Drugs for Diabetes Mellitus: Part 3

Question 1

Oral hypoglycemics

Answer 1

Sulfonylureas 
Glinides (Meglitinides) 
Biguanides 
Gliflozins 
Thiazolidinediones 
Alpha-glucosidase inhibitors 
Gliptins

Question 2

Sulfonylureas

Answer 2

Work by promoting insulin release by pancreas

Question 3

First gen Sulfonylureas

Answer 3

Tolbutamide (Orinase)

PROTOTYPE

Question 4

Second gen Sulfonylureas

Answer 4

Glipizide (Glucotrol)

Glyburide (DiaBeta)

Question 5

Tolbutamide (Orinase) action

Answer 5

Stimulates release of insulin from pancreatic cells

Question 6

Tolbutamide (Orinase) uses

Answer 6

Type 2 Diabetes

NOT type 1

Question 7

Tolbutamide (Orinase) adverse effects

Answer 7

Hypoglycemia
Teratogenic
Cardiovascular toxicity

Question 8

Tolbutamide (Orinase) Drug interactions

Answer 8

Alcohol
NSAIDS
Ranitidine
Beta blockers

Question 9

Tolbutamide (Orinase)- NSAIDS / Ranitidine

Answer 9

Can cause / intensify hypoglycemia

Question 10

Biguanides name

Answer 10

Metformin (Glucophage)

Question 11

Metformin (Glucophage) mechanism of action

Answer 11

Decreases liver production of glucose

Enhances uptake & utilization of glucose by muscles

Question 12

Do biguanides promote insulin release?

Answer 12

No, so CANNOT cause hypoglycemia

Question 13

Metformin (Glucophage) uses

Answer 13

Type 2 Diabetes (BG control)
Prevention of type 2 Diabetes
Polycystic ovarian syndrome (PCOS)

Question 14

Metformin (Glucophage) and PCOS

Answer 14

Can restore fertility

Question 15

Side effects of metformin

Answer 15

Decreases appetite Nausea
Diarrhea
Vitamin Deficiencies (B12)
Toxicity

Question 16

Metformin (Glucophage) Toxicity

Answer 16

Lactic acidosis (Metformin inhibits oxidation of lactic acid)
Medical emergency
Increased risk with alcohol

Question 17

Metformin (Glucophage) side effects…….

Answer 17

Get better with time

Question 18

Giflozins (SGLT2 Inhibitors) meds

Answer 18

Canagliflozin (Invokana)

Dapagliflozin (Farxiga/ Xigduo)

Question 19

Giflozins (SGLT2 Inhibitors) mechanism of action

Answer 19

Decrease blood glucose by causing the kidneys to remove sugar from the body through urine

Question 20

Giflozins (SGLT2 Inhibitors) adverse effects

Answer 20

UTIs 
Thirst
Elevated LDLs 
Increased urination 
Episodes of hypotension

Question 21

Alpha-Glucosidase inhibitors mechanism of action

Answer 21

Act on the intestine to delay absorption of carbohydrates (Reduce rise of blood glucose after meals - postprandial rise)

Question 22

Alpha-Glucosidase inhibitors meds

Answer 22

Acarbose (Precose)

Miglitol (Glyset)

Question 23

Alpha-Glucosidase inhibitors therapeutic uses

Answer 23

Type 2 Diabetes (not controlled by D&E)

Question 24

Alpha-Glucosidase inhibitors may be used alone or in combo with…

Answer 24

Insulin

Sulfonylureas

Question 25

Alpha-Glucosidase inhibitors adverse effects

Answer 25

``` Flatulence Cramps Abdominal distention Diarrhea Long-term: Liver dysfunction ```

Question 26

Alpha-Glucosidase inhibitors drug interaction

Answer 26

Should not be used with Metformin - significant GI effects

Question 27

Thiazolidinediones (Glitazones) mechanism of action

Answer 27

Reduce glucose levels by decreasing insulin resistance - increases cellular response to circulating insulin

Question 28

Thiazolidinediones (Glitazones) meds

Answer 28

Rosiglitazone (Avandia) | Pioglitazone (Actos)

Question 29

Thiazolidinediones (Glitazones) adverse effects

Answer 29

``` Fluid retention (use carefully with heart failure patients) (8-10lb swings) Raises plasma lipid levels ```

Question 30

Thiazolidinediones (Glitazones) Drug interactions

Answer 30

Insulin | Lopid

Question 31

Thiazolidinediones (Glitazones) - Insulin

Answer 31

Increases risk for fluid retention

Question 32

Thiazolidinediones (Glitazones) - Lopid

Answer 32

Increased levels of glitazones (Lopid is an antihyperlipidemics)

Question 33

Thiazolidinediones (Glitazones) increase both...

Answer 33

Good and bad cholesterol levels

Question 34

Meglitinides

Answer 34

Stimulate pancreatic insulin release (similar to sulfonylureas)

Question 35

Meglitinides meds

Answer 35

Repaglinide (Prandin) | Nateglinide (Starlix)

Question 36

Meglitinides adverse effects

Answer 36

Hypoglycemia | Especially with liver dysfunction patients

Question 37

Meglitinides drug interactions

Answer 37

Lopid -Used to decrease triglyceride levels (may cause increased levels of Meglitinides)