Diabetes Medications Flashcards
Non-Insulin Rx
Biguanides
Sulfonylureas
Disaccharide inhibitors
Thiazolidinediones (TZD)
GLP analogs
Amylin analogs
DPP-IV inhibitors
_____ is an example of a Biguanide
Metformin
Metformin/Biguanides mechanism of action
Mechanisms of action
↓ intestinal absorption of glucose
↓ hepatic gluconeogenesis
↑ insulin sensitivity in peripheral tissues
Excretion
90% in the urine
10% feces
What are additional benefits of Metformin?
↓ serum LDL
↑ fatty acid oxidation
Contraindications of biguanides?
- Acute or chronic metabolic acidosis including diabetic ketoacidosis
- Hypersensitivity to metformin
- Severe renal impairment: eGFR below 30 mL/min/1.73 m(2)
Side effects of biguanides
Diarrhea (10-53%)
Nausea/vomiting (7-26%)
Flatulence (12%)
Sulfonylurea drugs
Glimepiride (Amaryl®)
Glyburide (DiaBeta®)
Glipizide (Glucotrol®)
Sulfonylureas mechanism of action
- 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
Side effect of sulfonylureas
Hypoglycemia (4-20%)
Thiazolidinediones (TZDs) Mechanism of action
- ↑ insulin receptor sensitivity
- ↑ energy storage in fat & muscle
- ↓ glucose production
- Stimulate fat, muscle, & liver cells to ↑ insulin receptors
- Excretion: 15-64% urine, 23% feces
Side effects of TZDs
Fluid retention (5-15%)
Amylin Analogs Mechanism of Action
↓ glucagon secretion
↑ Satiety (↓ appetite)
↓ gastric emptying
Excretion: Most all in the urine
Pioglitazone (Actos®) and Rosiglitazone (Avandia®) are examples of _____
Thiazolidinediones (TZDs)
Pramlinitide (Symlin®) is an example of a ____
Amylin analog
Pramlinitide (Symlin®)/Amylin Analog side effects
Nausea (28-48% )
Non-Insulin Rx−GLP-1 Agonists Mechanism of Action
↑ Insulin secretion
↓ Glucagon secretion
Delays gastric emptying
↓ liver gluconeogenesis
↑ satiety
Excretion: Most all in the urine
Non-Insulin Rx−GLP-1 Agonists side effects
Nausea (28-39%)
Hypoglycemia
Vomiting (11-15%)
Constipation (10-19%)
Non-Insulin Rx−DPP-4 inhibitors
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
Non-Insulin Rx−DPP-4 inhibitors side effects
URI (5%)
HA (1-6%)
Hypoglycemia (.5-12%)
UTI
Vomiting
Abdominal pain
Gastroenteritis
SGLT-2 Inhibitors Mechanism of action
↓ glucose reabsorption in the kidney
↑ insulin sensitivity
↓ gluconeogenesis in the liver
↑ insulin release from ! cells
Excretion: 33% urine, 60% feces
SGLT-2 Inhibitors side effects:
Genital mycotic infection (4-11%, > in females)
Metformin PEARL
push through the nausea or start on a lower dose
Sulfonylurea PEARL
Avoid prescribing together with insulin
Black box warning of TZDs (PEARL)
may cause or worsen congestive heart failure. Monitor for S/S of heart failure after initiation/dose increases
