Pharm Test 3 Anti-Diabetes Flashcards
Tolbutamide: short half life
Chlorpropamide: Long half life
1st generation sulfonylureas, Effective at reducing Fasting Plasma Glucose and A1c
MOA: bind SUR1 (site on K+ channel to block it) = insulin release.
AE: Hyperemic flush when alcohol is consumed, SIADH with Chlor…, Hypoglycemia (especially in elderly), Weight gain
Glyburide
Glipizide: shortest half life
Glimepiride: Best one for no hypoglycemia
2nd generation sulfonylureas, Effective at reducing Fasting Plasma Glucose and A1c
MOA: bind SUR1 (site on K+ channel to block it) = insulin release.
MORE POTENT than 1st gen.
AE: Less than 1st generation
Repaglinide
Nateglinide
Meglitinides (Not sulfur so use in pts with sulfur allergy)
NOT Effective at reducing Fasting Plasma Glucose and A1c
MOA: bind SUR1 (site on K+ channel to block it) = insulin release. but less effective
AE: Hypoglycemia (repa), Weight gain (both)
**Must be taken with each meal
Metformin
Biguanide *(does NOT cause insulin secretion or hypoglycemia).
**DOC for DM2
MOA: decrease gluconeogenesis by reducing expression of enzymes (gene inhibition), Increases glucose utilization in muscle and liver
AE: N/V/D/decreased Vit B12 absorption. LACTIC ACIDOSIS
**reduces FPG and A1c
Pioglitazone-better lipid profile
Rosiglitazone
Thiazolidinediones (Less effective than sulfonylureas or metformin)
MOA: PPAR gamma(peroxidase proliferator activated receptor) agonist. Decreases insulin resistance by promoting uptake and utilization of glucose in fat cells
AE: Exacerbate CHF, FDA rqs hepatotoxicity monitoring, fluid retention and edema
*Slow onset and slow offset over weeks to months
*Both increase HDL but only Pio decreases TAGS. Rosi increases LDL
Acarbose
Miglitol
Alpha Glucosidase inhibitors
Moderate drop in FPG and A1c.
MOA: Competative inhibitors of alpha glucosidase which leads to decreased absorption of glucose from the gut. = cant digest starches=lowers postprandial hyperglycemia and hyperinsulinemia.
AE: Flatulence, diarrhea, Abdominal pain, Acarbose=reversible liver enzyme elevation
exenatide
Incretin analog=Glucagon like polypeptide 1.
MOA: incretins released from the gut
exenatide
Incretin analog=Glucagon like polypeptide 1.
MOA: incretins released from the gut=increase insulin secretion **resistant to Dipeptidyl peptidase IV (DPP4)
Enhances glucose dependent insulin secretions and decreases postprandial glucagon. Slows gastric emptying, decrease appetite, Stimulates Beta cells.
AE: N/V/D/Acute pancreatitis, Hypersensativity reaction
**Comes from Gila Monster spit
Sitagliptin
Selective DPP4 inhibitor
Increases GLP1 and Insulin, same AE as exenatide
Pramlintide
Amylin analog=cosecreted with insulin
Decreases food intake and gatric emptying and glucagon secretion
Colesevelam
Bile Acid sequestrant used in DM2 to lower LDL
Glucagon
Give in severe hypoglycemia, radiology of the bowel (relax intestine), and antidote for Beta blocker overdose
Canagliflozin
SGLT2 (Na and glucose cotransport) inhibitor=decreased glucose reabsorption, increase glucose excretion, and decrease blood glucose.
AE: UTI, osmotic diuresis, hTN, HYPER Mg, P, K. Increase serum creatinine
Lispro
Aspart
Glulisine
Rapid acting Insulin
- Do NOT for hexamers
- All are insulin analogs with a couple AA changes
Regular Insulin
DOC in pregnancy,
Short acting
IV in emergency
