Pharm endocrine Flashcards
What are the treatment strategies for type 1 DM ?Type 2? Gestational?
Low carb diet, insulin
dietary modification and exercise for weight loss
oral agents
non insulin injectables
insulin replacement
dietary modifications
Exercise
insuling replacement if modificaitons fails
What type of drugs are aspart, glulisine, and lispro? Action? Clinical use? Toxicities?
Insulin, rapid acting
Bind insulin receptor (tyrosine kinase)
Live: incr. glucose stored as glycogen
Muscle: incr. glycogen, protein synth, incr. K+ uptake
Fat: Incr. TG storage
Type I DM, Type 2 DM, GDM (postprandial)
Hypoglycemia
Rare HSR
What type of drugs are regular insulin? Action? Clinical use? Toxicities?
Insulin, short acting
Bind insulin receptor (tyrosine kinase)
Live: incr. glucose stored as glycogen
Muscle: incr. glycogen, protein synth, incr. K+ uptake
Fat: Incr. TG storage
Type I DM, type 2 DM, GDM, DKA (IV), hyperkalemia , stress hyperglycemia
What type of drugs are NPH? Action? Clinical use? Toxicities?
Insulin, intermediate
Bind insulin receptor (tyrosine kinase)
Live: incr. glucose stored as glycogen
Muscle: incr. glycogen, protein synth, incr. K+ uptake
Fat: Incr. TG storage
Type I DM, type 2 DM, GDM
What type of drugs are Detemir, glargine? Action? Clinical use? Toxicities?
Insulin, long acting
Bind insulin receptor (tyrosine kinase)
Live: incr. glucose stored as glycogen
Muscle: incr. glycogen, protein synth, incr. K+ uptake
Fat: Incr. TG storage
type I DM, type 2 DM, GDM (basal glucose control)
What type of drugs are metformin? Action? Clinical use? Toxicities? CI?
Biguanide-oral hypoglycemic
Exact mechanism unknown
Decr. glucoeneogenesis
Incr. glycolysis
Incr. periph. glucose uptake (incr. insulin sensitivity)
Oral: First line therapy in type 2 DM, causes modest weight loss
Can be used in patients w/o islet function
Lactic acidosis (CI in renal insufficiency)
What type of drugs are chlorpropamide, tolbutamide? Action? Clinical use? Toxicities?
First generation Sulfonylurea (oral hypoglycemic)
Close K+ channel in b cell membrane
Cell depolarizes
Insulin release via incr. Ca influx
Stimulate release of endogenous insulin in type 2 DM
Useless in type I DM (no islet function)
Risk of hypoglycemia incr. in renal failure
Disulfiram like effects
What type of drugs are glimepiride, glipizide, glyburide? Action? Clinical use? Toxicities?
Second generation Sulfonylurea (oral hypoglycemic)
Close K+ channel in b cell membrane
Cell depolarizes
Insulin release via incr. Ca influx
Stimulate release of endogenous insulin in type 2 DM
Useless in type I DM (no islet function)
Risk of hypoglycemia incr. in renal failure
Hypoglycemia
What type of drugs are Pioglitazone, rosiglitazone? Action? Clinical use? Toxicities?
Glitazones/thiazolidiediones
Incr. insulin sensitivity in peripheral tissue
Binds to PPARgamma nuclear transcription regulator
Monotherapy in type 2 DM or combined with other agents
Weight gain edema hepatotoxicity HF Incr. risk of fractures
What type of drugs are Pioglitazone, rosiglitazone? Action? Clinical use? Toxicities?
Glitazones/thiazolidiediones
Incr. insulin sensitivity in peripheral tissue
Binds to PPARgamma nuclear transcription regulator
Monotherapy in type 2 DM or combined with other agents
Weight gain edema hepatotoxicity HF Incr. risk of fractures
What type of drugs are Exenatide, liraglutide? Action? Clinical use? Toxicities?
GLP-1 analogs
Incr. insulin
Decr. glucagon release
Type 2 DM
Nausea, vomiting, pancreatitis
What type of drugs are linagliptin, saxagliptin, sitagliptin? Action? Clinical use? Toxicities?
DPP-4 Inhibitors
Incr. insulin
decr. glucagon
Type 2 DM
Mild urinary or resp infections
What type of drugs are pramlintide? Action? Clinical use? Toxicities?
Amylin analog
decr. gastric emptying
decr. glucagon
Type I DM
Type II DM
Hypoglycemia, nausea, diarrhea
What type of drugs are canagliflozin? Action? Clinical use? Toxicities?
SGLT-2 inhibitors
Block reabsorption of glucose in PCT
Type 2 DM
Glucosuria
UTIs
Vaginal yeast infections
What type of drugs are acarbose, miglitol? Action? Clinical use? Toxicities?
Alpha glucosidase inhibitors
Inhibit intestinal brush border alpha glucosidases
Delayed carb hydrolysis and glucose absorption
Decr. postprandial hyperglycemia
Monotherapy in type 2 DM or in combo therapy
GI disturbances