Exam 1 - oral diabetic agents Flashcards
Sulfonylureas
1: tolbutamide*, tolazamide, chlorpropamide
2: glyburide, glipizide, glimeperide
why are 2nd generation sulfonylureas better than 1st generation?
- less side effects
- less protein binding & drug interactions
- more potent
why use tolbutamide if using 1st generation sulfonylureas?
- shortest duration of effect (6-12 hours)
- SE gone faster than others
DOA of chlorpropamide & 2nd generations
chlorpropamide - more than 46 hours
2nd generation - 12-24 hours
MOA of sulfonylureas?
- bind receptor to increase insulin secretion
- increase insulin sensitivity
- decrease hepatic glucose production
ADRs of sulfonylureas?
- severe hypoglycemia
- weight gain (2-12 lbs)
- anemia
- sun sensitivity, itch, rash
- disulfiram (chloropropamide & tolbutamide)
- metallic taste
- GI (N, V, dyspepsia)
contraindications of sulfonylureas?
- advanced kidney or liver disease
- T1DM
- pregnancy
- sulfa-allergy
problem with long term use of sulfonylureas? causes?
secondary failure due to:
- decreased beta cells
- decreased physical activity
- increased fat
meglitinides
nateglinide* (less hypoglycemia)
repaglinide
moa of meglitinides
bind receptor to increase insulin secretion during/after meals
peak of meglitinides? when to take meglitinides?
peak at 1 hour
take 30 minutes prior to meal
ADRs of meglitinides
hypoglycemia
weight gain
URI
MOA of metformin
increases #/affinity of insulin receptors in periphery:
- decrease hepatic glucose production
- decreases glucose uptake in gut
- increase glucose uptake
Definition of euglycemic? Two euglycemic drugs?
Decreases high sugar without causing low sugar: No hypoglycemia!
Metformin &
High AM sugars?
metformin inhibits gluconeogenesis of liver at night and will reduce AM sugars
side effect of metformin inhibiting gluconeogenesis?
decrease ability to metabolize lactic acid
Drugs that do not cause weight gain?
metformin
ADRs of metformin
- B12 deficiency
- lactic acidosis
- GI (N, V, D, bloating, flatuence)
what to do when giving radio contrast dye while pt is on meformin?
stop 1 day before and hold until 2 days after
contraindications of metformin
- hepatic insufficiency
- SCr greater than 1.5 (M) and 1.4 (F)
- CrCl less than 30
- over 80 (check renal fxn)
- tissue hypoxia prone (old or CVD)
- ETOH (increase hypoglycemia)