Diabetes Drugs Flashcards by isma iqbal

Insulin secretagogues

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

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Sulfonylureas

Target fasting glucose

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

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

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Meglitinides

Repagli nide (Prandin)

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Phenylalanine Derivatives

Nateglinide

Starlix

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Thia zolidine diones

TZDs

Pio glitazone. (Actos)
Rosi glitazone (Avandia)

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a Glucosidase Inhibitors

Acarbose (Precose)

Miglitol (Glyset)

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DPP-IV Inhibitors

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

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Bile Acid Sesquestrants

Colesevelam (Welchol)

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Dopamine Agonist

Bromocriptine (Cycloset)

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GLP-1 Agonist

Exenatide (Byetta)

Liraglutide (Victoza)

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Amylin Agonist

Pramlintide (Symlin)

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Sulfonylureas adverse effects 1st gen

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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Secretagogues mech

Stimulates enhanced secretion of insulin from B cells

Reduces hepatic glucose output

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Secretagogues indication and contra

Indication:
T2DM only

Contraindications:
Severe renal or hepatic dysfunction
Elderly caution

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Biguanides

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

Glycemic management of T1DM & T2DM

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Metformin contraindication

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

Metformin mech

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

Side effects Metformin

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

TZDs indication

Contraindications

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

TZDs mech of action

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

TZDs side effects

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

a Glucosidase Inhibitors

Contraindications

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

a Glucosidase Inhibitors

Mech

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

a Glucosidase side effects

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

Dipeptidyl peptidase - IV (DPP-IV) Inhibitors

T2 DM Contra: Pancreatitis T1DM (glucose dependant insulin secretion)

DPP-IV Inhibitors mech

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.

Bile acid sesquestrants detail

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

Dopamine agonist detail

Bromocriptine Adjunct therapy for T2DM ``` Contra in patients with CVS issues Dementia Psychosis Peptic ulcer ``` May cause fatigue, GI discomfort

Available oral combos

``` 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) ```

Incretin Mimetics detail

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) ```

Incretin Mimetics mech

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

Amylin Agonist detail

T1DM T2DM Contra in patients with: Gastroperesis Mech: slow gastric emptying

Emergency treatment options

Once weekly exenatide (Bydureon) | Sodium Glucose Transporter 2 (SGLT2)

Exenatide emergency treatment

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

Sodium Glucose Transporter 2 Inhibitor

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