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Endocrinology > Diabetes mellitus - drugs > Flashcards

Diabetes mellitus - drugs Flashcards

1
Q

Gestational diabetes mellitus - treatment strategies

A
  1. dietary modification
  2. exercise
  3. insulin replacement (if lifestyle modification fails)
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2
Q

insulin preparations - side effects

A
  1. hypoglycemia
  2. rare hypersensitivity reactions
  3. lipodystrophy - rare
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3
Q

insulin preparations - rapid acting - drugs?

A
  1. aspart
  2. Lispro
  3. Glulisine
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4
Q

insulin preparations - short acting - drugs?

A

regular

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5
Q

insulin preparations - intermediate acting - drugs?

A

NPH

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6
Q

insulin preparations - long acting - drugs?

A
  1. Detemir

2. Glargine

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7
Q

insulin preparations - rapid acting - duration?

A

2-5h

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8
Q

insulin preparations - short acting - duration?

A

4-8h

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9
Q

insulin preparations - intermediate acting - duration?

A

8-12

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10
Q

insulin preparations - long acting - duration?

A

16-24

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11
Q

insulin preparations - short acting - clinical use

A
  1. type 1 DM
  2. type 2 DM
  3. Gestational DM
  4. DKA (IV)
  5. hyperkalemia (+glucose)
  6. stress hyperglycemia
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12
Q

Oral hypoglycemic drugs - classes

A
  1. Biguanides
  2. Sulfonylureas
  3. Glitazones/thiazolidinediones
  4. GLP-1 analogs
  5. DPP-4 inhibitors
  6. Amylin analogs
  7. SGLT-2 inhibitors
  8. α-glucosidase inhibitors
  9. Meglitinides
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13
Q

Oral hypoglycemic drugs -biguanides drugs?

A

metformin

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14
Q

metformin action

A 
exact mechanism unknown 
1. Decreased gluconeogenesis
2. increased glycolysis
3. increased peripheral glucose uptake 
(increased insulin sensitivity)
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15
Q

metformin clinical use

A

first-line therapy in type 2 DM (causes modest weight loss)

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16
Q

metoformin - side effects

A
  1. GI upset

2. lactic acidosis (in renal failure)

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17
Q

metoformin is contraindicated in …(and why)

A

renal insufficiency

because of lactic acidosis

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18
Q

sulfonylureas - drugs?

A

first generation: chlorpropamide, tolbutamine

seond generation: glimepiride, glipizide, glypuride

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19
Q

sulfonylureas - second generation drugs (and HT)

A
  1. glimepiride –> high HT
  2. glipizide –> low HT
  3. glypuride –> high HT
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20
Q

sulfonylureas toxicities

A
  1. increased risk of hypoglycemia in renal failure
  2. first generation: disulfiram like reaction
  3. second generation: hypoglycemia
  4. Weight gain
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21
Q

Glitazone/thiazolidinediones - drugs

A
  1. pioglitazone

2. rosiglitazone

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22
Q

Glitazone/thiazolidinediones - mechanism of action

A

increased insulin sensitivity in peripheral tissue. Binds PPAR-γ nuclear transcription regulator

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23
Q

Glitazone/thiazolidinediones - clinical use

A

Used in monotherapy in type 2 DM or combined with other agents

24
Q

Glitazone/thiazolidinediones - toxicity

A
  1. weight gain
  2. edema
  3. hepatotoxicity
  4. Heart failure
  5. increased risk for FRUCTURES
25
Q

GLP-1 analogs - drugs

A
  1. exenatide

2. Liraglutide

26
Q

GLP-1 analogs - mechanism of action

A
  1. increase glucose depended insulin release
  2. decrease glucagon release
  3. decrease gastric emptying
  4. increase satiety
27
Q

GLP-1 analogs - clinical use

A

type 2 DM

28
Q

GLP-1 analogs - toxicities

A
  1. nausea
  2. vomiting
  3. pancreatitis
  4. modest weight loss
29
Q

DDP-4 inhibitors - drugs

A
  • GLIPTIN
    1. Linagliptin
    2. Saxagliptin
    3. Sitagliptin
30
Q

DDP-4 inhibitors - mechanim of action

A

inhibits DPP-4 enzyme that deactivates GLP-1

  1. increase glucose-dependent insulin release
  2. decrease glucagon release
  3. decrease gastric emptying
  4. increase satiety
31
Q

DDP-4 inhibitors - clinical use

A

type 2 DM

32
Q

DDP-4 inhibitors - toxicities

A

Mild urinary or respiratory infections

wight neutral

33
Q

Amylin analogs - drugs

A

Pramlintide

34
Q

Amylin analogs - mechanims of action

A
  1. decrease gastric emptying

2. decrease glucagon

35
Q

Amylin analogs - clinical use

A
  1. type 1 DM

2. type 2 DM

36
Q

Amylin analogs - toxicities

A
  1. hypoglycemia (in setting of mistimed prandial insulin)
  2. nausea
  3. diarrhea
37
Q

SGLT-2 inhibitors - drugs

A
  • GLIFLOZIN

1. Canagliflozin 2. dapagliflozin 3. empagliflozin

38
Q

SGLT-2 inhibitors - mechanims of action

A

Block reabsorption of glucose in proximal convoluted tubule

39
Q

SGLT-2 inhibitors - clinical use

A

Type 2 DM

40
Q

SGLT-2 inhibitors - side effects

A
  1. Glucosuria
  2. UTIs
  3. vaginal yeast infection
  4. hyperkalemia
  5. dehydration (orthostatic hypertension)
41
Q

α-glcosidase inhibitors - drugs

A
  1. acarbose

2. Miglitol

42
Q

α-glcosidase inhibitors - toxicities

A

GI disturbances

43
Q

α-glcosidase inhibitors - clinical use

A

used as monotherapy in type 2 DM or in combination

44
Q

α-glcosidase inhibitors - mechanims of action

A

inhibit intestinal brush - border α-glcosidase –> delayed carbohydrate hydrolysis and glucose absorption –> decrease postprandial hyperglycemia

45
Q

diabetes mellitus drug with vaginal yeast infection as side effect

A

SGLT-2 inhibitors (Canagliflozin)

46
Q

diabetes mellitus drug with mild respiratory or urinary infection as side effect

A

DDP-4 inhibitors (linagliptin, saxagliptin, sitagliptin)

47
Q

diabetes mellitus drug that binds to PPAR-γ nuclear transcription

A

Glitazones/thiazolidinediones (pioglitazone, rosiglitazone)

48
Q

Meglitinides - drugs

A
  • Glinide
    1. Nateglinide
    2. Repaglinide
49
Q

Meglitinides - clinical use

A

used as monotherapy in DM 2 or combined with metformin

50
Q

Meglitinides - side effects

A
  1. weight gain

2. increased risk for hypoglycemia in renal failure

51
Q

oral hypoglycemic drugs - drugs administrated through SC injection

A
  1. GLP-1 analogs

2. Amylin analogs

52
Q

insulin in DKA

A

IV regular (HT –> 5 mins)

53
Q

before prescribe SLGT-2 inhibitors

A

check renal function

54
Q

treatment of severe hypoglycemia

A

IM glucagon in nonmedical setting (if glucagon is not available –> buccal or sublingual glucose
IV dextrose in medical setting
if mild hypoglycemia –>oral glucose (eg. juice)

55
Q

hyperkalemia - treatment

A

potassium exhange resins (eg. sodium polystyrene sulfonate) –> excrete potasium from the body (through stools) by exchange it with sodium

56
Q

insulin in DM2 - when / GOAL

A

added if the patient is not controled with oral hypoglycemic agens
HgA1c under 7%

57
Q

glargine vs NPH insulin regarding steady state of insulin

A

glargine is better

NPH is dosed twice a dday

Endocrinology (5 decks)

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