pharm wk 4 Flashcards
what drugs can cause dysglycemia
Beta-blockers (drugs ending in –olol)
Corticosteroids (prednisone)
HMG-CoA Reductase Inhibitors (drugs ending in statin)
Thiazide or loop diuretics (hydrochlorothiazide, furosemide)
Protease antiviral medications
Second-generation antipsychotics (olanzapine, quetiapine)
goals of T2D treatment
Establish and maintain glycemic control while avoiding hypoglycemia
Prevent or minimize the risk of acute and chronic complications
Achieve optimal control of associated risk factors such as hypertension, obesity, and dyslipidemia
where does insulin drugs come from
Most available are human insulin and insulin analogues since they cause less antibody generation and adverse effects
rapid onset insulin vs long-acting insulin- when are they useful?
Rapid onset insulin preparation are useful for postprandial insulin injections or use with an insulin pump (continuous infusion)
Long-acting insulin preparations are useful for basal insulin infusion
adverse effects of insulin preparations
Hypoglycemia is the most common and is usually the result of a missed meal or an increase in exercise
Localized fat hypertrophy
Allergic reactions
what type of drug is metformin
biguanides
examples of biguanides
metformin
what is the first choice drug for patients with new and uncomplicated T2D
metformin
what does metformin do
Decreases hepatic glucose production
how much does metformin lower HbA1c by
1-1.5%
what is metformin not associated with
weight gain
adverse effects of metformin
Nausea, diarrhea, abdominal discomfort, anorexia, metallic taste
May cause lactic acidosis in patients with existing hepatic or renal disease - contraindicated
Vitamin B12 deficiency with long-term use
Risk of hypoglycemia is low when used as monotherapy
vitamin deficiency in metformin
Vitamin B12 deficiency with long-term use
who is metformin contraindicated for
May cause lactic acidosis in patients with existing hepatic or renal disease - contraindicated
what is acarbose drug class
alpha-glucosidase inhibitors
what is an example of alpha-glucosidase inhibitors
acarbose
what does acarbose do
Inhibits intestinal alpha-glucosidases resulting in delayed digestion of starches and disaccharides which reduces postprandial glucose levels
what type of carb does acarbose work on
starches and disaccharides
what does acarbose not significantly inhibit
Does not significantly inhibit intestinal lactase
when must you take acarbose
only effective if taken with a meal
dosing on acarbose
TID
acarbose effect on HbA1c
lowers is by 1% or less
what should hypoglycemic patients taking acarbose be treated with
Hypoglycemic patients taking acarbose should be treated with glucose rather than sucrose
this is because they cant break down complex carbs
what does acarbose not cause
weight gain
adverse effects of acarbose
Flatulence, diarrhea, abdominal pain, cramps, nausea.
contradindications for acarbose
Contraindicated in irritable bowel syndrome, inflammatory bowel disease
what does acarbose reduce bioavailabitly of
metformin
sitagliptin is a …
DIPEPTIDYL PEPTIDASE-4 INHIBITOR
DIPEPTIDYL PEPTIDASE-4 INHIBITOR example
sitagliptin
Generic naming: -gliptin
what does sitagliptin
Inhibit the enzyme (DPP4) responsible for the degradation of GLP-1 and other active peptides involved in glucose homeostasis
what does sitagliptin indirectly act as
incretin mimetic
how much do DPP4 inhibitors/ sitagliptin lower HbA1c
1% or less
effect of sitagliptin on weight
Do not cause weight gain (considered weight neutral)
effect of sitagliptin on CVD risk
none
adverse effets of sitalgiptin
Nasopharyngitis, hypersensitivity reactions
Rare events of pancreatitis and severe joint pain
Sitagliptin does not inhibit cytochrome P450 isozymes resulting in a low potential for drug interactions
Low risk of hypoglycemia
2 examples of GLP-1 agonists
semaglutide and liraglutide
semaglutide and liraglutide action…
Direct incretin mimetics by acting on GLP-1 receptors
Increases insulin secretion, suppresses postprandial glucagon secretion, slows gastric emptying, increases satiety
how is semiglutide and liraglutide usually given
Usually given by subcutaneous injection although there is an oral formulation of semaglutide
semaglutide and liraglutide lower HbA1c by
1-1.5%
effect of semiglutide and liraglutide on weight and CVD
Do not cause weight gain (cause weight loss)
Evidence suggesting prevention of cardiovascular events in both primary and secondary prevention patients
adverse effects of semiglutide and liraglutide (GLP1 agonist)
GI adverse effects are common and nausea upon initiation is a common experience
May also cause injection site reactions
Rarely causes acute pancreatitis
Caution in patients with heart rhythm disturbances and severe renal impairment
Contraindicated in pregnancy and those with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
contraindications for GLP1 agonist
pregnancy
some cancer historys
example of sulfonylureas
glyburideg
Generic names often begin with gly or gli
glyburide is a
sulfonylurea
what does glyburide (a sulfonylurea) do?
Considered an insulin secretagogue which stimulates both basal and meal-stimulated insulin release
what can you add glyburide to as a therapy
Generally considered add-on therapies to metformin rather than used as monotherapy
how much does glyburide lower HbA1c by
1-1.5%
differences in sulfonyleureas
Significant differences exist between the available drugs in this class in terms of effectiveness, risk of hypoglycemia, and weight gain
glyburide effect on weight
Glyburide is associated with a higher risk of hypoglycemia and more weight gain
adverse effects of glyburide
Weight gain; prolonged hypoglycemia.
Risk of hypoglycemia may be greater compared with gliclazide and glimepiride, especially in elderly or patients with renal impairment
beta-blockers may mask hypoglycemic symptoms
what is repaglinide an example of
meglitinides
example of meglitinides
repaglinide
what is repaglinide
A different class of insulin secretagogues
meglitinides (ie.. repaglinide) is a different class of insulin secretagogue . what else is a insulin secretagogue?
sulfonylureas (i.e. glyburide)
what is the similarity and differences between meglitinides (ie.. repaglinide) and sulfonylureas (i.e. glyburide)
Stimulate insulin release but the activity is much shorter
Effect and adverse effects are similar to those with sulfonylureas
what is the pro and con of meglitinides (ie.. repaglinide) vs sulfonylureas (i.e. glyburide)
meglitinides:
Lower risk of hypoglycemia in the context of skipped meals
More extensive metabolic drug interactions
what is an example of a SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (SGC2I)
canagliflozin
canagliflozin is an example of
SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (SGC2I)
what does canagliflozin work on
Work by preventing glucose reabsorption in the kidneys which leads to enhanced glucose excretion
pneumonic for canagliflozin
“glifozin” = glucose flow
Work by preventing glucose reabsorption in the kidneys which leads to enhanced glucose excretion
effect of canagliflozin on weight
weight loss
effect of cangliflozin on HbA1c
1% or less
what effects do SGC2I / canaglifozin have
Shown to reduce the risk of cardiovascular mortality, major adverse cardiovascular events, and hospitalization due to heart failure
Cause a small decrease in blood pressure
Shown to slow the progression of nephropathy
what organ function is important for canagliflozin / SGC2I
Require sufficient kidney function to work; as kidney function declines so does the antihyperglycemic effect
Shown to slow the progression of nephropathy
adverse effects of canagliflozin / SGC2I
Increased risk of genitourinary infections
Reduced intravascular volume resulting in hypotension
Hyperkalemia,
Risk of diabetic ketoacidosis
Use with loop diuretics increase risk of hypotension
example of THIAZOLIDINEDIONES
pioglitazone
pioglitazone is a
THIAZOLIDINEDIONES
what is the mechanism of THIAZOLIDINEDIONES (pioglitazone)
act on PPARG receptors –> up regulate GLUT4 transporters –> reabsorb glucose
This class acts as agonists at peroxisome proliferator-activated receptor gamma (PPARG) receptors located on the cell nucleus (particularly in adipose tissue)
This influences gene expression including upregulation of GLUT4 transporters and lipoprotein lipase
This enhances glucose reabsorption and hydrolysis of circulating triglycerides, respectively
Precise mechanism is still unclear
what do thiazolidinediones (pioglitazone) do
Increased peripheral glucose uptake
Enhanced fat cell sensitivity to insulin
Decreased hepatic glucose output
thiazolidinediones (pioglitazone) effect on HbA1c
reduce by 1-1.5%
thiazolidinediones (pioglitazone) effect on weight
weight gain
adverse effects of thiazolidinediones (pioglitazone)
Increased incidence of heart failure likely because of their ability to cause increased fluid retention and edema
Increase the risk of fractures (hip and wrist)
Worsen macular edema
what needs to be done every time thiazolidinediones (pioglitazone) is prescribed
written consent
To ensure that the risks and benefits of this medication have been clearly communicated, Health Canada requires that physicians counsel patients and obtain their written consent for all new and renewed rosiglitazone prescriptions
Which of the following medications is generally considered first-line therapy for most patients with type 2 diabetes?
A. Glyburide
B. Metformin
C. Canagliflozin
D. Semaglutide
B. Metformin
