Exam 1 - oral diabetic agents Flashcards

1
Q

Sulfonylureas

A

1: tolbutamide*, tolazamide, chlorpropamide
2: glyburide, glipizide, glimeperide

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2
Q

why are 2nd generation sulfonylureas better than 1st generation?

A
  • less side effects
  • less protein binding & drug interactions
  • more potent
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3
Q

why use tolbutamide if using 1st generation sulfonylureas?

A
  • shortest duration of effect (6-12 hours)

- SE gone faster than others

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4
Q

DOA of chlorpropamide & 2nd generations

A

chlorpropamide - more than 46 hours

2nd generation - 12-24 hours

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5
Q

MOA of sulfonylureas?

A
  • bind receptor to increase insulin secretion
  • increase insulin sensitivity
  • decrease hepatic glucose production
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6
Q

ADRs of sulfonylureas?

A
  • severe hypoglycemia
  • weight gain (2-12 lbs)
  • anemia
  • sun sensitivity, itch, rash
  • disulfiram (chloropropamide & tolbutamide)
  • metallic taste
  • GI (N, V, dyspepsia)
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7
Q

contraindications of sulfonylureas?

A
  • advanced kidney or liver disease
  • T1DM
  • pregnancy
  • sulfa-allergy
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8
Q

problem with long term use of sulfonylureas? causes?

A

secondary failure due to:

  • decreased beta cells
  • decreased physical activity
  • increased fat
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9
Q

meglitinides

A

nateglinide* (less hypoglycemia)

repaglinide

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10
Q

moa of meglitinides

A

bind receptor to increase insulin secretion during/after meals

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11
Q

peak of meglitinides? when to take meglitinides?

A

peak at 1 hour

take 30 minutes prior to meal

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12
Q

ADRs of meglitinides

A

hypoglycemia
weight gain
URI

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13
Q

MOA of metformin

A

increases #/affinity of insulin receptors in periphery:

  • decrease hepatic glucose production
  • decreases glucose uptake in gut
  • increase glucose uptake
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14
Q

Definition of euglycemic? Two euglycemic drugs?

A

Decreases high sugar without causing low sugar: No hypoglycemia!

Metformin &

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15
Q

High AM sugars?

A

metformin inhibits gluconeogenesis of liver at night and will reduce AM sugars

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16
Q

side effect of metformin inhibiting gluconeogenesis?

A

decrease ability to metabolize lactic acid

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17
Q

Drugs that do not cause weight gain?

A

metformin

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18
Q

ADRs of metformin

A
  • B12 deficiency
  • lactic acidosis
  • GI (N, V, D, bloating, flatuence)
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19
Q

what to do when giving radio contrast dye while pt is on meformin?

A

stop 1 day before and hold until 2 days after

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20
Q

contraindications of metformin

A
  • 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)
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21
Q

when to use metformin?

A
  • pre - diabetes

- overweight T2DM

22
Q

benefits of metformin?

A

decrease macrovascular events (MI & CVA)

23
Q

examples of thiazolidinediones

A
  • pioglitazone

- rosiglitazone

24
Q

MOA of thiazolidinediones

A

Bind fat cells to increase adiponectin & decrease resisting:
- increase insulin sensitivity

25
Q

ADRs of thiazolidinediones

A
  • hepatotoxicity (BL LFTs) *
  • heart failure (BBW) *
  • hypoglycemia with other drugs
  • anemia & low WBC (first 4-8 weeks)
  • increase HDL, decrease LDL and TG
  • fluid retention (increase weight and edema) *
  • bladder cancer (pioglitazone)
  • bone fractures (no osteoporosis pt)
26
Q

contraindications of thiazolidindiones

A
  • hepatic impairment
  • pregnancy
  • fluid retention
  • class 3 or 4 HF
27
Q

alpha-glucodiase inhibitors

A
  • acarbose

- miglitol

28
Q

MOA of alpha-glucodiase inhibitors

A

inhibit digestion/absorption of starches and sucrose

29
Q

ADRs

A
  • GI (gas, D, pain)

- hypoglycemia with other SUs

30
Q

contraindications

A
  • colonic ulcers
  • inflammatory bowel
  • renal failure
  • partial obstruction
31
Q

DDP-4

A
  • sitagliptin
  • saxagliptin
  • linagliptin
  • alogliptin
32
Q

MOA DDP-4

A

inhibit breakdown of GLP-1

  • decreases glucagon
  • slows gastric emptying
  • increases satiety
  • increases insulin release
33
Q

ADRs DDP-4

A
  • hypoglycemia with SUs
  • URIs
  • UTIs
  • HA
  • sitagliptin: pacreastitis, angioedema, SJS, anaphylaxis
34
Q

contraindications of DDP-4

A

pancreatitis

hypersensitivity rxn

35
Q

MOA of GLP-1 analogs

A

bind GLP-1 receptor

  • decrease glucagon
  • increase satiety
  • slow gastric emptying
  • increase insulin secretion
36
Q

GLP-1 analogs

A

linaglutide
duraglutide
exenatide

37
Q

how to administer GLP-1 analogs

A

inject 1 hour before meal (as an adjunct to SU or metformin)

38
Q

ADRs of GLP-1 analogs

A
  • hypoglycemia with SUs

- GI: N, V, GERD (up to 4 weeks)

39
Q

contraindications of GLP-1 analogs

A
  • GI disorders (gastroparesis)

- CrCl

40
Q

sodium glucose cotransporter 2

A
  • canagliflozin (w/ metformin)
  • dapagliflozin (w/ metformin)
  • empagliflozin (w/ linagliptin)
41
Q

MOA of SGLT2

A

block/delay reabsorption of glucose in PCT

42
Q

ADRs of SGLT2

A
  • UTIs
  • yeast infections
  • polyuria
43
Q

contraindications SGLT2

A

CrCl

44
Q

amylin MOA

A

slows the rate of BG rise

  • decreasing glucagon
  • increasing satiety (targets brain)
  • slows gastric emptying
  • *decreases hepatic output of glucose
45
Q

amylin

A

pramlinitide

46
Q

ADRs

A
  • hypoglycemia (BBW)
  • GI: N, V, anorexia
  • HA
    (2-3 go away in 1st month)
47
Q

contraindications

A
  • gastroparesis
  • BG noncompliance
  • hypoglycemia unaware/freq.
  • A1C >9%
48
Q

Goals for T2DM

A
  • A1c less than 7
  • FPG 70-130
  • 1 hour postprandial 180
  • 2 hour postprandial 150
  • BP less than 140/80
  • LDL less than 100 (CVD less than 80)
  • TG less than 150
49
Q

drugs than only lower A1C by 0.5%

A

nateglinide
acarbose
miglitol

50
Q

drugs that cause weight gain

A

SUs, meglinides, thiazoldinediones

51
Q

drugs that don’t cause weight gain

A

metformin, alpha-glucosease inhibitors, GLP-1