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.
