PHARM: DIABETES Flashcards
FOCUS ON TYPE 2: insulin resistance resulting inn insulin deficiency over time and hyperglycemia
what drugs can cause dysglycemia?
- beta blockers (end in olol)
- corticosteriods
- HMG-CoA reductase inhibitors (statins)
- thiazide or loop diuretics
- protease antivirals
- 2nd gen anti-psychotics (olanzapine, quetiapine)
what are rapid onset insulin preparations useful for?
post prandial insulin injections or use with an insulin pump
what are long-acting insulin preparations useful for?
basal insulin infusion
what are the adverse effects of insulin?
hypoglycemia is the most common and usually due to missed meal or increase in exercise
localized fat hypertrophy
allergic
what class of drug is metformin? How does it work?
Biguanides
decreases hepatic glucose production. Also makes muscle tissue more sensitive to insulin so it can absorb glucose for energy.
what is considered the first choice for patients with new and uncomplicated diagnosis of T2DM?
metformin
(no weight gain, lowers HbA1c by. 1-1.5%)
adverse effects of metformin?
nausea, diarrhea, abdominal discomfort, anorexia, metallic taste.
may cause lactic acidosis in patients with existing hepatic or renal disease
Vitamin B12 deficiency
what drug class is Acarbose? how does it work?
alpha-glucosidase inhibitors
inhibits intestinal alpha-glucosidases resulting in delayed digestion of starches and disaccharides
- reduces postprandial glucose levels
what does Acarbose NOT significantly inhibit?
intestinal lactase
How to take Acarbose?
TID dosing WITH a meal
hypoglycemia patients taking acarbose should be treated with ______?
glucose rather than sucrose
adverse effects of Acarbose?
flatulence, diarrhea, abdominal pain, cramps, nausea
may reduce metformin bioavailabillity
contraindicated in IBS and IBD
what drug class is Sitagliptin and how does it work?
dipetidyl peptidase-4 inhibitors (enzyme that breaks down GLP-1)
so GLP-1 naturally reduces blood glucose levels, but it normally breaks down and stops working quickly. By interfering DPP4 inhibitors allow GLP-1 to remain active in body longer.
INDIRECTLY acting as an incretin mimetic
lowers HbA1c by 1% or less and also doesn’t help with CV risks
adverse effects of sitagliptin
nasopharyngitis, hypersensitivity reactions.
rare: pancreatitis, joint pain
what are some pros of sitaliptin?
low risk of hypoglycemia
does not inhibit cytochrome P450 isoymzes so low potential for drug interactions
weight neutral
how do glucagon-like peptide-1 receptor agonists work
they are direct incretin mimetics
increase insulin secretion, suppress postprandial glucagon secretion, slow gastric emptying, increase satiety
what drugs may help prevent CV events in primary and secondary patients?
GLP-1 agonists like liraglutide and semaglutide (ozempic)
what class of drug is Glyburide and how does it work?
sulfonylureas (generic name often begins with gly or gli)
insulin secretagogue - stimulates pancreas to release more insulin (basal and post prandial insulin release)
lower HbA1c by 1-1.5%
is Glyburide used alone as monotherapy?
generally an add on therapy to metformin
adverse effects of glyburide?
higher risk of hypoglycemia and more weight gain
Can interact with alcohol
beta-blockers can mask hypoglycaemic symptoms
what drug is in the class Meglitindes? How does it work
Repaglinide
this is a different class of insulin secretagogues. it stimulates insulin release but activity is shorter than sulfonylureas so only post prandial not basal insulin.
adverse effects of Repaglinide?
similar to sulfonylureas with more extensive metabolic drug interactions.
what drug and its class work by preventing glucose reabsorption in the kidneys, leading to more glucose excretion?
Drug: Canagliflozin
class: sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors)
What are the adverse effects of Canagliflozin?
risk of genitourinary infections
hypotension (increased with use of loop diuretics)
hyperkalemia
risk of diabetic ketoacidosis
what drugs may reduce the risk of cardiovascular complications?
Canagliflozin
liraglutide and semaglutide (ozempic)
what drugs do not alter CV risks?
sitaglipin (DPP-4 inhibitor)
glyburide (Sulfonylureas) - uncertain lack of evidence
what drugs can cause weight loss?
GLP-1 agnoists (semaglutide and liraglutide)
what drugs are not associated with weight gain?
metformin
Acarbose
Sitaglipin (DPP-4 inhibitor)
what drug could cause weight gain?
Glyburide (class: Sulfonylureas)
note: big difference b/t drugs in this class and terms of effectivness, risk of hypoglycemia, and weight gain.
Thiazolidinediones (Pioglitazone)
what drugs lower HbA1c by 1-1.5%?
Sulfonylureas (glyburide)
metformin
Thiazolidinediones (Pioglitazone)
How do Thiazolidinediones work?
agonist at PPARG receptors located at cell nucleus in adipose tissue.
this upregulates GLUT4 transporters and lipoprotein lipase
enhancing glucose reabsorption and hydrolysis of TGs
So they increase sensitivity to insulin in muscles and fat tissue. They also reduce glucose production in liver.
what do thiazolidinediones do?
increase peripheral glucose uptake
enhance fat cell sensitivity to insulin
decrease hepatic glucose output
adverse effects of Pioglitazone?
increased risk of heart failure (fluid retention and edema)
increase risk of fractures
worsen macular edema
(TZDs can cause water retention and increase risk of heart failure in some)
What drug do you need to obtain written consent for?
new and renewed rosiglitazone (thiazolidinediones)
