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PHAR 152 > Diabetes (Slide Deck 4) > Flashcards

Diabetes (Slide Deck 4) Flashcards

1
Q

What does metformin do?

A
  • ↓’s hepatic glucose production
  • Can also enhance sensitivity to insulin
  • Increases glucose utilization via action in the gut
  • Has effects on the gut microbiome which may explain some anti- inflammatory effects
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2
Q

What is the typical dose of metformin?

A

Start at 250-500 then work to 850-1000mg (Titrating dose decreases the side effect profile)

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3
Q

By how much does the A1C decrease typically decrease on Metformin?

A

1-1.5%

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4
Q

What is a common AE with metformin?

A

Diarrhea and GI discomfort

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5
Q

How can the side effects of metformin be avoided?

A

Titrating doses, Take with food, Extended release version

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6
Q

What are the precautions when taking metformin?

A

Lactic Acidosis which decreases arterial PH and accumulation of serum lactate

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7
Q

What ClCr is used for metformin decrease

A

Less then 60ml/min

45-59=1500mg/day
30-44 1000mg/day

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8
Q

What happens if someoen has a ClCr of <30ml/min and is on metformin

A

Can continue 500mg OD but should not start but can continue the dose

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9
Q

What is the MOA of Sulfonylureas

A

Enhance insulin secretion by binding to Su receptors on beta cells of the pancreas

This leads to K+ closing and opening of CC stimulating insulin secretion

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10
Q

What are the three 2nd generation sulfonylureas?

A

glyburide, gliclazide, glimepiride

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11
Q

How much A1C decrease do we see with Sulfonylureas usage?

A

1-1.5%

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12
Q

What are the adverse effects of Sulfonylureas usage?

A

Hypoglycemia and weight gain

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13
Q

Which of the sulfonylureas can you use during pregnancy?

A

glyburide

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14
Q

Which contraindications are present for sulfonylureas?

A

CI in hepatic and renal impairment
Hold in acute ilness

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15
Q

What are some common DI with sulfonylureas?

A

Sulfonamides
Alcohol

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16
Q

What is the MOA of Meglitinides?

A

Binds to a site adjacent to the SU receptor, resulting in stimulation of the secretion of insulin from the pancreas

Similar to SUs but have a faster onset and shorter D of A * Peak levels within 1 hour and half-life is 1 hour

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17
Q

What is the medication that falls under meglitinides?

A

Repaglinide

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18
Q

How much A1C decrease does repaglinide cause?

A

1 to 1.5

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19
Q

What adverse effects are associated with repaglinide?

A

Hypoglycemia and weight gain

20
Q

What precautions must be taken when on repaglinide?

A

Cyp 3A4 inhibitors (Increases concentration) grapefruit juice is the biggest one

21
Q

Alpha-Glucosidase Inhibitors MOA?

A
  • α-Glucosidase enzymes in the small intestine are responsible for the breakdown of polysaccharides into absorbable glucose
  • Acarbose inhibits these enzymes, hence there is a delay in the rate of digestion of CHO’s and glucose absorption

Net effect is reduction in PPG levels

22
Q

What level of A1C decreasing doe we see on Alpha-Glucosidase Inhibitors?

23
Q

What is a common Alpha-Glucosidase Inhibitors

24
Q

What are some adverse effects of Acarbose?

A

GI Flatulence and diarrhea

25
What is cautioned with taking acarbose?
IBD and Gi conditions eGFR <25ml/min and severe liver disease
26
What is a common Alpha-Glucosidase Inhibitors?
Acarbose
27
What is a common Alpha-Glucosidase Inhibitors?
Acarbose
28
What are the thiazolidinediones drugs
Rosiglitazone and Pioglitazone
29
What are the MOA thiazolidinediones drugs
Bind to PPAR-γ receptors which are primarily found in adipose tissue. Activation alters genes that influence glucose and lipid metabolism. Which enhances insulin sensitivity at muscle liver and fat tissues
30
What are the clinical effects of Thiazolidiendiones
Enhance insulin sensitivity at muscle, liver, and fat tissues. Decrease insulin resistance Decrease hepatic glucose production
31
What is the typical decrease in A1C level when on Thiazolidinediones?
1-1.5%
32
What are the adverse effects of Thiazolidinediones
Peripheral edema (~5%); combined with insulin (~15%) Weight gain New onset of worsening of HF Increase in distal fractures in postmenopausal women
33
What is the concern with TZDs and what did it cause?
Cardiovascular Effects, Hence all new Diabetes drugs require cardiovascular trials to back it up
34
What are the Incretin Based therapies targets?
GLP-1 DPP4 and GIP
35
What are the GLP-1 receptor agonists drugs
* Exenatide (Byetta®) * Liraglutide (Victoza®) ® * Dulaglutide (Trulicity®) * Exenatide weekly (Bydureon®) * Lixisenatide (Adlyxine®) * Semaglutide (Ozempic® SC), and Rybelsus® oral)
36
What are the DPP-4 inhibitors?
* Linagliptin (Trajenta®) * Sitagliptin (Januvia®) * Saxagliptin (Onglyza®) * Alogliptin (Nesina®)
37
What are the effects of activating GLP-1
Increase insulin secretion, decrease glucagon, slow gastric emptying and increase satiety
38
What does DPP-4i do?
Inhibits DPP-4 which stops the cleaving GLP-1
39
How much does DPP4 inhibitors decrease A1C?
0.7, but typically less then 1
40
What are some adverse effects and precautions of taking DPP4I
headaches Nasopharyngitis and URTI
41
Are DPP5 inhibitors CV safe?
yes! but not proven or shown to be cardioprotective
42
What are DPP4i typically good for?
Elderly and for individuals who do not have large A1C lowering targets
43
What is the GLP1RA MOA?
Stimulates insulin secretion in a glucose-dependent manner, decreases glucagon, slows gastric emptying, increases satiety
44
What is the GLP1RAs A1C lowering abilities
1-1.5%
45
What are the general AE of GLP1RA?
N/V/D, but will resolve in 4-8 weeks Weight loss due to medication not N/V/D
46
What are the drug interactions of GLP1RA
Oral Contraceptives Antibiotics Narrow TI drugs Levothyroxine
47
What renal measurement should Repaglinide be cautioned with?
<30ml/min

PHAR 152 (8 decks)

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