Diabetes Meds Flashcards
What are the names of sulfonylureas?
glyburide, glipizide, glimepramide
What is the mechanism of action of sulfonylureas?
beta cell insulin secreatogues
glyburide, glipizide, glimepramide
What is the main adverse effect of sulfonylureas? When is it contraindicateD?
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)
What are the names of biguanides?
metformin
What is the mechanism of action of biguanides?
inhibits hepatic glucose production
metformin
What is the main side effect of biguanide use? What are the contraindications?
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)
What are the names of alpha glucosidase inhibitors?
acarbose, miglitol
What is the mechanism of action of alpha glucosidase inhibitors?
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)
What are the main side effects of alpha glucosidase inhibitors?
GI side effects
they have no hypoglycemia and decreased CVD events
(acarbose, miglitol)
What are the names of glinides?
repaglinide, nateglinide
What is the mechanism of action of glinides?
increase beta cell insulin release (like sulfonylureas, only they are much shorter)
(repaglinide, nateglinide)
What are the main side effects of glinides?
like sulfonylureas, they can cause hypoglycemia…but these CAN be used in renal disease because their halflife is shorter
(repaglinide, nateglinide)
What are the TZDs?
pioglitazone and rosiglitazone
What is the mechanism of action of TZDs?
transcriptional regulators of PPAR gamma, which improves peripheral insulin activity by changing the way adipocytes are distributed, etc.
(pioglitazone and rosiglitazone)
What are the main side effects of TZDs?
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
What is symlin (pramlintide)? How does it work?
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
What are GLP-1 agonists?
exentide , albiglutide both SQ
How do GLP-1 agonists work?
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
What are the risks of GLP-1 agonists?
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)
What are DPP4 inhibitors?
sitagliptin, linagliptin, saxogliptin
How do DPP4 inhibitors work?
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)
What are the side effects of DPP4 inhibitors?
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)
What are the SGLT2 inhibitors?
dapagliflozin, canaglifozin
How do the SGLT2 inhibitors work?
dapagliflozin, canaglifozin
Block sodium glucose transporter in distal tubule
What are the side effects of SGLT2 inhibitors?
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.
