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NAPLEX > Diabetes Drugs > Flashcards

Diabetes Drugs Flashcards

1
Q

Insulin secretagogues

A 
Sulfonylureas 
Meglitinides
Phenylalanine derivatives
Biguanides
Thiazollidinediones (TZDs)
DPP-IV Inhibitors
Bile acid sesquestrants
Dopamine Agonist
GLP-1 Agonist 
Amylin Agonist
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2
Q

Sulfonylureas

A

Target fasting glucose

First gen:
Tolbutamide (Orinase)
Tolazamide (Tolinase)
Chlorpropamide ( Diabinese)

Sec Gen:
Glyburide (DiaBeta, Glynase)
Glipizide (Glucotrol)
Glimepride (Amaryl)

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3
Q

Meglitinides

A

Repagli nide (Prandin)

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4
Q

Phenylalanine Derivatives

A

Nateglinide

Starlix

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5
Q

Thia zolidine diones

TZDs

A 
Pio glitazone. (Actos)
Rosi glitazone (Avandia)
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6
Q

a Glucosidase Inhibitors

A

Acarbose (Precose)

Miglitol (Glyset)

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7
Q

DPP-IV Inhibitors

A

Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradenta)

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8
Q

Bile Acid Sesquestrants

A

Colesevelam (Welchol)

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9
Q

Dopamine Agonist

A

Bromocriptine (Cycloset)

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10
Q

GLP-1 Agonist

A

Exenatide (Byetta)

Liraglutide (Victoza)

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11
Q

Amylin Agonist

A

Pramlintide (Symlin)

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12
Q

Sulfonylureas adverse effects 1st gen

A

Thrombocytopenia
Agranulocytosis
Hemolytic anemia
Hyponatremia
SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion)
Disulfiram like reaction (adverse reaction to alcohol causing nausea vomiting, throbbing headache, chest and abdominal pain hangover feeling)

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13
Q

Secretagogues mech

A

Stimulates enhanced secretion of insulin from B cells

Reduces hepatic glucose output

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14
Q

Secretagogues indication and contra

A

Indication:
T2DM only

Contraindications:
Severe renal or hepatic dysfunction
Elderly caution

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15
Q

Biguanides

A

Metformin
( Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet)

Glycemic management of T1DM & T2DM

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16
Q

Metformin contraindication

A 
Renal disease (potential for accumulation and causing Lactic Acidosis)
Discontinued in Scr > 1.4 mg/dL for female
Scr > 1.5 mg/dL males

Hepatic impairment

Heart fail

Intravascular iodinated contrast media

17
Q

Metformin mech

A

Inhibits hepatic glucose output
Promote Glucose uptake by fat and muscles
Decreasing intestinal absorption of glucose (minor)

18
Q

Side effects Metformin

A

30% GI effects self limiting over 1 to 2 weeks
Minimal weight loss
Reduces B12 levels
Sweating and metallic taste

19
Q

TZDs indication

Contraindications

A

T2DM

Contra:
Hepatic dysfunction
Class III / IV HF
Anemia (plasma volume expansion , so decrease in haemoglobin and hematocrit)

Fracture risk (distal upper limbs female)

Rosi glitazone increased risk if CVS effects

Pio glitazone bladder Cancer risk

20
Q

TZDs mech of action

A

Promotes glucose uptake by fat & muscles & inhibit hepatic glucose output by stimulation of peroxisome - proliferator-activated receptor gamma (PPAR-y)

21
Q

TZDs side effects

A 
Weight Gain
Fluid retention
Fat accumulation
Shortness of breath
Swelling of lower extremities
Max effectiveness not seen until 6 to 12 weeks of use.
22
Q

a Glucosidase Inhibitors

Contraindications

A 
Inflammatory Bowel disease
Colonic ulceration
Obstructive Bowel disorders
Serum > 2.0 mg/dL
Hepatic impairment
23
Q

a Glucosidase Inhibitors

Mech

A

Competitive inhibition of alpha Glucosidases, in intestinal brush border , slower Absorption of complex carbs

24
Q

a Glucosidase side effects

A

Flatulence
Should be taken with meal
Hypoglycemia
GI effects (lessen over time)

25
Q

Dipeptidyl peptidase - IV (DPP-IV) Inhibitors

A

T2 DM

Contra:
Pancreatitis
T1DM (glucose dependant insulin secretion)

26
Q

DPP-IV Inhibitors mech

A

Prevent inactivation of incretin hormones (GLP-I) by enzyme DPP-IV.
GLP-I works to stimulate insulin secretion and decrease glucagon Secretion from pancreas during hyperglycemia.

27
Q

Bile acid sesquestrants detail

A

Cholesevelam

Adjunctive therapy for T2DM

Contra: in patients with 
History of  bowel obstruction
Hpertriglyceridemia-induced pancreatitis
Serum triglycerides above > 500 mg/dL
Gastroperesis

Oral meds should be taken 1 hr before or 4hr after cholesevelam

Constipation can occur

28
Q

Dopamine agonist detail

A

Bromocriptine

Adjunct therapy for T2DM

Contra in patients with
CVS issues
Dementia
Psychosis
Peptic ulcer

May cause fatigue, GI discomfort

29
Q

Available oral combos

A 
Metformin/glyburide (Glucovance)
M/glipizide (metagliptin)
M/Rosiglitazone (avandament)
M/pioglitazone (Actoplus Met)
M/Repaglinide (PrandiMet)
M/Saxagliptin (Kombiglyze)
M/Sitagliptin (Janumet)
Rosi/ glimepride (Avandaryl)
Pio/ gilmepride (Duetact)
30
Q

Incretin Mimetics detail

A

Exenatide (Byetta)
Liraglutide (Victoza)

T2DM

Contra in patients with
Gastroperesis
Pancreatitis
Renal hepatic impairment
Medullary thyroid carcinoma MTC 
Multiple Endocrine Neoplasia Syndrome type 2 (MEN2)
31
Q

Incretin Mimetics mech

A 
Increase glucose dependant insulin secretion
Decrease hepatic glucose output
Increase B cell growth  & replication
Slow gastric emptying
Enhance satiety
32
Q

Amylin Agonist detail

A

T1DM T2DM
Contra in patients with:
Gastroperesis

Mech: slow gastric emptying

33
Q

Emergency treatment options

A

Once weekly exenatide (Bydureon)

Sodium Glucose Transporter 2 (SGLT2)

34
Q

Exenatide emergency treatment

A

Dose once weekly as a 2mg subcutaneous injection
Targets all over Blood glucose rather than just post parendial
6 weeks to hit steady state

35
Q

Sodium Glucose Transporter 2 Inhibitor

A

SGLT2 is a transporter in kidney
Responsible for 90% renal glucose reabsorption
Inhibits transporter thus increase kidney excretion of Glucose
Insulin independent mechanism
No hypoglycemia

Dapa gliflozin
Ser gliflozin
Remo gliflozin

NAPLEX (6 decks)

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