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Oral Diabetic Agents Type 2 DM Flashcards

1
Q

4 types of oral antidiabetic drugs by action

A

1) drugs that stimulate insulin secretion
2) drugs that alter insulin action
3) Drugs that affect absorption of glucose
4) Incretins- hormones involved in glucose metabolism

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2
Q

Insulin secretagogues

A

drugs that stimulat insulin exrection

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3
Q

3 Rx insulin secretagogues

A

Sulfonylureas
Repaglinide
Nateglinide

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4
Q

Sulfonureas (first gen and 2 gen)

A

oldest insulin secretagogue
1st gen.-phasing out
2nd gen- more potent, less adverse effects

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5
Q

MOA sulfonureas

A

1) stim. B-cells to increase insulin secretion
2)increase peripheral sensitivity
3) Reduce hepatic glucose production
FOR TYPE 2

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6
Q

RX-First generation sulfonylureas

A

Tolbutamide
Chlorpropamide
Tolazamide

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7
Q

Tolbutamide

A

first gen sulfonylurea

shortest duration of effect of the first generation (6-12 hours) and so if use and get adverse effect it is gone quicker SAFEST FIRST GEN

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8
Q

Chlorpropamide

A

first gen sulfonylurea

duration>46 hrs

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9
Q

Tolazamide

A

first gen sulfonylurea

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10
Q

Rx- 2nd Gen sulfonylureas

A

Glyuride
Glipizide
Glimpiride

duration- 6-12 hrs

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11
Q

Glyuride

A

Rx- 2nd Gen sulfonylureas

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12
Q

Glipizide

A

Rx- 2nd Gen sulfonylureas

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13
Q

Glimpiride

A

Rx- 2nd Gen sulfonylureas

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14
Q

how many times more potent are second generation sulfonylureas?

A

100-200x more potent

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15
Q

If you use a first generation sulfonylurea, which one should you use?

A

tolbutamide

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16
Q

Why does the second generation have less adverse effects?

A

this group has less protein binding= less drug interaction

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17
Q

ADRs- Sulfonylureas

A

Hypoglycemia
weight gain
GI, anemia, sun sensitivity

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18
Q

Does medicare still pay for sulfonylureas?

A

No. They are not good for you

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19
Q

Disulfiram

A

injest ETOH while on sulfonylureas and you get naseous

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20
Q

Hypoglycemia with sulfonylureas

A

Prolonged and sever- medication has long duration

very dangerous for old ppl

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21
Q

Contraindication os Sulfonylurease

A 
PREGNANCY
TYPE 1
Kidney disease
organ failure
hypersensitivity
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22
Q

Secondary failure of sulfonylureas

A

secondary failure- on it a long time and then stop then DM gets worse

decreased beta cells
decreased ambulation
increased fat

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23
Q

Meglitinides

A

Drugs that stimulate insulin secretion

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24
Q

Rx meglitinides

A

Repaglinide

nateglinide

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25
MOA meglitinide
Increases insulin by stimulating receptor on beta cell BRIEF! more rapid pulse of insulin than seen with sulfonylurea take 30 min before meal
26
ADRS of meglitinides
hypoglycemia, weigh gain, URI
27
Nateglinide
Less hypoglycemia than reaglinide safest in this class
28
RX GROUPS that alter insulin
Metformin | Thiazolidinediones
29
Metformin
Class- Biguinide 1) increase affinity of insulin to receptors 2) decrease hepatic glucose production 3) decrease glcuose absorption from gut 4) increase glucose uptake
30
Metformin is Euglycemic
Decreases high sugars and dose not cause low sugars DOES NOT CAUSE HYPOGLYCEMIA
31
What effect does metformin have on gluconegensis
This drug inhibit gluconeogenesis this makes decreases your ability to metabolize lactic acid
32
ADR metformin
Decrease B12- Check once a year Lactic Acidosis This drug inhibit gluconeogenesis
33
Lactic acidosis
liver normaly metabolizes lactic acid- metformin inhibits this WHEN GIVING CONTRAST DYE
34
Cut off Cr levels for Metformin
``` women >1.4 men >1.5 CrCL less than 30, do not put on metformin 80 years or older- asess renal funtion prone to tissue hypoxia ```
35
Use of metforminI
Insulin resistance prevent type 2 PREVENT MACROVASCULAR complications
36
Rx list- Thiazolidinediones-TZDs - GLITAZONES
Rosiglitazone | Pioglitazone
37
Rosiglitazone
REMs removed Nov 2013 | mail order only
38
MOA TZDs
1) Bind to receptor on fat cells 2) secrete more adiponectin, less resistin 3) Adiopectin makes cells more sensitive to insulin - euglycemic effect like metformin
39
ADR TZDs
``` weight gain edema bone fracture bladder cancer HEART FAILURE-BLACK BOX decreased WBC hypoglycemia hepatotoxycity Increase HDL, lower LDL, decreas TG ```
40
Clinical use of TZDs
type 2 | monotherapy or combination
41
contraindications for TZDS
Class III and IV heart failure-ABSOLUTE C PREGNANCY hepatic impairment fluid retention
42
Drugs that effect insulin absorbtion
Alpha- Glucosidase INhibitors
43
RXs Alpha- Glucosidase Inhibitors
Miglitol | Acarbose
44
MOA of alpha- glucosidase inhibitors
alpha glucosidase is an enzyme that digests starch. this enyme is inhibited so sugars ar not created.
45
Clincial use of AGIs
type 2 alone or with sulfas SLOW TrItation- with meals
46
ADRs of AGIs
hypoglycemia w/ sulfas do not give to some1 w/ GI dissorder Renal Failure
47
Incretin Modulators
Dipeptidyl peptidase-4 (DPP-4) inhibitors
48
MOA of Dipeptidyl peptidase-4 (DPP-4) inhibitors
inhibit breakdown of glucagon-like peptide-1
49
4 things Dipeptidyl peptidase-4 (DPP-4) inhibitors Do
1) Increases pancreatic insulin secretion 2) Limits glucagon secretion 3) Slows gastric emptying 4) Promotes satiety
50
Rx list Dipeptidyl peptidase-4 (DPP-4) inhibitors
Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Alogliptin (Nesina)
51
Dosage Adjustments of Dipeptidyl peptidase-4 (DPP-4) inhibitors
ALL NEED RENAL ADJUCMENTS EXCEPT LINAGLIPTIN
52
Only dose of Linagliptin regardless of renal function
5mg
53
ADRs Dipeptidyl peptidase-4 (DPP-4) inhibitors
URI and UTI infection HA hypoglycemia w/ sulfa steven johnson syndrome
54
Contraindication for Dipeptidyl peptidase-4 (DPP-4) inhibitors
patients with history of pancreatitis or hypersensitivity t
55
Incretin Analogs: GLP-1 analogs | MOA and 4 things they do
binds to GLP-1 receptors 1) Glucose-dependent insulin secretion 2) Reduction in glucagon secretion 3) Reduced gastric emptying 4) Promotes satiety This is not a monotherapy drug, add it onto something else
56
Rx list of GLP-1 analogs
1) Exenatide (Byetta)-once weekly 2) Liraglutide (Victoza)- daily 3) Dulaglutide (Trulicity)- once weekly
57
Administration of GLP-1
injectable (pen), needs refrigeration, inject one hour before a meal
58
ADRs of GLP-1
GI | hypoglycemia w/ sulfa
59
Contraindications of GLP-1
CrCl
60
MOA SGLT2 (sodium glucose cotransporter 2)
increases glucose excretion via proximal comvoluted tuble
61
RXs (sodium glucose cotransporter 2)
-gliflozin
62
adverse effects of (sodium glucose cotransporter 2)
Increased urination Urinary tract infections Yeast infections
63
Contraindications of Increased urination Urinary tract infections Yeast infections
discontinue if CrCl
64
Amylin Agonist: Pramlintide (Symlin)
- ajunctive therapy for pts. on insulin | - used in type 1 and 2
65
MOA Amylin Agonist: Pramlintide (Symlin)
Amylin reduces the rate of rise of blood glucose after meals
66
4 things Amylin Agonist does
1) slows gastric emptying 2) Suppresses glucagon secretion 3) supresses glucose output from liver 4) reduce appetite Must decrease TDI by 50% inject 15 min before meal
67
ADRs of amylase
hypoglycemia (type 1) nausea HA ADRs- happen more frequently in 1st month
68
Contraindications of Amylin
Gastroparesis poor adherence of BG monitoring A1C> 9
69
Type 1 DM
- need insulin | also can use Pramlintide (amylin agonist) and Alpha glucose inhibitors (not in US)
70
Goals in treating type 2
Fasting BG of 70-130, 1 hour postprandial 180, 2 hour postprandial 150, HgbA1C
71
Drugs for Type 2 that cause weight gain
Glimepiride, glipizide, glyburide, pioglitazone, repaglinide, nateglinide and rosiglitazone
72
Drugs that do not cause weight gain
Metformin, acarbose, miglitol (alpha glucosidase inhibitor), exanatide &ampliraglutide (GLP-1 annalogue)
73
What drugs cause an increased risk of CHF and MI?
Pioglitazone and rosiglitazone (TZDs)
74
Pros and cons on insulin
pros- better control of sugar | cons- weight gain

pharmacology (5 decks)

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