Diabetes drugs Flashcards
What drugs are short acting insulins?
lispro
aspart
glulisine
regular
What are uses for short acting insulins?
bolus insulin at mealtime
often used in pumps
used in hospitals- rapid onsiet
What drugs are intermediate-long acting insulins?
NPH
glargine
detemer
What are uses for intermediate-long acting insulins?
basal insulin, taken independent of food intake
NPH does produce a _____
peak
What drugs are sulfonylureas?
Glipizide
Glyburide
Glimepride
What is the mechanism of action of sulfonylureas?
Bind to the sulfonylurea receptor (SUR1), closing the ATP-dependent potassium channel on the beta cells, depolarizing the cell, leads to increased insulin secretion
What reduction in A1c can be expected in a patient taking a sulfonylurea?
1-2%
What are adverse effects of sulfonylureas?
- Hypoglycemia
- Weight gain
- Use with caution in elderly, and in renal and liver failure
What drugs are meglitinides?
Nateglinide
Repaglinide
What is the mechanism of action of meglitinites?
Similar to sulfonylureas but shorter acting
Bind to the sulfonylurea receptor (SUR1), closing the ATP-dependent potassium channel on the beta cells, depolarizing the cell, leads to increased insulin secretion
What reduction in A1c can be expected in patients taking meglitinides?
0.5-1%
What are adverse effects of meglitinides?
MILD hypoglycemia, weight gain, caution in renal and liver failure
What drugs are biguanides?
metformin
What is the mechanism of action of metformin?
Poorly understood
- increases insulin sensitivity
- decreases hepatic glucose production
What reduction in A1c can be expected in patients taking metformin?
1-2%
Describe the advantages of metformin
weight loss or weight neutral
No hypoglycemia
What are the adverse effects of metformin?
GI- nausea, diarrhea, metallic taste
Lactic acidosis
What are contraindications to metformin use?
renal insufficiency liver disease alcohol abuse heart failure age >80 hold during acute illness
What drugs are in the thiazolidinedione class?
rosiglitazone
pioglitazone
What is the mechanism of action of thiazolidnediones?
PPAR agononist–> sensitizes skeletal msucle ot insulin, decreases hepatic glucose production
What reduction in A1c can be expected in patients taking thiazolidinediones?
0.5-1.4%
What are the advantages of thiazolidinediones?
NO hypoglycemia
Pioglitizone improves lipid profile
What are adverse effects of thiazolidinediones?
Weight gain
Edema
Risk of osteoporosis/fractures
Contraindicated in heart failure, caution in liver failure
Rosiglitizone- associated with increased risk of CV events
What are adverse effects of thiazolidinediones?
Weight gain
Edema
Risk of osteoporosis/fractures
Contraindicated in heart failure, caution in liver failure
Rosiglitizone- associated with increased risk of CV events
What drugs are in the a-glucosidase inhibitor class?
acarbose
What is the mechanism of action of acarbose?
a-glucosidase enzyme is intestinal wall responsible for conversion of carbohydrates into monosaccharides.
inhibition of a-glucosidase–> delaying digestion and absorption of carbohydrate, lowering BG
What are adverse effects of acarbose?
flatulence, diarrhea
What drugs are in the incretin mimetic class?
Exenatide
Liraglutide
What is the mechanism of action of incretin mimetics?
Promotes glucose-mediated insulin secretion (low risk of hypoglycemia- glucose must also be present).
Decreases hepatic glucose production
Slows gastric emptying
What are advantages of incretin mimetics?
improves satiety leading to weight loss
does not cause hypoglycemia
may support beta cell survival
What are adverse effects of incretin mimetics?
GI- NV
caution in renal insufficiency
What drugs are in the dipeptidyl peptidase 4 inhibitor class?
sitagliptin
saxagliptin
What is the mechanism of action of DPP-4 inhibitors?
Inhibits DPP-4, the enzyme responsible for degradation of GLP-1, increasing circulating endogenous GLP-1 levels and insulin secretion
What drugs are in the SGLT2 inhibitor class?
Canagliflozin
Dapagliflozin
Empagliflozin
What is the mechanism of action of SGLT2 inhibitors?
Inhibition of SGLT2 –> increased urinary glucose excretion and decreased
What are advantages of SGLT2 inhibitors?
weight loss
decrease in systolic BP
low risk of hypoglycemia
What are adverse effects of SGLT2 inhibitors?
GU infection
orthostatic hypotension
caution in renal insufficiency, severe liver impairment
______ is used to treat hypoglycemia when oral glucose intake is not possible
glucagon
