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Melissa's Pharm 2 > T2-Diabetes Oral Agents > Flashcards

T2-Diabetes Oral Agents Flashcards

1
Q

Oral agents are FDA approved for ___ diabetes

A

Type2

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2
Q

What are the 5 types of oral agents?

A 
Metformin
Sulfonylureas
TZDs
DPP-4 Inhibitors
SGLT-2 Inhibitors
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3
Q

What is the cornerstone of T2DM management?

A

Metformin

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4
Q

When do you start metformin?

A

Immediately after diagnosis of type 2 diabetes

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5
Q

How does metformin lower blood glucose and improve glucose tolerance?

A
  1. Decrease glucose production of the liver
  2. Decrease glucose absorption of the gut
  3. Increase sensitivity of insulin receptors
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6
Q

Does metformin stimulate insulin release from the pancreas? What does this mean?

A

No, it does not “hit” the pancreas to release glucose so it does NOT pose much threat to developing hypogycemia when used alone

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7
Q

What are the 5 most common adverse effects of metformin?

A
  1. Diarrhea and flatulence (very common and goes away with time)
  2. Decreased vitamin b12 (can contribute to peripheral neuropathy)
  3. Decreased folic acid (deficiency in pregnancy can impair development of CNS of fetus)
  4. Lactic acidosis (RARE)
  5. Weight neutral (does not cause weight gain or loss)
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8
Q

What must we teach patients who are taking metformin in regards to lactic acidosis?

A

Teach them the early signs of it (hyperventilation, myalgia, malaise, and unusual somnolence)

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9
Q

Who is metformin contraindicated in?

A

Patients with HF

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10
Q

Is it okay to drink alcohol when taking metformin?

A

No, avoid consuming alcohol in excess, discontinuing would be even safer because alcohol can inhibit the breakdown of LA and therefore, can intensify LA

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11
Q

What is the second most common T2DM?

A

Sulfonylureas

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12
Q

What is the MOA of sulfonylureas?

A

“Hits” pancreas over and over to secrete more insulin, so it makes blood sugar go down

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13
Q

If you are taking a sulfonylurea, is there a risk of hypoglycemia?

A

YES

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14
Q

What are the 3 examples of sulfonylureas?

A

Glipizide
Glyburide
Glimepiride

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15
Q

What sulfonylurea is the most kidney friendly aka the “least renally excreted”?

A

Glipizide

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16
Q

What are the 3 adverse effects of the sulfonylureas? (glipizide, glyburide, glimepiride)

A
  1. HYPOGLYCEMIA!!!
  2. Weight gain
  3. “Burn out”
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17
Q

How much weight gain may be seen with the sulfonylureas?

A

5-10 lbs

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18
Q

How long can you take a sulfonylureas before “burnout”?

A

5-10 years

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19
Q

Is it okay to take a sulfonylureas during pregnancy?

A

No!! ONLY oral drug that is okay in pregnancy is metformin!

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20
Q

Can you take alcohol with sulfonylureas?

A

NO! There is a disulfiram-like reaction because alcohol POTENTIATES the hypoglycemic effects of this drug!!!

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21
Q

TZDs are normally taking as an add on with what other oral anti-diabetic?

A

Metformin

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22
Q

What is the MOA of TZDs?

A

Reduce glucose levels primary by decreasing insulin resistance by activation of the PPAR gamma receptor

23
Q

Does TZDs work on DNA?

A

Yes

24
Q

Since TZDs work on DNA, what does that mean?

A

It will take 3-4 MONTHS before they start working!

25
Q

What are the two main drugs for TZD?

A

Rosiglitazone

Pioglitazone

26
Q

Which TZD has possible CV issues like sudden death?

A

Rosiglitazone

27
Q

Which TZD has mixed effects on lipids..and what does that mean?

A

Pioglitazone
Increases HDL and LDL
Decreases TG

28
Q

What are the 5 adverse effects of TZDs?

A
  1. Sodium retention (water follows sodium, so excess fluid) –> edema
  2. Weight gain (because the excess fluid and edema)
  3. Bone fractures
  4. Hepatotoxicity (RARE)
  5. Bladder cancer (RARE)
29
Q

What is the MOA of the DPP-4 Inhibitors?

A

Blocks the incretic hormones and keeps blood glucose from rising too high

30
Q

What drug is a DPP-4 inhibitor?

A

Sitagliptan

31
Q

What are the adverse effects of DPP-4 inhibitor (sitagliptan)?

A
  • Well tolerated
  • Upper respiratory issues (runny nose)
  • Pancreatitis (RARE)
32
Q

What is the MOA of SGLT-2 Inhibitors?

A

Reduce the reabsorption of glucose in the kidneys

33
Q

Explain how SLGT-2 inhibitor work?

A

Normally if blood glucose is less than 180, then it is reabsorbed back into the blood. If blood glucose is greater than 180, then it gets peed out. SGLT-2 Inhibitors will block the reabsorption if the blood glucose is only greater than 80

34
Q

What is the example of the SGLT-2 Inhibitor?

A

Canagliflozin

35
Q

What are the adverse effects of canagliflozin (SGLT-2 Inhibitor)?

A
  • Weight loss
  • Dehydration
  • Hyperkalemia
  • Genital infections
36
Q

How much weight is loss with SGLT-2 Inhibitors?

A

5-7 lbs

37
Q

What kind of genital infections are seen when taking canagliflozin (SGLT-2 Inhibitor)?

A

Fungal
10% of women
3-4% of men

38
Q

Glipizide

A

Sulfonylureas

39
Q

Canagliflozin

A

SGLT-2 Inhibitors

40
Q

Rosiglitazone

A

TZD

41
Q

Sitagliptin

A

DPP-4 Inhibitor

42
Q

Glyburide

A

Sulfonylureas

43
Q

Piolitazone

A

TZD

44
Q

Glimepiride

A

Sulfonylureas

45
Q

Metformin

A

No class

46
Q

What oral causes hypoglycemia?

A

Sulfonylureas (glipizide, glyburide, glimepiride)

47
Q

What oral causes genital infections?

A

Canagliflozin (SGLT-2 Inhibitors)

48
Q

What drug is well tolerated but has the rare effect of pancreatitis?

A

Sitagliptin (DPP-4 Inhibitors)

49
Q

What drug has the rare effect of causing cancer?

A

Pioglitazone (TZD)

50
Q

What drug causes weight gain, how much?

A

Sulgonylureas (glipizide, glyburide glimepiride); 5-10lbs

51
Q

What drug causes weight loss? how much?

A

SGLT-2 Inhibitor (Canagliflozin)

5-7 lbs

52
Q

What drug is weight neutral?

A

Metformin

53
Q

What drug has diarrhea and gas for adverse effects?

A

Metformin

54
Q

What drug must be taken before breakfast?

A

SGLT-2 Inhibitors (canagliflozin)

Melissa's Pharm 2 (32 decks)

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