Diabetes Drugs Flashcards
Insulin toxicity
Hypoglycemia
Rapid acting insulins
Aspart
Glulisine
Lispro
Intermediate acting insulin
NPH
Long acting insulin
Detemir
Glargine
Biguanides (Metformin) action
Decreased gluconeogenesis
Increased glycolysis
Increased peripheral glucose uptake (increased insulin sensitivity)
Use for Metformin
Oral
First line therapy in type 2 DM; causes modest weight loss
Can be used in patients without islet function
S/E of Metformin
GI upset Lactic acidosis (C/I in renal insufficiency)
Sulfonylureas
First gen - Chlorpropamide, Tolbutamide
Second gen - Glimepiride, Glipizide, Glyburide
Sulfonylureas mechanism
Closes K+ channel in Beta cell membrane –> cell depolarizes and insulin is released via increased Calcium influx
Use for Sulfonylureas
Type 2 DM - require some islet function
S/E of Sulfonylureas
Hypoglycemia risk increases in renal failure
First gen - Disulfiram like effects
Second gen - Weight gain, hypoglycemia
Glitazones/Thiazolidinediones mechanism
Increased insulin sensitivity in peripheral tissue (binds to PPAR-gamma nuclear transcription regulator) –> increased synthesis and translocation of GLUT4
When is Metformin C/I?
Any condition that precipitates lactic acidosis
Liver dysfunction, CHF, sepsis, alcoholism
S/E of Glitazones
HEPATOTOXICITY, HF, increased risk of fractures
GLP-1 Analogs
Exenatide
Liraglutide
Exenatide, Liraglutide mechanism
GLP 1 analogs that increase insulin and decrease glucagon release
S/E of GLP 1 analogs
Pancreatitis, N/V
DPP-4 Inhibitors
Linagliptin, Saxagliptin, Sitagliptin
DPP-4 inhibitors mechanism
DPP4 usually inactivates GLP-1; inhibition causes increased insulin and decreased glucagon release
Amylin analogs mechanism (Pramlintide)
Decreased gastric emptying and decreased glucagon
Amylin analog
Pramlintide
SGLT-2 Inhibitors (Canagliflozin)
Block reabsorption of glucose in PCT
S/E of Canagliflozin (SFLT-2 inhibitor)
Glucosuria
UTis
Vaginal yeast infections
Alpha-glucosidase inhibitors
Acarbose, Miglitol
Alpha-glucosidase inhibitors mechanism
Inhibit intestinal brush border alpha-glucosidases –> delay carbohydrate hydrolysis and glucose absorption –> decrease postprandial hyperglycemia
S/E of propylthiouracil and methimazole
Agranulocytosis, aplastic anemia
Hepatotoxicity (Propylthiouracil)
Methimazole is teratogen in first trimester
Conivaptan, Tolvaptan
ADH antagonists used for SIADH
Uses for Somatostatin
Acromegaly Carcinoid syndrome Gastrinoma Glucagonoma Esophageal varices
Demeclocycline
ADH antagonist used for SIADH (Tetracycline family so it causes nephrogenic DI, photosensitivity, bone/teeth abnormalities)
Cinacalcet
Sensitizes Ca sensing receptor in parathyroid gland to circulating Ca –> causes decreased PTH
- Used for Hypercalcemia due to primary or secondary hyperparathyroidism
- S/E is hypocalcemia
