Diabetes Flashcards
AE for insulin
Hypersensitivity rxn (less in recombinant) Hypoglycemia (tx w/ glucagon/glucose)
Hypoglycemia d/t insulin can be exacerbated by..
Alcohol
Beta blockers
Salicylates
Pathophysiology in type 2 DM (liver, skeletal muscle, adipocytes)
Liver: inc gluconeogenesis
Skeletal muscle: slow/dec glucose utilization
Adipocytes: lipolysis is shut down
Metformin (biguanide) MOA
Insulin sensitizer
Activates AMP-dependent protein kinase
Dec gluconeogesis, dec lipogenesis, inc glucose intake, inc fatty acid oxidation n
Pros of metformin
No hypoglycemia
No weight gain
Inhibits microvascular complications
AE of metformin
GI sx
Contra in renal/liver dz
Glipizide (sulfonylurea) MOA
Insulin secretagogue
Inhibits ATP K channel –> depol
Requires functional beta cells
AE of glipizide
Hypoglycemia
Weight gain
Drug intxns
Repaglinide (non-sulfonylurea secretagogues)
Insulin secretagogue
Rapid absorption - right before meal
AE: hypoglycemia, wt gain, drug intxn
Pioglitazone (thiazolidenediones TZDs)
Inc insulin sensitivity
Dec liver glucose output, inc utilization in muscle/adipose, dec FFA in adipose
AE: edema, weight gain, osteoporosis, HF, bladder cancer
Exenatide (GLP-1 mimetic)
Increases glucose-dependent insulin secretion
Slows gastric emptying (inc weight loss, contra in gastroparesis)
AE: pancreatitis, GI, renal failure
Hypoglycemia risk w/ secretagogues
Sitagliptin (DDP-4 inhibitor)
Prolongs GLP1 action
AE: joint pain, pancreatitis, liver failure, hypoglycemia with secretagogues
Canagliflozin (renal SGLT2 inhibitors)
MOA: inhibits sodium dependent glucose transporter in kidney -> supp glucose re-absorption -> excreted
AE: genital infxn, hypermetabolites
Hypoglycemia w/ rifampin, phenobarbital, phenytoin)
Acarbose (alpha-glucosidase inhibitors)
MOA: dec glucose absorption, dec post prandial
AE: GI sx, ab pain
Contra: chronic intestinal dz
