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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
Q

Mechanism: GLP-1 analogs

Exenatide

Liraglutide

Dulaglutide

Albiglutide

A
  1. Increase glucose-dependent insulin release
  2. Decrease glucagon release
  3. Decrease gastric emptying
  4. Increase satiety
26
Q

Clinical use: GLP-1 analogs

Exenatide

Liraglutide

Dulaglutide

Albiglutide

27
Q

Adverse effects: GLP-1 analogs

Exenatide

Liraglutide

Dulaglutide

Albiglutide

A
  1. N/V
  2. Pancreatitis
  3. Modest weight loss
28
Q

Class: Nateglinide

A

Meglitinide

29
Q

Class: Repaglinide

A

Meglitinide

30
Q

Class: Exenatide

A

GLP-1 analog

31
Q

Class: Liraglutide

A

GLP-1 analog

32
Q

Class: Dulaglutide

A

GLP-1 analog

33
Q

Class: Albiglutide

A

GLP-1 analog

34
Q

Mechanism: DDP-4 inhibitor

A

Inhibit DPP-4 enzyme that deactivates GLP-1, thereby:

  • Increasing glucose-dependent insulin release
  • Decreasing glucagon release
  • Decreasing gastric emptying
  • Increasing satiety
35
Q

Clinical use: DPP-4 inhibitors

36
Q

Adverse effects: DPP-4 inhibitors

Linagliptin

Saxagliptin

Sitagliptin

Alogliptin

A
  1. Urinary or respiratory tract infections
  2. Weight neutral
37
Q

Class: Linagliptin

A

DPP-4 inhibitor

38
Q

Class: Saxagliptin

A

DPP-4 inhibitor

39
Q

Class: Sitagliptin

A

DPP-4 inhibitor

40
Q

Class: Alogliptin

A

DPP-4 inhibitor

41
Q

Mechanism: Amylin analog

Pramlintide (sc injection)

A

Decrease gastric emptying

Decrease glucagon

42
Q

Clinical use: Amylin analog

Pramlintide (sc injection)

A

Type 1 DM

Type 2 DM

43
Q

Adverse effects: Amylin analog

Pramlintide (sc injection)

A
  1. Hypoglycemia (in setting of mistimed prandial insulin)
  2. Nausea
44
Q

Class: Pramlintide

A

Amylin analog

45
Q

Mechanism: SGL2 inhibitors

Canagliflozin

Dapagliflozin

Empagliflozin

A

Block reabsorption of glucose in PCT

46
Q

Clinical use: SGLT2 inhibitors

Canagliflozin

Dapagliflozin

Empagliflozin

47
Q

Adverse effects: SGLT2 inhibitors

Canagliflozin

Dapagliflozin

Empagliflozin

A
  1. Glucosuria
  2. UTIs
  3. Vaginal yeast infections
  4. Hyperkalemia
  5. Dehydration (orthostatic hypotension)
  6. Weight loss
48
Q

Class: Canagliflozin

A

SGLT2 inhibitor

49
Q

Class: Dapagliflozin

A

SGLT2 inhibitor

50
Q

Class: Empagliflozin

A

SGLT2 inhibitor

51
Q

Mechanism: Alpha-glucosidase inhibitors

Acarbose

Miglitol

A

Inhibit intestinal brush-border alpha-glucosidases

Delayed carbohydrate hydrolysis and glucose absorption → decreased postprandial hyperglycemia

52
Q

Clinical use: Alpha-glucosidase inhibitors

Acarbose

Miglitol

53
Q

Adverse effects: Alpha-glucosidase inhibitors

Acarbose

Miglitol

A
  1. GI disturbances

PHARMACOLOGY (33 decks)

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