Diabetes Drugs Flashcards
What side effects are associated with insulin administration?
Hypersensitivity, lipoatrophy, lipohypertrophy, hypoglycemia
Which diabetes drugs do not cause hypoglycemia?
Metformin, Pioglitazone, Sitagliptin, Acarbose, and Canagliflozin
*CAMPS- camps always have plenty of candy at the snack shack for kids
Name the biguanide and its mechanism of action.
Metformin: It enhances the effect of insulin by activating AMP-dependent protein kinase (AMPK), which results in FA oxidation and glucose uptake, and decreases lipogenesis and gluconeogensis.
*acts on skeletal muscle (glucose uptake) and the liver (decreases gluconeogenesis)
What is the clinical use of metformin?
It is first-line tx for diabetes Type 2.
Which diabetes medications should be avoided in patients with liver disease?
Metformin, Glipizide, Repaglinide, and Pioglitazone
Which diabetes medications are contraindicated in renal patients?
Metformin and Glipizide
Aside from its effects on glucose levels, what are the other pros of using metformin?
It does not cause weight gain and it inhibits microvascular complications
What adverse effects are associated with metformin?
n/v/d, lactic acidosis in renal impaired pts
Name the sulfonylurea and its mechanism of action.
Glipizide: increases insulin release by binding & inhibiting K+ channels in beta cells, allowing for depolarization and Ca++ influx and subsequent insulin release.
*requires functional beta cells
Name the non-sulfonylurea secretagogue and its mechanism of action.
Repaglinide: increases insulin release by binding SUR on ATP-sensitive beta cell K+ channels (same concept as Glipizide)
*requires functional beta cells
Which medications require functional beta cells?
Glipizide and Repaglinide (because they block K+ channels in the beta cells to facilitate insulin release from the pancreas
Name the thiazolidenedione (TZD) and its mechanism of action.
Pioglitazone: directly activates PPAR-y in the nucleus, increasing insulin sensitivity in target tissues, decreasing hepatic glucose output and FFA, and increasing glucose utilization
What adverse effects are associated with pioglitazone?
Fluid retention, increased risk of heart failure, weight gain, and decreased bone density in chronic use
Name the GLP-1 receptor agonist and its mechanism of action.
Exenatide: agonist at the GLP-1 receptor, increasing cAMP and thus increasing insulin secretion and decreasing post-prandial glucagon release. Also slows gastric emptying, increases satiety, decreases hepatic fat accumulation, and may increase beta cell mass (decreased apoptosis)
In what patients should exenatide be avoided?
Pts w/ gastroparesis (b/c it slows gastric emptying)
Name the DPP-4 inhibitor and its mechanism of action.
Sitagliptin: prolongs endogenous GLP-1 action by inhibting DPP-4 from converting GIP and GLP-1 to inactive metabolites. By inhibing DPP-4, the incretins remain active and stimulate insulin secretion
What is the major warning for sitagliptin?
Severe joint pain
Name the alpha-glucosidase inhibitor and its mechanism of action.
Acarbose: slows digestion of carbohydrates, decreases GI glucose absorption and post-prandial glycemia
In what patients is acarbose contraindicated?
Those with chronic intestinal dz
Name the renal SGLT-2 inhibitor and its mechanism of action.
Canagliflozin: inhibits glucose reabsorption in the proximal tubule by blocking the SGLT-2 sodium/glucose co-transporter
What is the major warning for canagliflozin?
Ketoacidosis
Discuss the role of insulin in diabetes management.
Insulin is the primary tx for Type 1 diabetes and comes in various forms distinguished by duration of action. Can supplement long-acting insulin with short-acting before meals. The kinetics are different from physiologic insulin.
