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Pre final studying > Drugs for Diabetes > Flashcards

Drugs for Diabetes Flashcards

1
Q

What are the 10 classes

A

1) Alpha-glucosidase inhibitors
2) Biguanides
3) sulfonylureas
4) meglitinides
5) Thiazolidinediones
6) Dipeptidyl peptidase-4 (DPP-4)
7) Glucagon-like peptide-1 GLP-1 receptor agonists
8) SGLT2 inhibitors
9) weight loss agents
10) Insulins

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2
Q

What is the A1C target for adults with T2D to reduce the risk of CDK and retinopathy if at low risk of hypoglycemia

A

<=6.5

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3
Q

What is the A1C target for most adults with T1D or T2D

A

<=7.0

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4
Q

What is the A1C target for the end of life

A

7.1-8.5

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5
Q

What pharmacotherapy do you give if A1C 1.5% over target

A

Initiate healhty behavior interventions and start metformin if not a target in 3 months or start metformin with helahty behavior interventions

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6
Q

What pharmacotherapy do you give if A1C >=1.5% over target

A

start metformin with healthy behaviour interventions and consider a second concurrent agent

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7
Q 
I patient presents as symptomatic hyperglycemia ad or metabolic decompensation 
Polyuria
polydipsia
weight loss
volume depletion
A

Start insulin plus or minus metformin

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8
Q

What are good drugs for Chronic kidney disease and Diabetes

A

SGLT2i and GLP1-RA

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9
Q

What is a good drug for Heart failure and Diabetes

A

SGLT2I

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10
Q

What is a good drug for

Atherosclerotic cardiovascular disease and Diabetes

A

SGT2I

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11
Q

What is the mechanism of action of Biguanide?

A

Acts on liver and decrease hepatic glucose output an decreases insulin resistance , increase glucose metabolism
decrease gluconeogenisi. drecreased glyconolysis
decreased FA oxidation
decreased insulin mediated glucose uptake

decrease
NADH oxidation, ampk signalling
TCA cycle flux 
ATP synthesis
GNG
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12
Q

What type of drug is metformin

A

Beguanide

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13
Q

Metformin advantages

A

effective gluvose lowering (1.5-2.0%)
no significant hypoglycemia (rare)
durable effect
not associated with weight gain or CV sdie effects (possible benefit

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14
Q

Metformin disadvantages

A

GI side-effects nausea diarrhea metallic taste

rare lactic acidosis

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15
Q

What are the two types of Secretagogues

A

Long acting sulfonylureas
GLyburide
glicalzide
glimepiride

Short-acting secretogogues
Repaglinide
Nateglinide

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16
Q

What are the long-acting sulfonylureas

A

GLyburide
glicalzide
glimepiride

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17
Q

What are the short-acting sulfonylureas

A

Repaglinide

Nateglinide

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18
Q

Mechanism of action of secretagogues

A

work in B cell to increase insulin secretion

block the Kir6.2/SUR-1 complex on the potassium channel leads to increased caldium incflux

19
Q

Secretagogues (Sulfonylurea) advantages

A

inexpensive
easy to administer
effective at lowering glucose (intially) (1.5-2.0%)

20
Q

Secretagogues (Sulfonylurea) disadvantages

A

Prone to wieght gain

risks of hypoglycemia

21
Q

Dipeptidyl peptidase-4 inhibitors (DPP-4) what is the last part of the name

A

“liptin”

alogliptin
liagliptin
saxagliptin
sitagliptin

22
Q

GLP-1 receptor agonists what is the last part of the name

A

“natide” or “glutide”

Short acting: exenatide
lixisenatide
liraglutide

long acting
exanatide LAR
dulagluide
semaglutide

23
Q

Mechanism of GLP-1 receptor agonist action

A

GLP-1 RA’s exerts its main effect by stimulating glucose-dependent insulin release from the pancreatic islets

24
Q

Mechanism of action of DPP-4 inhibitors

A

DPP-4 is an enzyme that breaks down GLP-1

The mechanism of DPP-4 inhibitors is to increase incretin levels (GLP-1 and GIP), which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.

25
Q

What does GLP-1 do? (4)

A 
It increases insulin release
decreases blood glucose
decreases glucagon secretion 
it decreases appetitive
by slowing gastric emptying
26
Q

Does GLP-1 help you lose weight

A

yes

27
Q

Do DPP-4 help you lose weight

A

no

28
Q

How do you administer GLP-1 RA

A

Injection

29
Q

What organs do Incretins act on

A

the liver,stomach and pancreaus, Increase insuling secretion decrease glucose output and decrease gastric tempting

30
Q

Advantages of incretin agents

A

Dpp-4 inhibitors- 0.5-0.9%
GLP-1 Recetor agonsits -1.0-1.5%
cardiovasucular benefit liraglutide semaglutide dulaglutide
Possible weight loss

31
Q

Disadvantages of incretins

A

Cost and coverage
DPP-4 side effects sasal stuffiness
saxagliptin-increased risk of heart failure
GLP-1 RA’s injectable nausea cholelithiasis

32
Q

What is the end part of SGLT2 inhibitors

A

“flozin”

Canagliflozin
dapagliflozin
empagliflozin
etrugiflozin

33
Q

Mechanism of action of SGLT2 inhibitors

A

increase amount of glucose excreted by kidneys by inhibiting sglt2 in the proximal convoluted tubule

34
Q

Advantages Of SGLT2 inhibitors

A

easy to admin
effective glucose lowering (1-1.5
promotes weight loss, lowers BP low risk of hypoglycemia
Cardiovascular benefit in high-risk patients -empagliflozin and canagliflozin
renal benefit reduces microalbuminuria, slows decline in kidney function ,reduces the risk of eskd or dialyssis

35
Q

Disadvantages of SGLT2 inhibitors

A 
polyuria
urininary frequency volumen deplecion 
hyperkalemia
mycotic yeast infections
rare cases of euhlycemic DKA
cnagliflozin-increased risk of ampuattion and bone fracutures  in people at high risk
36
Q

What is the mechanism of action of Thiazolidinediones(TZDs): PPAR-y activators

A 
act on liver adipose and muscle
reduces insulin resistance
modifies adipocyte differentiation 
inhibits VEGF-induced angiogenesis
reduces leptin levels leading to increased appetite

Their action, in large part, is mediated by activation of PPARϒ and involves the redistribution of surplus fatty acids to peripheral fat. This reduces fatty acid availability in the circulation as well as in the liver and muscle - thus improving insulin sensitivity

37
Q

ADvantages of Thiazolidinediones

A

easy to administer
effective glucose lowering (1.5-2.0%)
durable

38
Q

Disadvantages of TZDs

A

cost/coverage

sideeffects of weight gain edema worsening CHF distal bone fratures in women

39
Q

alpha-glucosidase inhibitors MOA

A

Binds to glucosidase enzyme in the gut and competitively inhibits the breakdown of non-absorbable complex poly-saccharides
reduces monosaccharide absorption

40
Q

Name of the one alpha-glucosidase inhibitor we know

A

Acarbose

41
Q

Disadvantages Acarbose

A

not systemically absorbed

targets post-prandial hyperglycemia

42
Q

Disadvantage of Acrabose

A

Modest A1C lowering (0.5%)
GI sideeffects gas bloating flatulence
multipel daily dosing

43
Q

What are the 4 Basal insulins

A

insulin glargine
insuline glargine u300
insulin determir
insulin gludec

44
Q

What are the 4 bolus insulings

A

Human regula insulin
analogue rapid insulins
analogue ultra-rapid insulins

Pre final studying (8 decks)

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