Oral antidiabetic agents

Question 1

First generation sulfonylurneas

Answer 1

chlorpropamide (Diabinese)

Question 2

second generation sulfonylurneas

Answer 2

glyburide (DiaBeta, Micronase, Glynase Press Tab)

Question 3

alpha glycosidase inhibitors

Answer 3

acarbose (Precose)

Question 4

Biguanide

Answer 4

metformin (Precose)

Question 5

Dipeptidyl petidase- 4 inhibitors (DDP-4 inhibitor)

Answer 5

sitagliptin (Januvia)

Question 6

Human amylin

Answer 6

pramlintide acetate (Symlin)

Question 7

Incretin mimetic

Answer 7

exenatide (Byetta)

Question 8

Meglitinides

Answer 8

repaglinide (Prandin)

Question 9

Thiazolidinediones (TZD’s)

Answer 9

rosiglitazone (Avandia)

Question 10

Actions of sulfonylureas

Answer 10

stimulate insulin release from the beta cells in the pancreas. Increases the number of insulin receptors.

Question 11

Indications of sulfonylureas

Answer 11

Effective ONLY in patients with functioning beta cells (cannot give to a type I diabetic). May loose effectiveness as the patient disease progresses.

Question 12

Adverse effects of sulfonylureas

Answer 12

hypoglycemia and GI symptoms

Question 13

Contraindications of sulfonylureas

Answer 13

sulfa allergies, type I DM and pregnancy with caution in lactation

Question 14

drug-drug interactions of sulfonylureas

Answer 14

meds that acidify the urine (output is decreased) and beta blockers mask the S&S of hypoglycemia.

Question 15

Chlorpropamide special info

Answer 15

Is associated with increased cardiovascular disease and has a long half life that put elderly at high risk for hypoglycemia.

Question 16

glyburide special info

Answer 16

does not interact with as may protein bound drugs and has a shorter duration.

Question 17

Alpha glucosidase inhibitor adverse effects

Answer 17

GI effects (gas & diarrhea) and hypoglycemia that should be treated with glucose tablets (not sucrose)

Question 18

actions of alpha glucosidase inhibitors

Answer 18

Inhibits the enzyme responsible for breaking down complex carbs.

Question 19

Biguanide actions of

Answer 19

works by decreasing liver glucose production and increasing insulin sensitivity.

Question 20

DDP-4 inhibitor (sitagliptin) acts on

Answer 20

prolonging the effects of insulin secretion, decreasing glucagon ans slows GI emptying

Question 21

Rare side effects of DDP-4 inhibitor

Answer 21

nausea, cold like symptoms, pancreatitis that can be fatal

Question 22

Actions of incretin mimetic (exenatide)

Answer 22

mimics effects of the GLP-1 (hormone in the GI track), thereby enhancing glucose dependent insulin secretion in the beta cells, decreases glucagon secretion and slows gastric emptying.

Question 23

Special info for incretin mimetic

Answer 23

• Discovered in the saliva of Gila Monster.
• given by injection 1 hr prior to AM and PM meals
• DO NOT GIVE IF UNABLE TO EAT

Question 24

Adverse effects of incretin mimetic

Answer 24

sour stomach, belching, N/V, diarrhea, heartburn, indigestion, (thus do not give it to pts with sever GI disease) Rare cases of pancreatitis.

Profs noted that this med is an injection than why would you not just use insulin.

Question 25

Actions of human amylin

Answer 25

modulates gastric emptying after a meal to promote feeling of fullness. prevents postmeal rise in glucagon that elevates glucose levels.

Question 26

Special info for human amylin

Answer 26

Injection SQ immediately prior to a major meal and can be used in combo with insulin or oral agents.

CANNOT BE USED IF PT IS UNABLE TO EAT, BECAUSE IT WORKS WITH GASTRIC EMPTYING

Question 27

Actions of meglitindes

Answer 27

works like sulfonylureas but have a more rapid onset action and shorter duration thus less risk of hypoglycemia. Give 30 min before meal due to rapid onset.

Question 28

Actions of Thiazolidinediones

Answer 28

increase the insulin sensitivity of skeletal muscle and adipose, thus increasing glucose uptake.

Question 29

Special info for thiazolidinediones

Answer 29

• lot of bad side effects
• associated with weight gain and fluid retention; leading to poor outcomes for heart failure pts.
• increase bone fracture; osteoporosis would be a concern
• possible increase risk of stroke