Diabetes Flashcards
what drugs are insulin secretogogues?
sulfonylureas
meglitinides
name the 6 sulfonylureas
- Chlorpropramine
- Tolbutamide
- Tolazamide
- Glipizide
- Glyburide
- Glimepiride
what are the 2 Meglitinides?
- Repaglinide
- Nateglinide
how do all sulfonylureas work?
Block ATP sensitive K+ channels in pancreatic beta cells.
Inhibits efflux of K+ and opening Ca channels (influx) causing release of pre-formed insulin
which sulfonylureas are 1st generation?
- Chlorpropramide
- Tolbutamide
- Tolazamide
which sulfonylureas are 2nd generation?
- Glipizide
- Glyburide
- Glimepiride
which sulfonylurea has the longest half life?
how long does it last?
chlorpropramide
32 hours
when is chlorpropramide contraindicated?
patients with hepatic disease (slowly metabolized in liver)
which sulfonylurea has the shortest half life?
which is why it is perfect to use in which patient?
tolbutamide
elderly patients
sulfonylureas, all of them, are used for what condition?
diabetes mellitus type 2
what are signs of sulfonylurea toxicity?
hypoglycemia
disulfiram like reaction with alcohol
(nausea, palpitation, sweating)
all sulfonylureas are contraindicated when?
pregnancy
when is Glipizide contraindicated?
In patients with hepatic disease (can cause hypoglycemia)
which sulfonylurea has the highest potency?
Glimepiride
how do Meglitinides work?
sames as sulfonylureas:
block ATP sensitive K+ channels in pancreatic beta cells. Inhibits the efflux of K+, resulting in depolarization. Opening of voltage gated Ca influx. Release of preformed insulin and increase insulin receptors
Repaglinide and Nateglinide have what type of onset?
and how long do they last?
rapid onset
have a short duration
Repaglinide, Nateglinide are used for what?
**good for controlling Postprandial hyperglycemia
too much Repaglinide, Nateglinide may lead to what?
hypoglycemia
Name a Biguanide drug
Metformin
how does biguinides work?
it is a Antihyperglycemic by Increasing peripheral insulin sensitivity by increasing insulin receptors and Inhibits hepatic gluconeogenesis.
will metformin give you hypoglycemia?
is metformin euglycemic?
no
yes
what is a secondary benefitial effect from metformin?
reduced triglycerides, reduced total cholesterol, reduced LDL, increased HDL.
when is metformin used?
- Obese Type 2 DM
- Polycystic Ovarian Syndrome: lowers the serum androgens and restores normal menstrual cycles
metformin toxicity will affect what organ only?
toxicity will elicit what effects?
GI
- Lactic acidosis
- Vitamin B12 deficiency.
- metabolic acidosis (extreme dehydration, hyperventialtion, high anion gap, acidic blood pH)
metformin causes lactic acidosis, especially in which patients?
in alcoholics and patients with hepatic impairment
what happens if you give metformin to an alcoholic?
he develops lactic acidosis
what is the category name for Insulin Sensitizers?
Thiazolidinediones
name the 2 Thiazolidinediones
- Pioglitazone
- Rosiglitazone
how does Pioglitazone and Rosiglitazone work?
Activate peroxisome proliferator-activating receptors (PPAR’s)
these are involved in the transcription of insulin responsive genes. Increase the glucose uptake in muscle and adipose tissue and decreases hepatic gluconeogenesis.
Insulin Sensitizers will have what effects?
Reduce plasma glucose and triglycerides.
will you develop hypoglycemia with insulin sensitizers?
***No hypoglycemia because they are euglycemic
toxicity with Thiazolidinediones will lead to what?
*****Hepatic enzyme inducers: hepatotoxicity (monitor)
name the 2 Alpha Glucosidase Inhibitors
- Acarbose
- Miglitol
how do Acarbose, Miglitol work?
they are competitive and reversible inhibitors of α-glucosidase in the small intestine.
will you develop hypoglycemia with alpha glucosidase inhibitors?
how about lactic acidosis?
what about weight gain?
**No hypoglycemia, lactic acidosis, or weight gain.
when are alpha glucosidase inhibitors used?
In significant postprandial hyperglycemia.
Pramlintide (new drug) is used when?
how is it administered?
how does it work?
postprandial hyperglycemia
subcutaneous
Synthetic analogue of amylin, and suppresses glucagon release. (GLP-1)
Exenatide (Incretin) (new drug) is used for what?
how does it work?
how is it adminstered?
toxicity may lead to what?
exenatide should never be given with what other drug?
Why?
- only type 2 diabetes
- Synthetic analogue of glucagon-like-peptide (GLP-1).
- subcutaneously
- loss of apetite because it slows gastric emptying
- NEVER give with INSULIN because it can cause fatal necrotizing pancreatitis or hemorrhagic pancreatitis
how does Sitaglyptin work?
Inhibitor of dipeptidyl peptidase-4 enzyme that degrades GLP-1.
name a Hyperglycemic Agents
glucagon
when is glucagon used?
in severe hypoglycemia
what are the Rapid and Short-Acting Insulin (onset: 5-15 min, duration: 3-5 hrs.)?
- Insulin lispro
- aspart
- glulisine
- inhaled human insulin
rapid and short acting insulin can be used in what other condition?
Can be used in diabetic ketoacidosis.
What is the Short-Acting Insulin (duration: 5-8 hrs.) drug?
when is it used?
insulin
diabetic ketoacidosis and other emergency situations.
what are the Intermediate-Acting Insulin (onset: 2-5 hrs, duration: 4-12 hrs.)?
- Lente insulin
- NPH insulin
What are the Ultra Long-Acting Insulin (slow onset, duration: 20-24 hrs.)?
when is it used?
- Ultra lene
- Insulin glargine
- Insulin detemir
to control basal glucose
identify the insulin preparations
