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Pharm > Diabetic Medications > Flashcards

Diabetic Medications Flashcards

1
Q

Rapid-acting Insulins uses

A
  • Insulin Lispro
  • Insulin Aspart
  • Insulin Glulisine

Uses: mimic prandial release of insulin; usually given with longer acting insuling to assure proper glucose control

Given SC 15 minutes before a meal; also can be IV

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2
Q

Short-acting Insulin

A
  • Regular Insulin (soluble crystalline zinc insulin)

30 minutes before a meal usually SC (IV in emergencies)

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3
Q

Intermediate-acting Insulins

A
  • Neutral Protamine Hagedorn (also called Isophane insulin)

Uses: for basal control

Only given by SC and usually given along with rapid or short acting insuling for mealtime control

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4
Q

Long-acting Insulins

A
  • Insulin Glargine
  • Insulin Detemir
  • Insulin Degludec

No peak

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5
Q

What are the drugs that cause hypoglycemia?

A
  • Ethanol
  • B-blockers
  • Salicylates
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6
Q

Drugs that cause Hyperglycemia

A
  • Epinephrine
  • Glucocorticoids
  • Atypical antipsychotics
  • HIV protease inhibitors
  • Phenytoin
  • Clonidine
  • Ca2+-channel blockers
  • Diuretics
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7
Q

What are the non-insulin antidiabetic agents?

A
  • Insulin Secretagogues - Sulfonylureas and Meglitinides
  • Biguanides
  • Thiazolidinediones (TZDs)
  • alpha-Glucosidase Inhibitors
  • Incretin Analogs
  • Amylin Analogs
  • Bile-Acid Sequestrants
  • SGLT2 Inhibitors
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8
Q

Sulfonylureas MOA, use, AE

A
  • Chlorpropamide - 1st generation; more AE so CI in elderly and hyperemic flush with alcohol; apparent SIADH
  • Glyburide (Glibenclamide) - hypoglycemia 20-30%
  • Glipizide - hypoglycemia 10-15%; short half life
  • Glimepiride - hypoglycemia 9-14%

MOA: stimulate release from B cells by binding to SUR1 subunit and block ATP-sensitive K+ channel in B cell membrane

Uses: effective at reducing fasting plamsa glucose (FPG) and HbA1C

AE: hypoglycemia, weight gain

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9
Q

Meglitinides MOA, use, AE

A
  • Repaglinide
  • Nateglinide

MOA: stimulate insuline relase by binding to SUR1 and inhibiting ATP-sensitive K+ channel

Uses: not as effective as sulfonylureas in reducing FPG and HbA1C

AE: hypoglycemia (less risk in Nateglinide), weight gain

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10
Q

Biguanides MOA, Uses, AE, CI

A
  • Metformin

MOA: activation of AMP-activated protein kinase (AMPK) > reduces glucose levels primarily by reducing gene expression of gluconeogenesis enzymes > improvement of glycemic control > insulin concentration decline; increases insulin mediated glucose utilization in muscle and liver

Uses: equivalent to sulfonylureas in reducing FPG and HbA1C but no hypoglycemia, reduces plasma TG by 10-15%, decreased body weight

AE: GI (anorexia, N/V, abd discomfort, diarrhea), long term > B12 deficiency, small risk of potentially fatal lactic acidosis

CI: pts with renal disease, hepatic disease, hypoxia, or alcoholism

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11
Q

Thiazolidinediones (TZDs)

A
  • Pioglitazone - better effects on lipids
  • Rosiglitazone

MOA: agonist of peroxisome proliferator-activated receptor-gamma (PPAR-g) which is intracellular recptors in muscle, fat, liver; slow onset over weeks or months

Uses: decrease insulin resistance, promote glucose uptake/utilization in adipose tissue, less effect in decreasing FPG/HbA1C

AE: fluid retention, weight gain, edema, cause/exacerbate CHF

CI: class III/IV heart failure; need LFTs

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12
Q

alpha-Glucosidase Inhibitors

A
  • Acarbose

MOA: competitive inhibitor of intestinal alpha-glucosidases > reduces postprandial digestion of starch and disaccharides > decreases postprandial hyperglycemia and hyperinsulinemia

Uses: modest drop in FPG and HbA1C levels

AE: flatulence, diarrhea, abd pain, reversible hepatic enzyme elevation (periodical LFTs)

CI: IBS or any condition worsened by gas/distention

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13
Q

Incretin Analogs

A
  • Exenatide - analog of glucagon-like-polypeptide 1 (GLP-1)

MOA: full agonist at human GLP-1 receptors

Uses: enhances glucose-dependent insulin secretions, suppresses postprandial glucagon release, slows gastric emptying, decreases appetite, may stimulate B-cell proliferation

AE: N/V/D, acute pancreatits

CI: gastroparesis

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14
Q

Inhibitors of DDP-IV MOA, AE

A
  • Sitagliptin

MOA: increases circulating GLP-1 and insulin levels

AE: pancreatitis, hypersensitivity reactions (urticaria, angioedema, anaphylaxis, and skin reactions like Stevens-Johnson syndrome

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15
Q

Amylin Analogs MOA

A
  • Pramlintide

MOA: peptide co-secreted with insulin from pancreatic B-cells and inhibits food intake, gastric emptying, and glucagon secretions

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16
Q

Bile-acid Sequestrants uses

A
  • Colesevelam

Uses: lower LDL cholesterol in type 2 DM

17
Q

SGLT2 Inhibitors MOA, AE

A
  • Canagliflozin

MOA: inhibition of SGLT2 in the proximal tubule > decrease glucose reabsorption, increased glucose excretion, and decreased blood glucose levels

AE: increased incidence of genetital and UTIs, volume depletion, increased serum creatinine levels, hyperkalemia, hypermagnesemia, hyperphosphatemia, hypotension

CI: GFR < 45ml/min/1.73m2

18
Q

Glucagon uses

A

Uses:

  • Severe Hypoglycemia - insulin overdose
  • Radiology of the Bowel - relaxes intestines
  • B-Blocker poisoning
  • Glucagon C-peptide test - test residual B-cell function in diabetes

Pharm (14 decks)

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