Diabetes Pharmacology

Question 1

Incretin Enhancers: Dipeptidyl Peptidase-4
Enzyme Inhibitors (DPP-4): Sitagliptin

Answer 1

Mechanism of action
* inhibition of DPP-4 reduces destruction of incretins
Desired effects
* lowers BG with low risk of causing hypoglycemia
Adverse effects
* H/A, diarrhea, nasopharyngitis, and upper respiratory infection
* allergic skin reactions and anaphylaxis have been reported
* possible hypoglycemia

Question 2

Incretin Enhancers: GLP-1 Receptor Agonists:
Liraglutide

Answer 2

Mechanisms of action
* acts like incretin hormone GLP-1
Desired effects
* lowers BG with low risk of hypoglycemia
* increases insulin secretion
* decreases glucagon secretion
* decreases rate of gastric emptying
* decreases appetite
* weight loss
Adverse effects
* nausea, which is usually goes away with time

Question 3

Insulin Sulfonylureas: Gliclazide

Answer 3

stimulates release of insulin
from beta cells
* but only works if some beta
cell function remains!
* decreases secretion of glucagon
from liver
* decreases glycogenolysis and
gluconeogenesis

Question 4

Sodium-Glucose Cotransporter 2 (SGLT2)
Inhibitors: Canagliflozin

Answer 4

Mechanisms of action
* inhibits SGLT2 cotransporter
* Inhibits proximal tubular renal transport of glucose
* decreases glucose reabsorption
* increases renal excretion of glucose in urine
Adverse effects
* added glucose in urine serves as substrate for bacterial and fungal growth
* urinary tract infections; female genital infections
* Hypotension (osmotic diuresis), renal impairment, hyperkalemia, hypoglycemia
* ketoacidosis, increased rates of toe amputation, increased risk of lowered bone density and
fractures

Question 5

Thiazolidinediones: Rosiglitazone

Answer 5

Mechanisms of action
* make body’s tissues more sensitive to insulin
Adverse effects
* H/A
* fluid retention, weight gain
* increased risk of heart failure
* associated with sig. increase in MI and cardiovascular death

Question 6

Insulins

Answer 6

Lispro
- rapid acting, peak 30-50, lasts <5hrs
Humulin R
- short acting, peak 2-3, lasts 5-7 hrs
Humulin-N
- intermediate, peak 5-8hrs, lasts up to 18
Insulin Glargine
- long acting, peak is always, lasts 24hrs