Diabetes Not Insulin Flashcards
2 drugs that sensitize the body to insulin ( decrease insulin resistance) and/or control hepatic glucose production (decrease hepatic formation of glucose)
- ”glitazones”:: pioglitazone (Actos)
2. biguanides:: metformin (Glucophage)
2 Drugs that stimulate the pancreas to make more insulin
- Sulfonylureas: glipizide (Glucotrol XL)
- meglitindes: repaglinide (Prandin)
Secrete More Please
Drugs that slow the absorption of starches
Alpha-glucosidase inhibitors: acarbose (Precose)
Drugs that act on incretins
- “gliptins” DPP-4 inhibitors:Sitagliptin (Januvia)
2. Incretin mimetics: GLP-1 Receptor Agonist- Exanatide (Byetta)
drugs that Manipulate kidney excretion of glucose
- SGLT-2 inhibitors : canagliflozin (Invokana)
keep it flozin
drugs that are synthetic amylin
Amylin Mimetic: Pramlintide (Symlin)
6 ways non insulin drugs can control diabetes
- sensitize the body to insulin and/or control hepatic glucose production
- stimulate the pancreas to make more insulin
- slow the absorption of starches
- act on incretins
- Manipulate kidney excretion of glucose
- Synthetic amylin
prototype for biguanides
metformin (Glucophage)
how dooes metformin (Glucophage) fxn?
biguanide
-(1) decrease hepatic formation of glucose and (2) reducing insulin resistance (endogenous and exogenous)
non insulin drug that is drug of choice for most patients?
metformin
side effects of metformin
GI (anorexia, nausea, diarrhea, weight loss, FLATULENCE), Lactic acidosis risk (rare)
s/s of lactic acidosis from metformin ? What patient population does it occur in?
EMERGENCY- malaise, hyperventilation, somnolence
‣ occurs w/ renal impairment, infection, liver disease, cimetidine use, alcoholic
‣ take patients off metformin in the hospital
which non insulin DM drug has risk of B12 and folic acid deficiency?
(biguanide)
-metformin
does metformin have a risk of hypoglycemia?
• Low to No risk of hypoglycemia when used alone
which non insulin DM drug has IV contrast contraindication?
(biguanide)
metformin
what happens w/ IV contrast dye and metformin? how do we prevent it?
stop for 1-2 days before IV contrast test and for 48 hours.
• Can cause Acute Renal Failure—which can lead to lactic acidosis.
*Acute Renal Failure or CKD IV or V patients at risk for this.
prototype for sulfonylureas?
glipizide (Glucotrol XL)
how does glipizide (Glucotrol XL) fxn?
(Sulfonylureas)
Act by (1) stimulating the release of insulin from islet cells and by (2) increasing the sensitivity of insulin receptors on target cells
*note have to have a pancreas that can make insulin still –> not for type 1 diabetics
side effects of glipizide?
(Sulfonyurea)
- Common: HYPOGLYCEMIA
- Other: antabuse effect, weight gain
which non insulin DM drug has side effect of antabuse effect?
glipizide
Take glipizide with or without meal?
with a meal
drug drug interactions for glipizide?
(sulfonylurea)
NSAIDs, sulfonamides, alcohol , cimetidine –> increase hypoglycemia response
prototype for Glinides (Meglitinides)
repaglinide (Prandin)
how do repaglinide (Prandin) fxn?
Glinides (Meglitinides)
Act by stimulating the release of insulin from islet cells
*not for type 1 diabetes- need pancreas that can make insulin
onset and duration of repaglinide (Prandin)
Onset: rapidly
Duration: short
side effects of repaglinide (Prandin)
Hypoglycemia, weight gain