Diabetes Medications

Question 1

Non-Insulin Rx

Answer 1

Biguanides
Sulfonylureas
Disaccharide inhibitors
Thiazolidinediones (TZD)
GLP analogs
Amylin analogs
DPP-IV inhibitors

Question 2

_____ is an example of a Biguanide

Answer 2

Metformin

Question 3

Metformin/Biguanides mechanism of action

Answer 3

Mechanisms of action
↓ intestinal absorption of glucose
↓ hepatic gluconeogenesis
↑ insulin sensitivity in peripheral tissues
Excretion
90% in the urine
10% feces

Question 4

What are additional benefits of Metformin?

Answer 4

↓ serum LDL
↑ fatty acid oxidation

Question 5

Contraindications of biguanides?

Answer 5

• Acute or chronic metabolic acidosis including diabetic ketoacidosis
• Hypersensitivity to metformin
• Severe renal impairment: eGFR below 30 mL/min/1.73 m(2)

Question 6

Side effects of biguanides

Answer 6

Diarrhea (10-53%)
Nausea/vomiting (7-26%)
Flatulence (12%)

Question 7

Sulfonylurea drugs

Answer 7

Glimepiride (Amaryl®)
Glyburide (DiaBeta®)
Glipizide (Glucotrol®)

Question 8

Sulfonylureas mechanism of action

Answer 8

• Stimulates islet ! cells to release insulin
• Blocks the ATP sensitive K+ pump, → action
  potential to open voltage Ca++ channels →
  release insulin vesicles
• Excretion
  80% urine
  10% feces

Question 9

Side effect of sulfonylureas

Answer 9

Hypoglycemia (4-20%)

Question 10

Thiazolidinediones (TZDs) Mechanism of action

Answer 10

• ↑ insulin receptor sensitivity
• ↑ energy storage in fat & muscle
• ↓ glucose production
• Stimulate fat, muscle, & liver cells to ↑ insulin receptors
• Excretion: 15-64% urine, 23% feces

Question 11

Side effects of TZDs

Answer 11

Fluid retention (5-15%)

Question 12

Amylin Analogs Mechanism of Action

Answer 12

↓ glucagon secretion
↑ Satiety (↓ appetite)
↓ gastric emptying
Excretion: Most all in the urine

Question 13

Pioglitazone (Actos®) and Rosiglitazone (Avandia®) are examples of _____

Answer 13

Thiazolidinediones (TZDs)

Question 14

Pramlinitide (Symlin®) is an example of a ____

Answer 14

Amylin analog

Question 15

Pramlinitide (Symlin®)/Amylin Analog side effects

Answer 15

Nausea (28-48% )

Question 16

Non-Insulin Rx−GLP-1 Agonists Mechanism of Action

Answer 16

↑ Insulin secretion
↓ Glucagon secretion
Delays gastric emptying
↓ liver gluconeogenesis
↑ satiety
Excretion: Most all in the urine

Question 17

Non-Insulin Rx−GLP-1 Agonists side effects

Answer 17

Nausea (28-39%)
Hypoglycemia
Vomiting (11-15%)
Constipation (10-19%)

Question 18

Non-Insulin Rx−DPP-4 inhibitors

Answer 18

DPP-4 enzyme brakes down GLP-1
naturally. Inhibition allows GLP-1
to work longer
Slows incretin metabolism
↑ insulin synthesis & release
↓ glucagon levels
Excretion: 75% urine, 22% feces

Question 19

Non-Insulin Rx−DPP-4 inhibitors side effects

Answer 19

URI (5%)
HA (1-6%)
Hypoglycemia (.5-12%)
UTI
Vomiting
Abdominal pain
Gastroenteritis

Question 20

SGLT-2 Inhibitors Mechanism of action

Answer 20

↓ glucose reabsorption in the kidney
↑ insulin sensitivity
↓ gluconeogenesis in the liver
↑ insulin release from ! cells
Excretion: 33% urine, 60% feces

Question 21

SGLT-2 Inhibitors side effects:

Answer 21

Genital mycotic infection (4-11%, > in females)

Question 22

Metformin PEARL

Answer 22

push through the nausea or start on a lower dose

Question 23

Sulfonylurea PEARL

Answer 23

Avoid prescribing together with insulin

Question 24

Black box warning of TZDs (PEARL)

Answer 24

may cause or worsen congestive heart failure. Monitor for S/S of heart failure after initiation/dose increases

Question 25

Amylin Analogs (Pramlinitide) side effects

Answer 25

give any oral drugs requiring rapid GI absorption 1 hr before injection or 2 hours after meal