Endocrine pharm - first aid Flashcards
Insulin rapid acting
LAG - lispro, aspart, glulisine
Insulin short acting
regular insulin
intermediate acting insulin
NPH
insulin long acting
determir, glargine
Oral hypoglycemic agents
biguanides (metformin), sulfonylureas, glitazones/thiazolidinediones, meglitinides, GLP-analogs, DPP-4 inhibitors, amylin analogs, sodium glucose co-transporter 2 inhibitors, alpha glucosidase inhibitors.
Biguianides (metformin) - mechanism of action
exact mechanism is unknown. this medication decreases gluconeogenesis, increases glycolysis, increase peripheral glucose uptake by increasing insulin sensitivity.
Biguianides (metformin) - clinical use
FIRST line therapy in T2DM, can cause modest weight loss.
Biguianides (metformin) - adverse effects
Gi upset, most serious is lactic acidosis (thus contraindicated in renal insufficiency).
sulfonylureas - mechanism
chlorpropamide, tolbutamide, glimepiride, glipizide, glyburide
close beta cell potassium channel, cell depolarizes, calcium influx, insulin released.
sulfonylureas - mechanism
Type2DM only as they stimulate endogenous insulin release. Requires some islet cell function.
sulfonylureas - adverse effects
risk of hypoglycemia, weight gain,
glitazones/thiazolidinediones - mechanism
pioglitazone, rosiglitazone
increase insulin sensitivity in peripheral tissue, binds to PPAR-gamma nuclear transcription regulator.
glitazones/thiazolidinediones - clinical use
monotherapy in T2DM or with metformin of sulfonylurea. can be used safely in patients with renal impairment. Weight gain, edema, hepatotoxicity.
Meglitinides - mechanism
nateglinide, repaglinide.
stimulate postprandial insulin release by binding to potassium channels on beta-cell membranes. NOTE that the binding site differs from sulfonylurea.
Meglitinides - clinical use
montherapy or combined with metformin in T2DM.
GLP-1 analogs - mechanism
exenatide, liraglutide
increase GLUCOSE DEPENDENT insulin release. decrease glucagon release, decrease gastric emptying, increase satiety.
GLP-1 analogs - adverse effects
nausea, vomiting, pancreatitis
–> note can cause modest weight loss.
DPP-4 inhibitors - mechanism
linagliptin, saxagliptin, sitagliptin
- INHIBITS DPP-4 enzyme that DEACTIVATES GLP-1 thereby increasing glucose dependent insulin release. decrease glucagon release, decrease gastric emptying, increase satiety.
DPP-4 inhibitors - adverse effects
mild urinary or respiratory infections, weight neutral.
SGLT-2 inhibitors - mechanism
canagliflozin, dapagliflozin, empagliflozin
block reabsoprtion of glucose in the PCT.
SGLT-2 inhibitors - adverse effects
glucosuria, UTIs, vaginal yeast infections, hyperkalemia, dehydration
Thionamides - mechanism
Propylthiouracil (PTU), methinazole
–> block thyroid peroxidase, this inhibits the oxidation of iodide and the organification (coupling), of iodine –> decreased thyroid hormone synthesis.
NOTE PTU also blocks 5-deiodinase, which blocks peripheral conversion of T4 to active T3.
PTU is also the drug of choice during pregnancy
