Diabetes Drugs

Question 1

What are the sulfonylureas and what is their MOA?

Answer 1

glyburide, glipizide, glimepramide

Beta cell insulin secretagogues

Question 2

What are the sulfonylureas and what is their main adverse effect?

Answer 2

glyburide, glipizide, glimepramide

Have LONG half lives. Main adverse effect = hypoglycemia, beware if patient not eating reliably!

Question 3

What ar ethe sulfonylureas and what are their contraindications?

Answer 3

glyburide, glipizide, glimepramide

contraindicated in sulfa allergy, caution if advanced liver/kidney disease

Question 4

What should preprandial plasma gluocse be? Peak postprandial?

Answer 4

preprandial: 70-130
postprandial: <180

Question 5

What is a biguanide and what is its MOA?

Answer 5

Metformin! Inhibits hepatic glucose production

Question 6

What is a biguanide and what are its associated side effects?

Answer 6

Metformin
GI upset (so take with food); can cause lactic acidosis with kidney, liver disease (so contrandicated in renal and heaptic failure)

Question 7

What are alpha-glucosidase inhibitors and what is their MOA?

Answer 7

Miglitol, acarbose
Delay carbohydrate absorption (patients with diabetes have a delay in teh release of insulin, so this synchronizes it better)
Main effect is on postprandial hyperglycemia

Question 8

What are the metaglinides/glinides?

Answer 8

Repaglinide, nateglinide
Increase beta cell insulin release (but half life of only one hour, versus the 12-24 seen in the sulfonylureas (glyburide, glipizide, glimepramide)

Question 9

What are the thiazolindinedones? What is their MOA?

Answer 9

Pioglitazone and rosiglitazone
TRANSCRIPTIONAL regulators of PPAR-gamma (so they take a while to elicit effect). Changes the way adipocytes are distributed, etc

Question 10

Do TZDs cause weight gain or weight loss?

Answer 10

WEIGHT GAIN

Question 11

What are the risks associated with TZD?

Answer 11

fracture risk (concern in osteopenic patients); bladder cancer, and was thought to be associated with CVD (not so much anymore)

Question 12

What is amylin and what is its MOA?

Answer 12

cosecreted with insulin; given to decrease glucagon secretion and slow gastric emptying after eaten

Question 13

What are GLP-1 agonists?

Answer 13

exentaide (an incretin mimic), albiglutide (given once weekly)

Question 14

What are the DPP4 inhibitors and what is their MOA?

Answer 14

sitagliptin, linagliptin, saxogliptin. Increase and prolong active incretin levels (GLp-1 and GIP)

Question 15

What are the alpha-glucosidase inhibitors and what are contraindications to their use?

Answer 15

miglitol, acarbose

do not use in GI problems

Question 16

Which drug is used in Type 1 and Type 2 DM and can be used WITH insulin?

Answer 16

amylin/pramlintide (must be injected!)

Question 17

What are the GLP-1 analogues and what intraabdominal pathology are they associated with?

Answer 17

sitagliptin, linagliptin, saxogliptin

Pancreatitis