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pharmacology > Oral Diabetic Agents Type 2 DM > Flashcards

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
Q

MOA meglitinide

A

Increases insulin by stimulating receptor on beta cell

BRIEF! more rapid pulse of insulin than seen with sulfonylurea

take 30 min before meal

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26
Q

ADRS of meglitinides

A

hypoglycemia, weigh gain, URI

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27
Q

Nateglinide

A

Less hypoglycemia than reaglinide

safest in this class

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28
Q

RX GROUPS that alter insulin

A

Metformin

Thiazolidinediones

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29
Q

Metformin

A

Class- Biguinide

1) increase affinity of insulin to receptors
2) decrease hepatic glucose production
3) decrease glcuose absorption from gut
4) increase glucose uptake

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30
Q

Metformin is Euglycemic

A

Decreases high sugars and dose not cause low sugars

DOES NOT CAUSE HYPOGLYCEMIA

31
Q

What effect does metformin have on gluconegensis

A

This drug inhibit gluconeogenesis

this makes decreases your ability to metabolize lactic acid

32
Q

ADR metformin

A

Decrease B12- Check once a year
Lactic Acidosis
This drug inhibit gluconeogenesis

33
Q

Lactic acidosis

A

liver normaly metabolizes lactic acid- metformin inhibits this

WHEN GIVING CONTRAST DYE

34
Q

Cut off Cr levels for Metformin

A 
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
Q

Use of metforminI

A

Insulin resistance
prevent type 2
PREVENT MACROVASCULAR complications

36
Q

Rx list- Thiazolidinediones-TZDs - GLITAZONES

A

Rosiglitazone

Pioglitazone

37
Q

Rosiglitazone

A

REMs removed Nov 2013

mail order only

38
Q

MOA TZDs

A

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
Q

ADR TZDs

A 
weight gain
edema
bone fracture
bladder cancer
HEART FAILURE-BLACK BOX
decreased WBC
hypoglycemia
hepatotoxycity
Increase HDL, lower LDL, decreas TG
40
Q

Clinical use of TZDs

A

type 2

monotherapy or combination

41
Q

contraindications for TZDS

A

Class III and IV heart failure-ABSOLUTE C
PREGNANCY
hepatic impairment
fluid retention

42
Q

Drugs that effect insulin absorbtion

A

Alpha- Glucosidase INhibitors

43
Q

RXs Alpha- Glucosidase Inhibitors

A

Miglitol

Acarbose

44
Q

MOA of alpha- glucosidase inhibitors

A

alpha glucosidase is an enzyme that digests starch. this enyme is inhibited so sugars ar not created.

45
Q

Clincial use of AGIs

A

type 2
alone or with sulfas
SLOW TrItation- with meals

46
Q

ADRs of AGIs

A

hypoglycemia w/ sulfas
do not give to some1 w/ GI dissorder
Renal Failure

47
Q

Incretin Modulators

A

Dipeptidyl peptidase-4 (DPP-4) inhibitors

48
Q

MOA of Dipeptidyl peptidase-4 (DPP-4) inhibitors

A

inhibit breakdown of glucagon-like peptide-1

49
Q

4 things Dipeptidyl peptidase-4 (DPP-4) inhibitors Do

A

1) Increases pancreatic insulin secretion
2) Limits glucagon secretion
3) Slows gastric emptying
4) Promotes satiety

50
Q

Rx list Dipeptidyl peptidase-4 (DPP-4) inhibitors

A

Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)

51
Q

Dosage Adjustments of Dipeptidyl peptidase-4 (DPP-4) inhibitors

A

ALL NEED RENAL ADJUCMENTS EXCEPT LINAGLIPTIN

52
Q

Only dose of Linagliptin regardless of renal function

A

5mg

53
Q

ADRs Dipeptidyl peptidase-4 (DPP-4) inhibitors

A

URI and UTI infection
HA
hypoglycemia w/ sulfa
steven johnson syndrome

54
Q

Contraindication for Dipeptidyl peptidase-4 (DPP-4) inhibitors

A

patients with history of pancreatitis or hypersensitivity t

55
Q

Incretin Analogs: GLP-1 analogs

MOA and 4 things they do

A

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
Q

Rx list of GLP-1 analogs

A

1) Exenatide (Byetta)-once weekly
2) Liraglutide (Victoza)- daily
3) Dulaglutide (Trulicity)- once weekly

57
Q

Administration of GLP-1

A

injectable (pen), needs refrigeration, inject one hour before a meal

58
Q

ADRs of GLP-1

A

GI

hypoglycemia w/ sulfa

59
Q

Contraindications of GLP-1

A

CrCl

60
Q

MOA SGLT2 (sodium glucose cotransporter 2)

A

increases glucose excretion via proximal comvoluted tuble

61
Q

RXs (sodium glucose cotransporter 2)

A

-gliflozin

62
Q

adverse effects of (sodium glucose cotransporter 2)

A

Increased urination
Urinary tract infections
Yeast infections

63
Q

Contraindications of Increased urination
Urinary tract infections
Yeast infections

A

discontinue if CrCl

64
Q

Amylin Agonist: Pramlintide (Symlin)

A
  • ajunctive therapy for pts. on insulin

- used in type 1 and 2

65
Q

MOA Amylin Agonist: Pramlintide (Symlin)

A

Amylin reduces the rate of rise of blood glucose after meals

66
Q

4 things Amylin Agonist does

A

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
Q

ADRs of amylase

A

hypoglycemia (type 1)
nausea
HA
ADRs- happen more frequently in 1st month

68
Q

Contraindications of Amylin

A

Gastroparesis
poor adherence of BG monitoring
A1C> 9

69
Q

Type 1 DM

A
  • need insulin

also can use Pramlintide (amylin agonist) and Alpha glucose inhibitors (not in US)

70
Q

Goals in treating type 2

A

Fasting BG of 70-130,
1 hour postprandial 180,
2 hour postprandial 150,
HgbA1C

71
Q

Drugs for Type 2 that cause weight gain

A

Glimepiride, glipizide, glyburide, pioglitazone, repaglinide, nateglinide and rosiglitazone

72
Q

Drugs that do not cause weight gain

A

Metformin, acarbose, miglitol (alpha glucosidase inhibitor), exanatide &ampliraglutide (GLP-1 annalogue)

73
Q

What drugs cause an increased risk of CHF and MI?

A

Pioglitazone and rosiglitazone (TZDs)

74
Q

Pros and cons on insulin

A

pros- better control of sugar

cons- weight gain

pharmacology (5 decks)

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