Diabetic drugs Flashcards
What type of cell make and secretes pancreatic juice
Acinar cells
What properties make up the pancreas’ endocrine system
islets of langerhans
-beta cells
-alpha cells
-delta cells
What do beta cells secrete
insulin
what do alpha cells secrete
glucagon
What do delta cells secrete
somatostatin
What stimulates a higher secretion of insulin
High blood glucose
What hormones will cause an increase in insulin secretion
GIP
GLP-1
What is Insulins role in the body
lower BG levels
regulate metabolism (Fat & Protein)
increase K+ uptake in the cell
How does insulin lower BG levels in the body
facilitate glucose into the cells
inhibit glycogenolysis
Inhibits gluconeogenesis
When is type 1 diabetes often diagnosed
early childhood to early adulthood
What causes type 1 diabetes
autoimmune destruction of the beta cells in the pancreas
What is the treatment for type 1 diabetes
insulin
What is the greatest concern with those who have type 1 diabetes
DKA
Infection
End-organ damage from untreated hyperglycemia
What is the cause of type 2 diabetes
inability of the beta cels to produce the appropriate quantities of insulin
insulin resistance
When is type 2 diabetes typically diagnosed
after 35
What type of diabetes is most common
type 2
What are some complications of DM
Retinopathy
Nephropathy
neuropathy
CV complications
Gastroparesis, autonomic insufficiency
What is the normal glucose tolerance on FBG compared to DM
<100 vs >126
What is a normal A1C compared to DM
5.7 vs >6.5
What are the different groups of insulin that can be used to manage DM
Long acting
Intermediate acting
Rapid acting
Short acting
How is insulin typically administered
SQ
*IV in emergencies like DKA
What are some long acting insulin products
Insulin Glargine (Lantus)
Insulin detemir (Levemir)
What is an intermediate acting insulin product
neutral protamine hagedorn (NPH)
What are the short acting insulin products
regular (Humalin, Novolin)
*SQ & IV options
What are the rapid acting inulin products
Insulin Lispro (Humalog)
Insulin aspart (Novolog)
Insulin glulisine (Apidra)
Which type of DM may require higher doses of insulin and why
Type 2 because of resistance patterns
What are adverse reactions to insulin
Weight gain
Somogyi effect
Dawn phenomenon
Hypoglycemia
What is Somogyi effect
If blood sugar drops too low in the early morning, hormones are released to help reverse the low blood sugar and may have the opposite effect
What is the Dawn phenomenon
normal rise in blood sugar as a persons body prepares to wake up
What are some symptoms of hypoglycemia
headache
tachycardia
vertigo
anxiety
confusion
diaphoresis
What are some GLP-1 receptor agonists
Exenatide
Liraglutide
Dulaglutide
**IV only
What form of diabetes has a reduced secretion of incretin
Type 2
What is the job of incretin
Responsible for most of the postprandial insulin secretion
What is the action of GLP-1 agonists
Promote insulin secretion
enhances satiety
decrease post prandial glucagon secretion
promotes beta cell proliferation
Which medications stimulate insulin secretion
Sulfonylureas
meglitinides
Which medications increase insulin sensitivity
Biguanides (Metformin)
Thiazolindediones (Glitazones)
What are some oral agents to manage DM
Dipeptidyl peptidase-4 inhibitors
Alpha glucosidase inhibitors
Sodium-glucose co-transport 2 inhibitors
What are first generation sulfonylureas (Not currently used)
Tolbutamide
Chlorpropamide
What are second generation of sulfonylureas
Glyburide
Glipizide
Glimepiride
What is the MOA for sulfonylureas
Stimulates insulin release from pancreatic beta cells
decreases production of hepatic glucose
increased sensitivity of insulin in the periphery
What are the adverse reactions and contraindications of sulfonylureas
Weight gain
hyperinsulinemia
hypoglycemia
Contra: Sulfa allergy / preggers
caution w/: Hepatic or renal insufficiency, geriatric patients
What drugs are meglitinides
Repaglinide
Nateglinide
What is the MOA of meglitinides
release insulin from pancreatic beta cells
*has rapid onset and short duration
What are the ADRs for metglitinides
Hypeglycemia
caution w/ renal/hepatic insufficiency (repaglinide)
What is the MOA of metformin (biguanides)
Decreases hepatic gluconeogenesis and increases insulin sensitivity
What is the ADR for metformin
abdominal discomfort
What are the contraindications of metformin
hepatic/renal impairment
DKA
AMI
CHF
IV contract
Alcoholism
What drugs are thiazolidinediones (glitazones)
Rostiglazone
pioglitazone
What is the MOA for the glitazones
Increases insulin sensitivity
enhances peripheral glucose uptake
reduce hepatic glucose production
What are the contraindications of the glitazones
Heart failure
What are the ADRs for the glitazones
Weight gain
osteopenia
HA
anemia
Which drugs are alpha-glucosidase inhibitors
Acarbose
Miglitol
What is the MOA for alpha-glucosidase
inhibitor of alpha-glucosidase in intestinal brush border
delay digestion of carbs which lowers postprandial glucose levels
What are the ADRs of the alpha glucosidase inhibitor
GI intolerance
What are the contraindications for alpha-glucosidase inhibitors
IBD
colon CA / other conditions that predispose them to obstruction or perforation
What drugs are DPP-4 inhibitors
Sitagliptin
Saxagliptin
What is the MOA of the DPP-4 inhibitors
Inhibits DPP-4 which increases the release of insulin and decrease glucagon release
What is GLP-1
glucagon like peptide
Which drugs are SGLT2 inhibitors
Canagliflozin
Dapagliflozin
Empagliflozen
What is the MOA of SGLT2 inhibitors
They reabsorb filtered glucose in the tubular lumen of the kidney. Therefore, by inhibiting this cotransporter, there will be decreased absorption of glucose
What is the ADR for the SGLT2 inhibitors
Vaginal candidiasis
UTI
