Pharm-diabetes Flashcards
What drugs can cause dysglycemia? (6)
- beta blockers
- corticosteriods
- HMG coA reductase inhibitors
- Thiazide/ loop diuretics
- Protease antiviral meds
- 2nd-gen antipsychotics
What is rapid onset insulin best for?
postprandial insulin injection
OR
use with insulin pump (continuous infusion)
What is long acting insulin best for?
Basal insulin infusion
Adverse effects of insulin injection (3)?
- hypoglycemia (most common) (due to missed meal or increase in exercise)
- localized fat atrophy
- allergic reactions
Which drug lowers hepatic glucose production?
Metformin
(Biguanides)
Which drug is the 1st choice for new + uncomplicated diabetes?
Metformin
(Biguanides)
Which drug inhibits intestinal alpha-glucosidases → delayed digestion (starches, disaccharides) → ↓ postprandial glucose levels
(AND must be taken w/ meal)
Acarbose
(Alpha-Glucosidase inhibitors)
Which drug Inhibits enzyme responsible for degradation of GLP-1 & other active peptides in glucose homeostasis
Indirectly: incretin mimetic
Sitagliptin
(Dipeptidyl peptidase-4 Inhibitors)
Which drugs: Incretin mimetics → act on GLP-1 R
↑ insulin secretion, suppresses postprandial glucagon secretion, slows gastric emptying, ↑ satiety
Semaglutide + Liraglutide
(Glucagon-like peptide-1 R agonists)
Which drugs is protective against CVD events
Semaglutide + Liraglutide
(Glucagon-like peptide-1 R agonists)
Which drug: Insulin secretagogue → stimulates both basal & meal-stimulated insulin release
Glyburide
(Sulfonylureas)
Which drug is considered an add on therapy to metformin?
Glyburide
(Sulfonylureas)
Insulin secretagogue → stimulate insulin release
Repaglinide
(Meglitinides)
Difference between glyburide + repaglinide?
Repaglinide has shorter activity
Which drug: Precent glucose reabsorption in kidneys → enhanced glucose excretion
Canagliflozin
(Na-glucose cotransporter 2 inhibitors)
Which drug: Reduced risk of CV mortality , small ↓ bp, slows progression of nephropathy
Canagliflozin
(Na-glucose cotransporter 2 inhibitors)
Which drug: Agonist at peroxisome proliferator-activated R gamma (PPARG) R located on cell nucleus (adipose tissue) → influences gene expression (upregulation of GLUT-4 + lipoprotein lipase) → enhances glucose reabsorption + hydrolysis of circulating TGs
↑ peripheral glucose uptake
Enhanced fat cell sensitivity to insulin
↓ hepatic glucose output
Pioglitazone
(Thiazolidinediones)
Which drugs lower HbA1c by 1-1.5% (4)?
- metformin
- Semaglutide + liraglutide
- Glyburide
- Pioglitazone
Nausea, diarrhea, abdominal discomfort, anorexia, metallic taste
CI: hepatic/ renal disease → lactic acidosis
Vitamin B12 deficiency (long term use)
Risk of hypoglycemia is ↓ when monotherapy
Metformin
(Biguanides)
Flatulence, diarrhea, abdominal pain, cramps, nausea
May reduce metformin availability
CI: IBS, IBD
Hypoglycemia pts should be tx w/ glucose not sucrose
Acarbose
(Alpha-Glucosidase inhibitors)
Nasopharyngitis, hypersensitivity reactions
Rare: pancreatitis + severe joint pain
Low potential for drug interactions (does not inhibit cytochrome P450)
Low risk of hypoglycemia
Sitagliptin
(Dipeptidyl peptidase-4 Inhibitors)
Nausea upon initiation + GI adverse effects (common)
Rare: Acute pancreatitis
Caution: heart rhythm disturbances + renal impairment
CI: Pregnancy & family hx of medullary thyroid carcinoma OR multiple endocrine neoplasia syndrome type 2
Semaglutide + Liraglutide
(Glucagon-like peptide-1 R agonists)
Weight gain, prolonged hypoglycemia
Risk of hypoglycemia greater w/ gliclazide + glimepiride (esp. elderly or patients w/ renal impairment)
beta blockers may mask hypoglycemia symptoms
Glyburide
(Sulfonylureas)
Similar risks to sulfonylureas but ↓ risk of hypoglycemia
More extensive metabolic drug interactions
Repaglinide
(Meglitinides)
↑ risk genitourinary infections
↓ intravascular volume results in hypotension
(Use w/ loop diuretics ↑ risk of hypotension)
Hyperkalemia
Risk of diabetic ketoacidosis
Does not cause weight gain (causes weight loss)
Canagliflozin
(Na-glucose cotransporter 2 inhibitors)
Weight gain
↑ incidence of heart failure → must obtain written consent from pts for prescription
↑ risk of fractures (hip + waist)
Worsen macular edema
Pioglitazone
(Thiazolidinediones)
