Oral Diabetes Meds

Question 1

Glucagon

Answer 1

Given IM or SubQ if pt becomes unconcious

Question 2

Diazoxide

Answer 2

• Treats low BS
• Opens/Activates K channel and hyperolizes Beta cells inhibiting insulin release
• decrease insulin release–> less hypoglycemia

Question 3

Approaches to treating T2D

Answer 3

Question 4

Glimepiride

Answer 4

• SULFONYLUREAS
• Mech: increase insulin secretion, increase tissue sensitivity, decrease glucagon secretion
• Used ALONE, IN COMBO, OR WITH INSULIN
• Less prone to cause hypoglycemia than other Sulfonylureas
• ONCE A DAY USE
  
  • ​Metabolized by LIVER AND KIDNEY
• Adverse: Hypoglycemia, **WEIGHT GAIN, **GI, Skin and liver problems

Question 5

Repaglinide

Answer 5

• MEGLITINIDES
• Same effects as Sulfonylureas/Glimepiride but have a different mechanism
• Faster and Shorter acting that Glimepiride, Safer with Kidney disease
• Adverse: WEIGHT GAIN (just like sulfonylureas)

Question 6

Metformin

Answer 6

• Biguanide
• FIRST CHOICE T2D and Prediabetes med, best outcomes
• NO HYPOGLYCEMIA, NO WEIGHT GAIN
• Mech: Activates AMP Kinase in LIVER,Decrease glucose production and increased glucose uptake primarily in the LIVER,
  
  • ​INCREASED INSULIN EFF but not INSULIN SECRETION
• Oral, given 2-4 times per day or 1 day slow release, AFTER MEALS
  
  • Well absorbed
• LIVER DISEASE=CONTRAINDICATION for Met
• Adverse: Risk of Lactic Acidosis(Fatal), Dangerous even with mild Kidney disease, a_void with Alcohol_, diarrhea nausea vomiting

Question 7

Acarbose

Answer 7

• Decrease Glucose absorption form Gut
• Block Hydrolysis of Disaccarides, Only Monosaccarides(Glucose) absorbed
• Method: Take 30 min before meal, not powerful combined with other agents
• Larger polysac, Remains in Gut

Question 8

Miglitol

Answer 8

• Acts just like Acarbose by blocking disaccaride absorption from the gut
• It is absorbed unlike Acarbose,
• Adverse Effects for Mig and Acarbose
  
  • NO HYPOGLYCEMIA if used alone
    
    • IF USED WITH OTHER DRUGS
  • FARTING, Cramps, and Diarrhea

Question 9

Pioglitazone

Answer 9

• Thiazolidinediones
• Mech: Activate Perioxisome proliferator receptor
  
  • INCREASES RESPONSE TO INSULIN STIMULATION
• EFFECTS OF INSULIN ARE INCREASED
• Use: TOGETHER, with INSULIN, SULFONYLUREAS, or METFORMIN
• REDUCE INSULIN REQUIREMENT
• Oral, with food, 1x/day, LIVER METAB
• NO HYPOGLYCEMIA, but Increase Fracture risk
  *

Question 10

Rosiglitazone

Answer 10

-Thiazolidinedione

Works Same as Pioglitazone

increase the effects of insulin, decrease amount of insulin needed to treat

-had more warnings that pioglitazone but now are =

Question 11

Exenatide

Answer 11

• GLP-1 Analog (Peptide Hormones)
• Mech- Increase Insulin Secretion, decrease glucagon secretion, slow gastric emptying, increase satiety
• Effects: Weight Loss, MAJOR decrease for post meal glucose, some fasting decrease
• Adverse:Nausea, Increased Hypoglycemia, AVOID IF PT HAS KIDNEY DISEASE
• Interactions with Contraceptives and Abs

Question 12

Sitagliptin

Answer 12

• DPP-IV Inhibitors
• Block breakdown of GLP-1, increase functional endogenous hormone
• Similar effects to Exenatide
• Oral, 1x/day
• Can be used Monotherapy or with Metformin, or with Thiazolidinediones
• NO WEIGHT GAIN, DOES CAUSE HYPOGLY, ** NO MAJOR SIDE EFFECTS**

Question 13

Pramlintide

Answer 13

• Amylin analog
  
  • USED in T1D and T2D

Question 14

Canaglifozin

Answer 14

• SGLT-2 inhibitor
• blocks glucose reabsorption, increased glucose excretion
• Oral, 1x/day,
• NO EFFECT ON INSULIN
• Can cause problem for those already on diuretic regiment