DM-2 Flashcards
Decreased insulin secretion __________ beta cells sensitivity to glucose
decreased
What is the drug of choice for type 2 diabetes
metformin
Metformin is transported into the cells by organic _______ transporters
cation
Metformin is excreted into urine by what
MATE 1 and 2
OCT-1 and OCT-3 are in _______ for activity in the liver
hepatocytes
OCT-2 are in ____ cells for excretion
renal
Metformin has a slow onset and a long duration of action meaning it is what kind of coverage
basal
Effects of metformin in liver
decrease gluconeogenesis
decrease lipogenesis and increase fatty acid oxidation
Effects of metformin in muscle
increase glucose uptake
increase glycogen storage
decrease lipogenesis
Effects of metformin in intestine
decrease intestinal glucose absorption
MOA of metformin (biguanides)
-decrease cellular respiration by inhibiting mitochondrial respiratory chain complex 1
-decrease ATP by inhibiting fructose 1,6 bisphosphate
-activate AMPK causing protein phosphorylation and decrease gluconeogenesis and lipogenesis gene expression
-antagonizes the action of glucagon by inhibiting adenylate cyclase
Adverse effects of metformin
GI upset
Metallic taste
decrease Vit B12
Rare: lactic acidosis
Metformin drug interaction with inhibitors of _____ transporters
OCT
Metformin drug interactions with drugs that increase plasma glucose can _________ the effects
antagonize (corticosteroids, estrogens)
Cimetidine _______ renal elimination of metformin
decreases
Ranolazine ___________ metformin serum levels
increase
Iodinated contrast media can enhance _______ adverse effecrs and renal failure
metformin
Insulin secretagogues are effective in patients with functional ______ cells
beta
Sulfonylureas cover _____ insulin levels and ________ insulin
basal
mealtime
MOA of sulfonylureas
-Bind to SUR 1 complex in Katp channel
-activate exocytosis and release endogenous insulin independent of plasma glucose
-increase tissue sensitivity to insulin (improved metabolic control)
-decreased hepatic glucose production and increase glucose uptake
Sulfonylureas adverse effects
hypoglycemia
weight gain
(GI, hematological rxn, hypersensitivity rxns, SIADH)
Aspirin, sulfonamides, chlorofibrates cause increased hypoglycemic effect in which drug class
Sulfonylureas
Miconazole, chloramphenicol, warfarin decrease __________ metabolism
Sulfonylureas
Ethanol increase action of _____________
Sulfonylureas