Met 1: Oral diabetes drugs Flashcards
What is first-line treatment for T2D?
What is second-line?
- Lifestyle changes
- (low calorie diet with complex carbs and lean protein, physical activity)
- Metformin
What is Metformin’s MOA?
- Inhibits complex-1 in Electron Transport Chain
- think “No spark in the Sketchy valentine relationship”
- This prevents hepatic glucose release
*It does NOT affect insulin release
ADR of metformin (2)
Price?
Weight status?
Hypoglycemia common?
Metformin
ADR: lactic acidosis (esp if renal dz), N/V
Cheap
Weight neutral
No hypoglycemia
Describe the normal incretin effect
When glucose is given orally (as opposed to IV), there is an increased insulin response b/c intestinal cells secrete GLP-1
GLP-1 suppresses glucagon and potentiates insulin release
What happens to the incretin effect in T2D patients?
Lessens
Exenatide, liraglutide, dulaglutide
MOA?
GLP-1 Agonists
ADR of GLP-1 agonists (1)
Route
Weight status
Price
Hypoglycemia risk
ADR: N/V
Injection
Causes weight loss
Expensive
Low hypoglycemia risk b/c glucose-dependent activity
Sitagliptin, Saxagliptin
MOA?
DPP-4 inhibitor
(prevent degradation of GLP-1)
Sitagliptin:
Route
Weight
Hypoglycemia risk
Sitagliptin is…
oral
weight-neutral
low risk of hypoglycemia
Compare sitagliptin and liraglutide
Sitagliptin is a DPP-4 inhibitor
Liraglutide is a GLP-1 agonist (MORE POTENT)
Canagliflozin, dapagliflozin
MOA
SGLT-2 inhibitors
Block reuptake of glucose in kidney
ADR of Canagliflozin, dapagliflozin (3)
ADR: Fournier’s Gangrene, GU infections, euglycemic ketoacidosis
Canagliflozin, dapagliflozin
Weight status
Hypoglycemia risk
Route
Canagliflozin, dapagliflozin
Weight loss
No hypoglycemia
oral
Sulfonylurea MOA
Close the ATP-sensitive K+ channel in beta cells, causing insulin release (regardless of glucose)
*This requires having some functional beta cells
Sulfonylurea ADR (2)
Sulfonylurea ADR
- Hypoglycemia
- Weight gain
What is glipizide, glyburide?
sulfonylurea
Which two drugs are used if a pt has concurrent CVD or CKD?
SGLT2 inhibitor or GLP-1 agonist
Which two diabetes drugs are best for weight loss?
SGLT-2 inhibitor or GLP-1 agonist
Which 2 diabetes drugs increase risk of hypoglycemia?
Sulfonylurea, amylin
When should metformin not be used in T2D?
If GFR is low
MOA of -glitazone drugs?
TZD/-glitazone drugs are PPAR-gamma agonists
increase insulin sensitivity via adiponectin production
2 ADR of -glitazone drugs
Worsening of CHF
Bladder cancer
Amylin MOA
Amylin is another hormone made by the beta cells
Analog suppresses glucagon release, slows gastric emptying
Amylin
Weight status?
ADR (2)”
T2D or T1D?
Amylin
Weight loss-inducing
ADR (2): hypoglycemia, nausea
Both T1D and T2D
