Diabetic Drugs Flashcards
How is diabetes mellitus diagnosed
- A confirmed fasting blood glucose level of >126 mg/dL.
- Non-fasting blood glucose of >200 mg/dL in a patient presenting with symptoms or exam findings consistent with diabetes.
- A positive oral glucose tolerance test resulting in a blood glucose of >200mg/ dL at 2 to 3 hours after a bolus of glucose
What is the MOA of biguinide type drugs (metformin)
inhibits glucose production by the liver and decreases insulin resistance
What is the MOA of sulfonylurea and meglitinide type drugs
increase secretion of insulin
What is the MOA of alpha-glucosidase inhibitors
delay absorption of glucose by the intestine
What is the MOA of thiazolidinediones (Glitazones) type drugs
Decrease insulin resistance
What is the MOA of DPP-4 inhibitors
Promote the release of insulin from the pancreas after eating a meal
What is a risk of using drugs that enhance the secretion of insulin or sensitivity
Hypoglycemia. This risk is not seen in biguinides or alpha-glucosidase inhibitors
How are DM2 women managed when pregnant
insulin is preferred over other hypoglycemics
What class is metformin (glucophage)?
Biguanide class
What is the advantage of biguanides?
does not enhance the effect of insulin, does not cause hypoglycemic events. Decrease hepatic glucose production, enhances insulin sensitivity in skeletal ms.
What are some good effects (seen on labs) of metformin?
can decrease fasting/non-fasting, and A1c levels. Can also cause modest weight reduction
what are the common side effects of metformin?
Abdominal cramping, nausea. (diminished with extended release version). Metallic taste. B12 deficiency.
What are the serious side effects of metformin?
Lactic acidiosis (rare but can be fatal!) don't use in pts with renal insufficiency)
What is the MOA of sulfonylureas?
increase the amount of insulin the beta cell produce/releases.
Increased insulin release occurs as a result of the interaction of a sulfonylurea with the ATP-sensitive potassium channels in the beta cell membrane.
Adverse effects of sulfonylureas?
hypoglycemia (esp in renal and hepatic fx). Weight gain.
how long are sulfonylureas effective and why
ineffective in achieving glucose control after 5-10 yrs as the pts beta cell fx dec (type 2).
when should sulfonylureas be avoided
in patients with a known sulfa allergy
what class is meglitinides?
non-sulfonylurea secreatagogues
MOA of meglitinides?
also bind to ATP-sensitive potassium channels on beta cells and thereby increase insulin release.
**potential for hypoglycemia (and wt gain) similar to sulfonylureas
What drug should not be combined with meglitinides?why?
Sulfonylurea class due to increased risk for hypoglycemia
when should meglitinides be taken?
before each meal, if a meal is missed, drug should not be taken.
What do thiazolidinediones/glitazones do?
Primarily improve insulin sensitivity, somewhat decreases hepatic glucose production (inverse of biguinide MOA)
adverse affects of TZDs/Glitazones? (know)
CVD, CHF, increased risk of MI
what tests should be done for glitazones and how often?
LFTs: when initiating tx and repeated at 1 month, then 3 months. Looking for any rise in ALT.
What is the MOA of alpha-glucosidase inhibitors?
inhibit the alpha-glucosidase enzymes that line the brush border of the small intestine, interfering with hydrolysis of carbohydrates and delaying absorption of glucose and other monosaccharides.
Side effects of alpha-glucosidase inhibitors?
lots of gas and bloating (often not used dt discomfort) diarrhea, pain.
at high doses assoc w/high transaminase
CI in pts with IBD, colonic ulceration, obstruction…
which drugs do not let blood sugar drop below 60?
Biguanides and alpha glucosidase inhibitors
what is the MOA of Sitagliptin/Januvia?
competitively inhibit the enzyme dipeptidyl peptidase 4 (DPP-4). which potentiates the secretion of insulin and suppress the release of glucagon by the pancreas.
no generic available
Main side effect of Sitagliptin/Januvia?
pancreatitis
which drug was first isolated from the saliva of the gila monster?
Exenatide (synthetic version of exendin 4)
What two injectable drugs are approved for type 1 and 2 diabetes?
pramlintide and exenatide
what is pramlintide?
a synthetic form the hormone amylin, which is produced along with insulin by the beta cells.
which drug is the only agent that can be added to insulin to treat type 2 diabetes?
pramlintide/symlin
what is the MOA of insulin?
stimulates glucose movement into cells, storage as glycogen, fatty acid synthesis, TG storage, inhibits hepatic ketogen and glucogenesis.
which population absolutely needs insulin?
type 1 diabetics
How is insulin delivered?
SQ, IM, or IV, ineffective orally.
what are 4 different categories of insulin preparations?
rapid, short, intermediate, long acting… or a combo
what is the onset and duration for: Rapid acting insulin?
less than 15 minutes
what is the name, onset, and duration for: Short acting insulin
0.5-1 hr, and 4-12 hours (Regular / Humulin R)
what is the name, onset, and duration for: intermediate insulin?
1-3 hrs, and 10-18 hrs (NPH / Humulin N)
what is the name, onset, and duration for: long acting insulin?
4-6 hrs, and 24 hrs (Glargine / Lantus)
What is the most feared result of insulin administration?
hypoglycemia –> seizures, coma, and death can result.
What is indicated for the tx of severe hypoglycemia?
glucagon
What effect does insulin have on potassium?
hypokalemia can occur bc potassium entry into the cell from the serum is stimulated. (IV insulin is combined with potassium)
How do oral steroids affect insulin dosage
you must increase the dose because prednisone increase blood sugar levels
