Endocrine Pharm Flashcards
What are the pathways that blood glucose can be controlled by?
- Pancreatic: stimulating beta cells to release more insulin
- Hepatic: decreasing glycogenolysis and FFA metabolism for energy
- Intestinal: altering glucose absorption from food
- Renal: increasing glucose elimination by the kidney for excretion into the urine
- Tissues: increasing insulin receptors or stimulating those receptors to allow for more glucose metabolism
Exogenous insulin if necessary
Biguanides
Indications: First line treatment for Type 2 DM, PCOS
MOA: Primary action is to decrease hepatic glycogenolysis, decreases intestinal glucose absorption, and increases peripheral muscle glucose sensitivity
Drug: Metformin
DPP-4 Inhibitors
Dipeptidyl Peptidase 4 Inhitors (…gliptin)
Indications: Type 2 DM (second line)
MOA: Inhibits breakdown of GLP-1, allowing it to stay more physiologically active (incretin effect)
Drugs: sitagliptin (januvia) linagliptan, alogliptin
Which drug class is the first line treatment for T2DM?
Biguanides (Metformin)
GLP-1 Agonist
glucagon polypeptide 1
(…aglutide or …atide)
Indications: Type 2 DM (second line); cardiovascular event risk reduction in high risk (dulaglutide, semaglutide); obesity – decreases coloric intake and regulates appetite (semaglutide only)
MOA: activates glucagon-like peptide-1 receptors, increasing insulin secretion, decreasing glucagon secretion, and delaying gastric emptying
Drugs: *semaglutide (original drug from this class)
SGLT2 inhibitors
Sodium-glucose transporter 2 (SGLT2) inhibitor (…gliflozin)
Indications: DM Type 2 (second line) and
-CV risk reduction in high risk patients (empagliflozin, canagliflozin, dapagliflozin)
-Renal disease progression (canagliflozin, dapagliflozin)
-HF exacerbation risk reduction (dapagliflozin)
MOA: block SGLT2’s renal glucose reabsorption action, causing excess glucose to be eliminated in the urine
Drugs: dapagliflozin, canagliflozin, empagliflozin, and others
Which SGLT2 inhibitors are good for CV risk reduction in high risk patients?
empagliflozin, canagliflozin, dapagliflozin
Which SGLT2 inhibitors are good for preventing renal disease progression?
canagliflozin, dapagliflozin
Which Which SGLT2 inhibitors are good for HF exacerbation risk reduction?
dapagliflozin
Sulfonylureas
First and second generation
Only second generation drugs used currently (…ride)
Indications: DM Type 2 (second line)
MOA: Stimulates pancreatic islet beta cell insulin release
Drugs: glipizide, glyburide, glimepiride
TZD’s
Thiazolidinediones (…glitazones)
Indications: DM Type 2 (second line)
MOA: increases insulin sensitivity in peripheral tissues, particularly muscle and adipose; smaller impact on hepatic glycogenlysis
Drugs: pioglitizaone, rosiglitazone
Insulin
Indications: First line DM Type 1; DM Type 2 uncontrolled or uncontrollable; gestational diabetes, severe hyperkalemia
MOA: Replaces the deficient or absent endogenous insulin which allows glucose to move into peripheral tissues (moves potassium with it)
Result: Regulation of glucose metabolism by increased peripheral glucose uptake, inhibits gluconeogenesis, inhibits lipolysis/proteolysis
Drugs:
Rapid-acting (lispro)
Short-acting (regular)
Intermediate-acting (NPH)
Long-acting (glargine, detemir, etc)
What are treatment options for hyperthyroidism ?
-Temporary suppression or definitive destruction
Drug Classes:
Thioamides
Radioactive iodine
-Acute radiation thyroiditis followed by chronic atrophy
What are treatment options for hypothyrodism?
-replace endogenous thyroid hormone with exogenous
Drugs:
Levothyroxine (T4)
Liothyronine (T3)
Mixed agents/porcine
Thioamides
Indications: hyperthyroidism due to any cause
MOA: Block iodine’s ability to combine with tyrosine, thereby blocking thyroid hormone synthesis
Drugs: Methimazole and Propothiouracil (PTU)
