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PHARMACOLOGY > Diabetes Mellitus Management > Flashcards

Diabetes Mellitus Management Flashcards

1
Q

Adverse effects: Insulin therapy

A
  1. Hypoglycemia
  2. Lipodystrophy
  3. Rare hypersensitivity reactions
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2
Q

Mechanism: Insulin therapy

A

Binds insulin receptor (TK activity)

  • Liver: Increase glucose stored as glycogen
  • Muscle: Increase glycogen, protein synthesis, K+ uptake
  • Fat: Increase TG storage
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3
Q

Mechanism: Metformin

A

Inhibit hepatic gluconeogenesis and action of glucagon

  • Decreases gluconeogenesis
  • Increases glycolysis
  • Increases peripheral glucose uptake (sensitivity)
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4
Q

Clinical use: Metformin

A

First-line therapy in type 2 DM

Causes modest weight loss

Can be used in patients without islet function

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5
Q

Mechanism: Metformin

A
  1. GI upset
  2. Lactic acidosis
    • Contraindicated in renal insufficiency
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6
Q

Mechanism: Sulfonylureas

A

Close K+ channel in beta cell membrane → cell depolarizes → insulin release via increased calcium influx

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7
Q

Clinical use: Sulfonylureas

A

Stimulate release of endogenous insulin in type 2 DM

Requires some islet function; useless in type 1 DM

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8
Q

Adverse effects: Sulfonylureas

1st generation:

Chlorpropamide

Tolbutamide

Acetohexamide

Tolazamide

A
  1. Hypoglycemia (increased risk in renal failure)
  2. Weight gain
  3. Disulfiram-like reaction (1st generation only)
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9
Q

Class: Chlorpropamide

A

1st generation sulfonylurea

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10
Q

Class: Tolbutamide

A

1st generation sulfonylurea

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11
Q

Class: Acetohexamide

A

1st generation sulfonylurea

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12
Q

Class: Tolazamide

A

1st generation sulfonylurea

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13
Q

Class: Glimepiride

A

2nd generation sulfonylurea

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14
Q

Class: Glipizide

A

2nd generation sulfonylurea

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15
Q

Class: Glyburide

A

2nd generation sulfonylurea

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16
Q

Mechanism: Thiazolidinediones (TZDs)

Pioglitazone

Rosiglitazone

(-glitazone)

A
  • Increase insulin sensitivity in peripheral tissue
  • Binds to PPAR-y nuclear transcription regulator
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17
Q

Adverse effects: Sulfonylureas

2nd generation:

Glimepiride

Glipizide

Glyburide

A
  1. Hypoglycemia (increased risk in renal failure)
  2. Weight gain
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18
Q

Clinical use: Thiazolidinediones (TZDs)

Pioglitazone

Rosiglitazone

(-glitazone)

A

Used as monotherapy in type 2 DM or combined with other agents (e.g., metformin)

Safe in renal impairment

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19
Q

Adverse effects: Thiazolidinediones (TZDs)

Pioglitazone

Rosiglitazone

(-glitazone)

A
  1. Weight gain
  2. Edema
  3. HF
  4. Increased risk of fractures
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20
Q

Class: Pioglitazone

A

Thiazolidinediones (TZD)

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21
Q

Class: Rosiglitazone

A

Thiazolidinediones (TZD)

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22
Q

Mechanism: Meglitinides

Nateglinide

Repaglinide

A

Stimulate postprandial insulin release by closing K+ channels on beta cell membranes (site differs from sulfonylureas)

23
Q

Clinical use: Meglitinides

Nateglinide

Repaglinide

A

Monotherapy in type 2 DM

or

In combinated with metformin

24
Q

Adverse effects: Meglitinides

Nateglinide

Repaglinide

A
  1. Hypoglycemia (increased risk with renal failure)
  2. Weight gain
25
Mechanism: **GLP-1 analogs** Exenatide Liraglutide Dulaglutide Albiglutide
1. Increase glucose-dependent insulin release 2. Decrease glucagon release 3. Decrease gastric emptying 4. Increase satiety
26
Clinical use: **GLP-1 analogs** Exenatide Liraglutide Dulaglutide Albiglutide
Type 2 DM
27
Adverse effects: **GLP-1 analogs** Exenatide Liraglutide Dulaglutide Albiglutide
1. N/V 2. Pancreatitis 3. Modest weight **_loss_**
28
Class: Nateglinide
Meglitinide
29
Class: Repaglinide
Meglitinide
30
Class: Exenatide
GLP-1 analog
31
Class: Liraglutide
GLP-1 analog
32
Class: Dulaglutide
GLP-1 analog
33
Class: Albiglutide
GLP-1 analog
34
Mechanism: DDP-4 inhibitor
Inhibit DPP-4 enzyme that deactivates GLP-1, thereby: * Increasing glucose-dependent insulin release * Decreasing glucagon release * Decreasing gastric emptying * Increasing satiety
35
Clinical use: DPP-4 inhibitors
Type 2 DM
36
Adverse effects: **DPP-4 inhibitors** Linagliptin Saxagliptin Sitagliptin Alogliptin
1. **Urinary** or **respiratory** tract infections 2. Weight **_neutral_**
37
Class: Linagliptin
DPP-4 inhibitor
38
Class: Saxagliptin
DPP-4 inhibitor
39
Class: Sitagliptin
DPP-4 inhibitor
40
Class: Alogliptin
DPP-4 inhibitor
41
Mechanism: **Amylin analog** Pramlintide (sc injection)
Decrease gastric emptying Decrease glucagon
42
Clinical use: **Amylin analog** Pramlintide (sc injection)
Type 1 DM Type 2 DM
43
Adverse effects: **Amylin analog** Pramlintide (sc injection)
1. Hypoglycemia (in setting of mistimed prandial insulin) 2. Nausea
44
Class: Pramlintide
Amylin analog
45
Mechanism: **SGL2 inhibitors** Canagliflozin Dapagliflozin Empagliflozin
Block reabsorption of glucose in PCT
46
Clinical use: **SGLT2 inhibitors** Canagliflozin Dapagliflozin Empagliflozin
Type 2 DM
47
Adverse effects: **SGLT2 inhibitors** Canagliflozin Dapagliflozin Empagliflozin
1. Glucosuria 2. **UTIs** 3. **Vaginal yeast infections** 4. **Hyperkalemia** 5. **Dehydration** (orthostatic hypotension) 6. Weight **_loss_**
48
Class: Canagliflozin
SGLT2 inhibitor
49
Class: Dapagliflozin
SGLT2 inhibitor
50
Class: Empagliflozin
SGLT2 inhibitor
51
Mechanism: **Alpha-glucosidase inhibitors** Acarbose Miglitol
Inhibit intestinal brush-border alpha-glucosidases Delayed carbohydrate hydrolysis and glucose absorption → decreased postprandial hyperglycemia
52
Clinical use: **Alpha-glucosidase inhibitors** Acarbose Miglitol
Type 2 DM
53
Adverse effects: **Alpha-glucosidase inhibitors** Acarbose Miglitol
1. GI disturbances

PHARMACOLOGY (33 decks)

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