treatment of diabetes Flashcards
what is the first line therapy in newly diagnosed T2DM ?
lifestyle modification - 3-6 month trial
what are the biguanides ?
metformin
what is the primary effect of metformin ?
lower hepatic glucose production
increases glycolysis
decreases glucogenesis
what is the most common adverse effect of metformin ?
GI upset
lactic acidosis
vitamin B12 deficiency
when does lactic acidosis happen when given with metformin ?
in patients with renal insufficiency
liver disease
when is metformin held or avoided ?
patients with renal insufficiency
patients with lactic acidosis (bicarb is low)
p[patients with liver disease
patient undergoing IV contrast
what is the MOA of sulfonylurea ?
close potassium channels
so they increase insulin release
what is the major side effect of sulfonylurea ?
hypoglycemia
weight gain
what are common examples of sulfonylureas ?
glipizide
glyburide
what is the side effect associated with first generation sulphonylureas ?
disulfram like reaction
hyponatremia
close cousin to sulfonylurea ?
meglitinides
when can meglitinides be used ?
used in patients with sulfa allergies
what is the MOA of TZD ?
decreases insulin resistance
all of them end in glitazone
what are the receptors associated with TZDs?
PPAR gamma receptors
where are TZD receptors highest in concentration ?
PPAR gamma receptors are highest in adipose tissue
after TZD bind to PPAR gamma receptors , what does this complex bind to ?
RXR retinoid X receptors
what are the major side effects of TZDs ?
may case weight gain
risk of hepatotoxicity
what type of patients should avoid TZDs ?
patients with heart failure due to increased risk of pulmonary edema
what are the alpha glucosidase inhibitors ?
acarbose
miglitol
voglibose
what is the MOA of alpha glucosidae inhibitors ?
decrease absorption of glucose in the small intestine
what is the main side effect of alpha glucosidase inhibitos ?
diarrhea
flatulence
what are the amylin analogs ?
pramlintide
what is the MOA of amylin ?
hormone that is co secreted with insulin
that suppresses glucagon release
always given with insulin
what are the main side effects of amylin ?
hypoglycemia
nausea
what are incretins ?
hormones that increase insulin secretion
including GIP
GLP-1
oral glucose or IV glucose metabolized faster ?
oral glucose
what are the GLP 1 analogues ?
exenatide
liraglutide
what are the side effects of GLP. ?
nause and diarrhea
what are the DPP 4 inhibitors ?
sitagliptin
linagliptin
what is the MOA of DPP4 inhibitors ?
DPP4 normally breaks down the incretins
with its inhibiton the effects of GLP1 and GIP last longer
what are the side effects associated with DPP-4 inhibitors ?
infections
due to glycosuria
urinary infections, vulvovaginitis
respiratory infections
weight gain
what are the SGLT2 inhibitors ?
canagliflozin
dapagliflozin
what is the MOA of SGLT 2 inhibitors ?
block the reabsorption of glucose in proximal convulated tubules
what are the side effects of SGLT 2 inhibitors ?
glucosuria
vulvovaginal candidiasis
UTI
weight loss
renal failure avoid ?
metformin
advanced heart failure avoid ?
TZDs
Metformin
