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pharm 2 > Diabetic Drugs > Flashcards

Diabetic Drugs Flashcards

1
Q

How is diabetes mellitus diagnosed

A
  • 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
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2
Q

What is the MOA of biguinide type drugs (metformin)

A

inhibits glucose production by the liver and decreases insulin resistance

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3
Q

What is the MOA of sulfonylurea and meglitinide type drugs

A

increase secretion of insulin

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4
Q

What is the MOA of alpha-glucosidase inhibitors

A

delay absorption of glucose by the intestine

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5
Q

What is the MOA of thiazolidinediones (Glitazones) type drugs

A

Decrease insulin resistance

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6
Q

What is the MOA of DPP-4 inhibitors

A

Promote the release of insulin from the pancreas after eating a meal

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7
Q

What is a risk of using drugs that enhance the secretion of insulin or sensitivity

A

Hypoglycemia. This risk is not seen in biguinides or alpha-glucosidase inhibitors

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8
Q

How are DM2 women managed when pregnant

A

insulin is preferred over other hypoglycemics

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9
Q

What class is metformin (glucophage)?

A

Biguanide class

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10
Q

What is the advantage of biguanides?

A

does not enhance the effect of insulin, does not cause hypoglycemic events. Decrease hepatic glucose production, enhances insulin sensitivity in skeletal ms.

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11
Q

What are some good effects (seen on labs) of metformin?

A

can decrease fasting/non-fasting, and A1c levels. Can also cause modest weight reduction

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12
Q

what are the common side effects of metformin?

A

Abdominal cramping, nausea. (diminished with extended release version). Metallic taste. B12 deficiency.

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13
Q

What are the serious side effects of metformin?

A 
Lactic acidiosis (rare but can be fatal!)
don't use in pts with renal insufficiency)
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14
Q

What is the MOA of sulfonylureas?

A

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.

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15
Q

Adverse effects of sulfonylureas?

A

hypoglycemia (esp in renal and hepatic fx). Weight gain.

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16
Q

how long are sulfonylureas effective and why

A

ineffective in achieving glucose control after 5-10 yrs as the pts beta cell fx dec (type 2).

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17
Q

when should sulfonylureas be avoided

A

in patients with a known sulfa allergy

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18
Q

what class is meglitinides?

A

non-sulfonylurea secreatagogues

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19
Q

MOA of meglitinides?

A

also bind to ATP-sensitive potassium channels on beta cells and thereby increase insulin release.

**potential for hypoglycemia (and wt gain) similar to sulfonylureas

20
Q

What drug should not be combined with meglitinides?why?

A

Sulfonylurea class due to increased risk for hypoglycemia

21
Q

when should meglitinides be taken?

A

before each meal, if a meal is missed, drug should not be taken.

22
Q

What do thiazolidinediones/glitazones do?

A

Primarily improve insulin sensitivity, somewhat decreases hepatic glucose production (inverse of biguinide MOA)

23
Q

adverse affects of TZDs/Glitazones? (know)

A

CVD, CHF, increased risk of MI

24
Q

what tests should be done for glitazones and how often?

A

LFTs: when initiating tx and repeated at 1 month, then 3 months. Looking for any rise in ALT.

25
Q

What is the MOA of alpha-glucosidase inhibitors?

A

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.

26
Q

Side effects of alpha-glucosidase inhibitors?

A

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…

27
Q

which drugs do not let blood sugar drop below 60?

A

Biguanides and alpha glucosidase inhibitors

28
Q

what is the MOA of Sitagliptin/Januvia?

A

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

29
Q

Main side effect of Sitagliptin/Januvia?

A

pancreatitis

30
Q

which drug was first isolated from the saliva of the gila monster?

A

Exenatide (synthetic version of exendin 4)

31
Q

What two injectable drugs are approved for type 1 and 2 diabetes?

A

pramlintide and exenatide

32
Q

what is pramlintide?

A

a synthetic form the hormone amylin, which is produced along with insulin by the beta cells.

33
Q

which drug is the only agent that can be added to insulin to treat type 2 diabetes?

A

pramlintide/symlin

34
Q

what is the MOA of insulin?

A

stimulates glucose movement into cells, storage as glycogen, fatty acid synthesis, TG storage, inhibits hepatic ketogen and glucogenesis.

35
Q

which population absolutely needs insulin?

A

type 1 diabetics

36
Q

How is insulin delivered?

A

SQ, IM, or IV, ineffective orally.

37
Q

what are 4 different categories of insulin preparations?

A

rapid, short, intermediate, long acting… or a combo

38
Q

what is the onset and duration for: Rapid acting insulin?

A

less than 15 minutes

39
Q

what is the name, onset, and duration for: Short acting insulin

A

0.5-1 hr, and 4-12 hours (Regular / Humulin R)

40
Q

what is the name, onset, and duration for: intermediate insulin?

A

1-3 hrs, and 10-18 hrs (NPH / Humulin N)

41
Q

what is the name, onset, and duration for: long acting insulin?

A

4-6 hrs, and 24 hrs (Glargine / Lantus)

42
Q

What is the most feared result of insulin administration?

A

hypoglycemia –> seizures, coma, and death can result.

43
Q

What is indicated for the tx of severe hypoglycemia?

A

glucagon

44
Q

What effect does insulin have on potassium?

A

hypokalemia can occur bc potassium entry into the cell from the serum is stimulated. (IV insulin is combined with potassium)

45
Q

How do oral steroids affect insulin dosage

A

you must increase the dose because prednisone increase blood sugar levels

pharm 2 (18 decks)

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