Diabetes Meds

Question 1

What are the names of sulfonylureas?

Answer 1

glyburide, glipizide, glimepramide

Question 2

What is the mechanism of action of sulfonylureas?

Answer 2

beta cell insulin secreatogues

glyburide, glipizide, glimepramide

Question 3

What is the main adverse effect of sulfonylureas? When is it contraindicateD?

Answer 3

hypoglycemia (do not give to patients who do not eat regular meals)
contraindicated in sulfa allergy, and in liver/kidney disease (it has a long half life)

(glyburide, glipizide, glimepramide)

Question 4

What are the names of biguanides?

Answer 4

metformin

Question 5

What is the mechanism of action of biguanides?

Answer 5

inhibits hepatic glucose production

metformin

Question 6

What is the main side effect of biguanide use? What are the contraindications?

Answer 6

main side effect is GI upset (n/v/d) so take with food!
rarely can cause lactic acidosis (usually in patients with kidney, liver disease, so contraindicated in these patients
also can cause vit B 12 deficiency

(metformin)

Question 7

What are the names of alpha glucosidase inhibitors?

Answer 7

acarbose, miglitol

Question 8

What is the mechanism of action of alpha glucosidase inhibitors?

Answer 8

delay carbohydrate absorption (patients with DM2 have a delay in the release of insulin, those these drugs synchronize release of insulin with carbohydrate absorption better)’

Best for patients with POSTPRANDIAL SPIKES (peak post prandial should be less than 180)

(acarbose, miglitol)

Question 9

What are the main side effects of alpha glucosidase inhibitors?

Answer 9

GI side effects

they have no hypoglycemia and decreased CVD events

(acarbose, miglitol)

Question 10

What are the names of glinides?

Answer 10

repaglinide, nateglinide

Question 11

What is the mechanism of action of glinides?

Answer 11

increase beta cell insulin release (like sulfonylureas, only they are much shorter)

(repaglinide, nateglinide)

Question 12

What are the main side effects of glinides?

Answer 12

like sulfonylureas, they can cause hypoglycemia…but these CAN be used in renal disease because their halflife is shorter

(repaglinide, nateglinide)

Question 13

What are the TZDs?

Answer 13

pioglitazone and rosiglitazone

Question 14

What is the mechanism of action of TZDs?

Answer 14

transcriptional regulators of PPAR gamma, which improves peripheral insulin activity by changing the way adipocytes are distributed, etc.

(pioglitazone and rosiglitazone)

Question 15

What are the main side effects of TZDs?

Answer 15

weight gain (subcutaneous), edema, hemodilution, CVD (but pioglitazone is associated with reduction in CVD)
FRACTURE Risk, BLADDER CANCER
but can be useful in renal disease

Question 16

What is symlin (pramlintide)? How does it work?

Answer 16

Symlin is an analogue of amylin, a 37 AA peptide cosecreted with insulin
It reduces post-prandial glucose by suppresion of glucagon secretion and by slowing of gastric emptying

reduces weight, but not really a1c. SQ administration

Question 17

What are GLP-1 agonists?

Answer 17

exentide , albiglutide both SQ

Question 18

How do GLP-1 agonists work?

Answer 18

bind/activate GLP-1 recptor: stimulates beta cell insulin release and inhibits glucagon secretion from alpha cells; also slows gastric emptying, promoting satiety.

exentide , albiglutide both SQ

Question 19

What are the risks of GLP-1 agonists?

Answer 19

exentide , albiglutide both SQ

injection site reactions; hypoglycemia when used with sulfonylurea; n/v/d.
Increase of medullary thyroid cancer (don’t give in FH of MTC or MEN2)

Question 20

What are DPP4 inhibitors?

Answer 20

sitagliptin, linagliptin, saxogliptin

Question 21

How do DPP4 inhibitors work?

Answer 21

sitagliptin, linagliptin, saxogliptin

increase and prolong the active incretin levles (GLP1 and GIP, which increase insulin release from beta cells and decrease glucagon release from alpha cells)

Question 22

What are the side effects of DPP4 inhibitors?

Answer 22

sitagliptin, linagliptin, saxogliptin

weight neutral. lower dose for renal insufficiency. URI, nasopharyngitis, HA, UTI, SJS/angioedema very rarely

big difference with GLP-1 receptor agonists (exentide, albiglutide) is that DPP4 inhibitors do not delay gastric emptying –> lead to weight loss. But DPP4 is an oral, not injected drug (convenience)

Question 23

What are the SGLT2 inhibitors?

Answer 23

dapagliflozin, canaglifozin

Question 24

How do the SGLT2 inhibitors work?

Answer 24

dapagliflozin, canaglifozin

Block sodium glucose transporter in distal tubule

Question 25

What are the side effects of SGLT2 inhibitors?

Answer 25

dapagliflozin, canaglifozin

can lead to osmotic diuresis (will have to adjust preexisting diuretics and hypertensive drugs). Can increase risk of female candida infections as it will increase glucosuria.