Diabetes / HTN / Hyperlipidemia Drugs Flashcards
What are the Diabetes Mellitus drugs?
- Biguanides
- Sulfonylureas
- Thiazolidinediones
- Alpha Glucosidase Inhibitors
- “GLP-1” Agonists (Glucagon-Like Peptide-1)
- “DPP-4” Inhibitors (Dipeptidyl Peptidase)
- Pramintide “Amylin”
- Bile Acid Sequestrants
- Bromocriptine
- SGLT-2 Inhibitors
What are the drugs of Biguanides?
- Metformin
What is the action of Biguanides?
It reduces glucose by suppressing hepatic glucose production
*NO RISK OF HYPOGLYCEMIA
What are the positive side effects of Biguanides?
- Weight loss
2. REDUCES triglycerides
What are the negative side effects of Biguanides?
- GI “Diarrhea” (GOLD)
- Vitamin B12 Deficiency (Mimics peripheral neuropathy)
- Check B12 levels IF unexplained peripheral neuropathy or anemia (HIGH MCV value)
What are the contraindications for Biguanides?
- INCREASED risk for lactic acidosis
- Serum creatinine:
- Abnormal clearance (Male > 1.5 / Female > 1.4)
* Normal = 0.6 - 1.2 and because of this you need to monitor the renal function prior to prescribing biguanides
What are the drugs of Sulfonylureas?
- Glyburide
- Glipizide
- Glimepiride
Newer:
- Repaglinide
- Nateglinide
What are the negative side effects of Sulfonylureas?
- INCREASED weight
2. HYPOGLYCEMIA
What are the drugs of Thiazolidinediones?
- Pioglitazone
2. Rosiglitazone
What is the action of Thiazolidinediones?
Sensitizes the tissue to insulin (Used alone or as an adjunct to sulfonylureas, metformin, or insulin)
*NO RISK OF HYPOGLYCEMIA
What are the negative side effects of Thiazolidinediones?
- Pioglitazone:
- INCREASED risk for bladder CA
- INCREASED weight
- Edema - Rosiglitazone:
- Cardiac risks (Requires FDA approval) - INCREASED risk of fractures
What are the contraindications of Thiazolidinediones?
- CHF (Class 3/4)
2. Liver disease
What are the drugs of Glucosidase Inhibitors?
- Acarbose
2. Miglitol
What is the action of Glucosidase Inhibitors?
Delays carbohydrate absorption by blocking “Glucosidase enzyme” thus REDUCES post-prandial glucose levels.
*Lasts for 4 hours
What are the negative side effects of Glucosidase Inhibitors?
GI
What are the drugs of GLP-1 Agonists?
- Exenatide (Bydureon)
- Livaglutide (Victoza)
- Albiglutide(Tanzeum) *Injectable
What are the actions of GLP-1 Agonists?
- Slows gastric emptying
- Stimulates pancreatic insulin response to glucose
- REDUCES glucagon post-prandial
- REDUCES sugar released by the liver
What are the negative side effects of GLP-1 Agonists?
- Nausea
2. Acute Pancreatitis
What are the positive side effects of GLP-1 Agonists?
- Weight loss
What are the contraindications of GLP-1 Agonists?
- Gastroparesis
2. Thyroid CA
What are the drugs of DPP-4 Inhibitors?
- Saxagliptin
- Sitagliptin “Januvia”
- Vildagliptin
- Linagliptin
“Gliptins”
What is the action of DPP-4 Inhibitors?
Inhibits DPP-4 which will thus prolong GLP-1 action thus causing all GLP-1 actions to occur prolonged.
- 1 daily dose
- NO RISK OF HYPOGLYCEMIA or WEIGHT CHANGES
What are the side effects of DPP-4 Inhibitors?
- Pancreatitis
- Urticaria
- Angioedema
What is the “Synthetic Analog of Beta-Cells”?
Amylin / Pramlintide
*Injectable (MUST USE WITH INSULIN)
What is the action of Pramlintide?
- Delays gastric emptying
2. REDUCES glucagon and appetite
What are the drugs of Bile Acid Sequestrants?
- Colesevelam “Welchol”
2. Cholestyramine
What is the action of Bile Acid Sequestrants?
Binds to intestinal bile acids and glucose
*REDUCES glucose and LDL’s
*NO RISK OF HYPOGLYCEMIA
What are the contraindications of Bile Acid Sequestrants?
- HIGH triglycerides
2. Drug/Food interactions
What is the Dopamine Agonist used for Diabetes Mellitus?
- Bromocriptine
* NO RISK OF HYPOGLYCEMIA
What are the side effects of Bromocriptine?
- Dizziness
- Syncope
- Fatigue
- Rhinitis
What is the contraindication for Bromocriptine?
Simultaneous use with “Ergot” containing medications.
What drugs are of SGLT-2 Inhibitors?
- Invokana
What is the action of SGLT-2 Inhibitors?
Na and glucose cotransporter inhibitor (Because of this you will see increased glucose in the urine)
What is the side effect of SGLT-2 Inhibitors?
- INCREASED risk of acidity within the blood (DKA)
When should one begin treating HTN?
- IF DM or CKD + > 140/90 mmHg
- IMMEDIATELY - IF Stage 2 HTN (>160 or >100 mmHg)
- 2 drug regimen
What are the HTN drugs?
- Diuretics
- Beta Blockers
- ACE/ARB’s
- Ca Channel Blockers
What HTN drugs are capable to be used in refractory cases?
- Aldosterone Receptor Agonists
- Beta Blockers
- Central Sympatholytics
- Arteriolar Dilators
- Peripheral Sympathetic Inhibitors
- Aliskiren “Renal Inhibitors”
What are the actions of Diuretics?
- REDUCES plasma volume and thus chronically reduces peripheral resistance.
* FIRST LINE TX ESSENTIAL HTN
- Thiazide Diuretics (GOLD)
- Loop Diuretics (IF renal dysfunction or with close electrolyte monitoring)
- May require K supplementation
What are the actions of Beta Blockers?
- REDUCES HR and Cardiac Output
* BEST FOR WHITES
*IF B/P to high and you can’t get it down then ask the patient if they have taken their BP medication today?
In what patients are Beta Blockers best to use with HTN?
Post MI or with CHF
*Reduces morbidity
*Carvedilol > Metoprolol in reducing the HR with CHF patients.
When should you use caution with Beta Blockers?
- Pulmonary disease (May trigger pulmonary conditions)
- Diabetes Mellitus (May disguise true hyperglycemia)
*Most cardio-selective beta blocker should be used
What is the order of least cardio-selective - most cardio-selective beta blockers?
Propanolol > Carvedilol > Etanolol > Metoprolol > Nebevilol “Bystolic”
What are the actions of ACE-Inhibitors?
INHIBIT bradykinin degradation (INCREASES bradykinin) + INCREASES synthesis of vasodilators (Prostaglandins) by inhibiting ACE (Angiotensin Converting Enzyme)
*STOPS the reduction of bradykinins which increases prostaglandins, which are vasodilators, thus ACE-I aid in vasodilation
What patients are ACE-I best to use with?
IF:
- HTN + (DM + CKD)
- These help to preserve the kidney function, thus it is imperative to place patient on if you see any signs of kidney damage
- HTN (Mild-Mod) + Young white person where a diuretic hasn’t worked
- Post MI/CHF (Second to Beta Blockers)
What is the greatest S/E of ACE-I?
Cough
What are the action’s of ARB’s (Angiotensin Receptor Blockers)?
-They block the interaction of Angiotensin 2 receptors and they works similar to ACE-I without the inhibition of Bradykinin, thus NO COUGH
What patients are ARB’s best to use with?
-DM + CKD (They preserve the kidney function and thus they should be used if the ACE-I cough is retractable).
What are the actions of Calcium Channel Blockers?
-Peripheral vasodilation
What are the patients that are best to use Calcium Channel Blockers on?
-Blacks and Elderly
Whats the drug used for HTN as an Aldosterone Receptor Antagonist?
- Spironolactone
* Best to use if refractory HTN. but as an adjunct
When is it best to use spironolactone?
-As an adjunct with Beta Blockers or ACE-I/ARB’s in patients who are post MI/CHF
What is the action of Alpha Adrenergic Antagonists?
-They DECREASE peripheral vascular resistance
What patients are Alpha Adrenergic Antagonists best to use with?
-MEN with symptoms of BPH
How to treat HTN urgencies or emergencies?
- Parenteral agents:
* DON’T reduce HTN too fast = Cerebral Ischemia
What are common agents to treat HTN urgency or emergency?
- Na Nitroprusside (Gold)
- IF Myocardial ischemia:
- Nitroglycerin
- Beta Blockers - Diuretics and Calcium Channel Blockers:
- Nicardipine
- Loop Diuretic
What’s the best drug for an “Aortic Dissection”?
- Nitroprusside + Beta Blockers (Labetolol / Esmolol)
What’s the best Anti-HTN with ARF “Acute Renal Failure”?
Dopamine-1 receptor Agonist
“Fenoldopam”
What’s the best Anti-HTN with pregnancy?
- Hydralazine “Apresoline”
- Methyldopa “Aldomet”
* Methyldopa ensure you use caution when breast feeding as this is passed via the breast milk.
What are the drugs with the class of Diuretics?
- HIGH Ceiling “Loop Diuretics” (First line for CHF)
- LOW Ceiling “Thiazides” (First line for HTN)
* Thiazide-Like Diuretics - Potassium Sparing
- Aldosterone Antagonists
- Carbonic Anhydrase Inhibitors
- Calcium Sparing Diuretics
- Osmotic Diuretics
What drugs are in the class of Loop Diuretics?
- Furosemide “Lasix”
- Bumetanide “Bumex”
- Torsemide “Demadex”
- Ethacrynic Acid “Edecrin”
What are the side effects of loop Diuretics?
- Electrolyte disturbances:
a. Hypokalemia (Low K)
b. Hyponatremia (Low Na) - Metabolic Alkalosis
- Signs of reduced perfusion:
a. HOTN
b. BUN and Serum creatinine (High)
c. HYPERuricemia (High Uric Acid) - Sulfonamides, thus rash or acute interstitial nephritis
- Ototoxicity
Mnemonic for remembering the diuretics?
Leak Over The CAN
-Loop diuretics / Osmotics / Thiazides and Thiazide like / Carbonic Anhydrase Inhibitors / Aldosterone Inhibitors / Na Channel Blockers
What drugs are in the class of thiazide and thiazide like diuretics?
- Hydrochlorothiazide (HCTZ) “Esidrix”
- Chlorothiazide “Diuril”
- Chlorthalidone “ Thalitone”
What are the side effects of thiazide diuretics?
- Dizziness / Lightheadedness / Headache
- Blurred vision
- Loss of appetite / Nausea
- Itching / Rash (SLE like)
- Electrolyte Abnormalities:
a. Hypokalemia (Low K)
b. Hypomagnesemia (Low Mg)
c. Hyponatremia (Low Na)
d. Hypercalcemia (High Ca) - Hyperuricemia (Increased risk of gout from uric acid)
- Hyperlipidemia
What drugs are in the class of potassium sparing diuretics?
- Amiloride (Midamore)
- Spironolactone (Aldactone)
- Triamterene (Dyrenium)
What are the side effects of potassium sparing diuretics?
- Hyperkalemia (High K)
- GI disturbances:
- N/V/D
- Anorexia - Impotence and sexual dysfunction
- Gynecomastia
- Rash (SLE-like syndrome)
