Diabetes Medications Flashcards
Name the sulfonylureas
1) Glipizide
2) glyburide
3) glimepride
4) tolazamide
5) tolbutamide
Name the biguaindes
Metformin
Name the meglitinides
1) repaglinide
2) nateglinide
Name the thiazolidinediones
1) rosiglitazone
2) pioglitazone
Name the a-glucosidase inhibitors
1) miglitol
2) acarbose
Name the amylin replacement
1) pramlintide
Name the GLP-1 agents
1) exenatide
Name the DPP-4 inhibitors
1) sitagliptin
2) vildagliptin
What is the biggest adverse effect of the sulfonylureas?
hypoglycemia
weight gain
Which DM 2 medications are often first line?
sulfonylreas
metformin
What are the major side effects of metformin?
GI upset lactic acidosis CHF respiratory disease liver disease
Which DM 2 drugs cause weight loss?
metformin
GLP-1 agents (exenatide)
Major side effects of meglitinides?
hypoglycemia
Major side effects of thiazolidinedions?
fluid retention
liver disease
increase risk of CV death (rosiglitazone)
Which DM 2 is the last choice of oral agent?
thiazolidinediones
Major side effects of a-glucosidase inhibitors?
gas
bloating
diarrhea
Major side effects of amylin replacement?
nausea
major side effects of GLP-1 agents
nausea
vomiting
diarrhea
major side effects of DPP-4 inhibitors?
GI upset
Which DM 2 medications are SQ?
amylin replacement
GLP-1 agents
What insulins are ultra-short-acting?
1) lispro
2) insulin
3) aspart
4) gluisine
What is the onset, peak and duration of ultra-short-acting insulin?
onset: 5-15 min
peak: 1-1.5 hours
duration: 3-4
What is the short-acting insulin?
regular
What is the onset, peak and duration of short-acting insulin?
onset: 15-30 min
peak: 1-3 hours
duration: 5-7 hours
What are the intermediate-acting insulins?
1) lente
2) NPH
What is the onset, peak and duration of intermediate-acting insulin?
onset: 2-4 hours
peak: 8-10 hours
duration: 18-24 hours
What are the long-acting insulins?
1) ultralente
2) glargine
3) detemir
What is the onset, peak and duration of long-acting insulins?
onset: 4-5 hours
peak: 8-14 hours
duration: 25-36 hours
What is the MOA of sulfonylurea’s?
1) bind to ATP dependent K+ channels on pancreatic beta cell membrans
2) inhibits hyperpolarizing efflux of K+
3) causes membrane potential to be more +
4) this depolarization opens voltage gated Ca2+ channels
5) intracellular Ca2+ leads to increased fusion of insulin to the cell membrane
6) increased secretion of insulin
What is the MOA of metformin?
decreases hyperglycemia by suppressing glucose production by the liver
What is the MOA of meglitinide?
they bind to ATP-dependent K+ channels of pancreatic beta cells much like sulfonylureas but have a weaker binding affinity and faster dissociation
What is the MOA of thiazolidinedions?
activate PPARs (a group of nuclear receptors) with greatest specificity for PPAR gamma. When activated they bind to DNA and increase transcription of certain genes
What genes are up-regulated with thiazolidinedions?
1) insulin resistance decreased
2) adipocyte differentiation is modified
3) VEGF-induced angiogenesis is inhibited
4) leptin levels decrease
What is the MOA of a-glucosidase inhibitor?
they are saccharides that act as competitive inhibitors of enzymes needed to digest carbohydrates
What is the MOA of amylin?
plays a role in glycemic regulation by slowing gastric emptying and promoting satiety so therefore prevents post-prandial spikes in blood glucose levels
What is the MOA of GLP-1 agents?
1) causes pancreases to secrete more insulin
2) suppresses pancreatic release of glucagon
3) slows down gastric emptying
4) reduces appetite
5) reduces liver fat content
