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7
Q

Sulfonylurea

A
  • amide - zide - ide

1st gen - amide
1. Chlorpropamide (long acting)
2. Tolbutamide
3. Acetohexamide

2nd gen -amide -zide
1. Glibenclamide
2. Glyclazide
3. Glipizide

3rd gen -ide
1. Glimepiride

CAT - amide
G
2nd gen - amide + zide
3rd gen - ide

30 minutes before breakfast

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8
Q

Mechanism of action of sulfonylureas

A

Pancreatic
1. ↑ insulin secretion - inhibits K+ ATP dependant channels
2. ↓ serum glucagon

Extrapancreatic
1. ↑ insulin receptor sensitivity
2. ↓ glucose hepatic output - gluconeogenesis

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9
Q

Adverse effect of sulfonylurea

A
  1. Hypoglycemia
    - Chlorpropamide (long acting)
    - Elderly patients with hepatic or renal dysfunction
  2. Increased appetite and weight gain
  3. Pharmacological failure is common
    - Primary 15-30%
    - Secondary 6-7 yrs 90%
  4. Hepatoxicity
  5. Allergic reactions
  6. Teratogenicity
    Chlorpropamide
  7. Disulfiram like reaction in patients that consume alcohol
  8. Dilutional hyponatremia SIADH
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10
Q

Sulfonylurea contraindications

A
  1. DM 1
  2. Renal, hepatic and liver failure
  3. Pregnancy “gestational diabetes” - fetal hypoglycemia
  4. Sulfa drug hypersensitivity - use meglitinide
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11
Q

Meglitinide

A
  • glinide
    1. Repaglinide
    2. Nateglinide

Repa/nate glinide

  • Just before meals to prevent postprandial hyperglycemia - very fast onset and short duration of action
  • ORAL
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12
Q

Mechanism of action of Meglitinide

A

↑ insulin secretion - similar to sulfonylurea different binding site on beta cells

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13
Q

Adverse effects of meglitinide

A

Hypoglycemia

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14
Q

Contraindications

A

Use with caution in patients with renal and hepatic dysfunction

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15
Q

Biguanides

A

Metformin

  • Oral x3 with meals
  • Well absorbed from GIT
  • Does not bind to plasma proteins
  • Excreted unchanged
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16
Q

Mechanism of action of biguanides

A

Increases
1. Insulin receptor sensitivity
Decreases
2. Intestinal glucose absorption
3. Hepatic gluconeogenesis

DOES NOT CAUSE HYPOGLYCEMIA since it does not increase insulin secretion

17
Q

Therapeutic uses of metformin (biguanides)

A
  1. DM 2 - alone if mild or combination
  2. Weigh loss (decreases glucose absorption)
  3. PCOS - decreases androgen levels + restores normal menstrual cycle and ovulation
18
Q

Adverse effects of metformin (biguanides)

A
  1. GIT upset - anorexia, diarrhea and vomiting
  2. Lactic acidosis ↑ anaerobic glycolysis
  3. ↓ absorption of B12
19
Q

Contraindications of metformin (biguanides)

A

Lactic acidosis
1. Patients with history of lactic acidosis
2. Renal or hepatic dysfunction
3. Chronic lung disease

20
Q

Thiazolidinediones

A
  • glitazone
    1. Pioglitazone
    2. Rosiglitazone

Slow onset + prolonged duration of action → gene regulation

21
Q

Mechanism of action of thiazolidinediones (pioglitazone and rosiglitazone)

A

Nuclear gene PPAR γ (peroxisomal proliferator activated receptor gamma) in muscles, adipose tissue and liver
Increase
1. Insulin receptor sensitivity + ↓ insulin resistance
2. GLUT transporters ↑ glucose uptake
Decrease
3. TGs

DOES NOT CAUSE HYPOGLYCEMIA

22
Q

Thiazolidinediones (pioglitazone and rosiglitazone) therapeutic use

A

Improve insulin resistance in DM 2

23
Q

Adverse effects of thiazolidinediones (pioglitazone and rosiglitazone)

A
  1. Hepatoxicity
  2. Fluid retention - edema and weight gain (contraindicated in CHF)
24
Q

Contraindications of thiazolidinediones (pioglitazone and rosiglitazone)

A

CHF

25
Q

α glucosidase inhibitors (starch blockers)

A

Acarbose - miglitol

> 90% elimination by kidney (contraindicated in patients with kidney disease)

26
Q

Mechanism of action of α glucosidase inhibitors

A

Competitive blocking of intestinal α glucosidase enzyme - ↓ digestion and absorption of glucose

DOES NOT CAUSE HYPOGLYCEMIA

27
Q

Adverse effect of α glucosidase inhibitors

A

GIT - fluctuance, diarrhea and abdominal pain

28
Q

Contraindications of α glucosidase inhibitors

A

IBD

Endocrine drugs (1 decks)

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