Diabetes: Drugs Flashcards
What are the short acting insulins?
lispro, aspart, glulisine
What are the side effects of lispro, aspart, glulisine?
most dangerous is hypoglycemia
also allergies and local reactions
What are the long acting insulins?
ultralente, glargine, detemer
What are the side effects of ultralente, glargine, detemer?
hypoglycemia, allergy, local reactions.
How do the sulfanylureas work?
bind to and inhibit the ATP dependent, outward flowing K channel. this triggers insulin release from the beta cell- insulin secretegogue.
What are the side effects of sulfanylureas?
- hypoglycemia, especially in patients with renal failure.
- can cause beta cell failure
- can cause an allergic reaction in people with sulfa allergies.
What are meglitinides?
insulin secretegogues that bind to the ATP-dependent outward flwing K channel, triggering depolarization, and, ultimately, insulin release.
What are the advantages of meglitinides?
it is rapid and fast acting, making it good for post-prandial hyperglycemia. also, causes less hypoglycemia, even in renal patients, than sulfanylureas.
What is exanatide?MOA
GLP-1 analogue
it is like GLP-1 but isn’t degraded as quickly by DPP. this increases insulin release in response to glucose.
What are disadvantages of exanatide?
it must be injected, it causes nausea and vomiting, and is quite expensive.
What are the advantages of exanatide?
it increases pancreatic beta cell mass, can cause weight loss, and stimulates insulin production only when glucose levels are high (not a hypoglycemia risk_
What is vidagliptin/sitagliptin?
DPP-IV inhbitor. that leads to slower degradation of GLP-1.
Whar are advantages and disadvantages of vidagliptin and sitagliptin?
- Advantage: can be taken orally, causes less nausea
disadvantages: no weight loss, less potente than exenatide/GLP1 analogues, very,very expensive
What are thiazolidinediones? MOA
they are drugs taht interact with PPAR, a transcription faction that increases glucose sensitivity, among other things. also decreases free fatty acids.
What are the advantages of thiazolidinediones?
they correct insulin resistance, they are only taken 1 time per day, they don’t cause hypoglycemia, they decrease serum triglycerides
What are the disadvantages of thiazolidinediones?
may not work alone, they cause weight gain and edema, they increase LDL, they take weeks/months to see max response, and they may cause sudden cardiac death/ worsen osteoporosis
What are bigaunides?
metformin
increeases insulin sensitiviy and decreases gluconeogenesis and glucose output form the liver. acts primarily on the live
may also reduce glucose absorption.
What are the advantages of bigaunides?
rapid onset, no weight gain, no hypoglycemia, improved lipid profile.
What are the disadvantages of bigaunides?
lactic acidosis a risk for patients with liver, renal and heart problems.
may initially have GI effects
can’t take IV contrast.
clinical features of short acting insulin
convenient administration prior to meals, fast onset of action, limit post-prandial hyperglycemic peaks
shorter duration of activity reduces late postprandial hypoglycemia but often results in post-prandial hyperglycemia
What are alpha glucosidase inhibitors? MOA etc.
alpha glucosidase is the enzyme that breaks down complex carbs i nthe stomach and digestive tract to glucose. alpha-glucosidases inhbitors competitively inhibt alpha-glucosidase, causingdecreased glucose absorption
most effective for pts with significant post-prandial hyperglycemia
expampels: acarbose, miglitol
disadvantages of alpha glucosidase inhibitors
gas and diarrhea
eventually, you induce alpha glucosidases in the distal bowel, which reduce the gas and diarrhea
start low and go slow
contraindications to alpha glucosidase inhibitors
DKA, colonic ulceration, IBD, allergy
What are SGLT2 inhibitors
drugs that prevent resorption of glucose in the kidney
What is the role of bariatric surgery in treatment of DM type 2
80% of the time, it can induce remission
combined restrictive and malabsorptive is most effective
