TRH's diabetic drugs; 3.18 Flashcards
What are the rapid acting insulin drugs?
Lispro insulin
Aspart insulin
Glulisine insulin
(Think LAG, there is no LAG)
What is a short acting insulin drug?
Regular insulin
When should rapid/short acting insulin drugs be used?
Bolus/meal time
What is an intermediate acting insulin drug?
NPH insulin
What are examples of long acting insulin drugs?
Glargine insulin
Detemir insulin
What are some side effects of using insulin drugs?
Hypoglycemia Weight gain (no longer leaking calories) Allergic reaction Atrophy/hypertrophy of subcutaneous fat at injection site Insulin resistance
What is the mechanism of biguanides (metformin)?
Inhibit hepatic enzymes and uptake of gluconeogenic substrates (like lactate)
Is metformin metabolized?
No…excreted unchanged
What are some potential side effects of biguanides?
Diarrhea (with initial high dose) Lactic acidosis (liver doesn't take up lactate)
What drugs increase skeletal muscle uptake of insulin and increase cell responsiveness?
PPAR agonists (thiazolidinedione) (they have glitazone in the name). Sensitize cells to insulin so more GLUT 4 synth and transport
What do TZD and glitzazones require to be functional?
The presence of insulin
Besides increased muscular uptake of glucose, what is another effect of PPAR agonists?
Activate insulin responsive genes in the liver that regulate carb and lipid metabolism
What drugs increase insulin secretion by closing potassium channels?
Sulfonylureas (glimepiride)
Meglitinides (repaglinid, nateglinide)
How does glimepiride work?
Binds to SUR1 subunit of the ATP-sensitive K channel
Where are sulfonylureas metabolized? Excreted?
Sulfonylureas are metabolized in the liver and excreted by the kidneys (urine)
What is a major difference b/w first and second generation sulfonylureas?
Second generation have shorter half lives (more potent & fewer side effects)
Besides the typical hypoglycemia and weight gain, what other adverse effects can happen with meglitinides?
Tremor, GI symptoms, dizziness
What drugs increase insulin secretion by activating adenylate cyclase?
GLP analogs (exenatide) Dipeptidase IV inhibitors (increase GLP (end in GLiPtin))
Which of the drugs that activates AC is administered SQ? Oral?
Exenatide is given SQ before meals
Dipeptidase IV inhibitors are orally effective
What class of drugs slows intestinal digestion/absorption of carbs?
Alpha-glucosidase inhibitors. Delayed sugar hydrolisys and absorption
What are examples of alpha-glucosidase inhibitors?
Acarbose (latin for without carbose) and miglitol (no mnemonic, just remember it)
What is the normal function of alpha-glucosidase?
Breaks down disaccharides to monosaccharides
What drug delays gastric emptying and inhibits glucagon secretion?
Amylin analog (pramlintide [more like prAMYLINtide))
What is the effect pramlintide?
Inhibits glucagon synthesis
Inhibits glucose synthesis in liver
Delays gastric emptying
Increases satiety
How is pramlintide administered?
Subcutaneous administration before meals
What are some side effects of amylin analogs?
GI symptoms
Severe hypoglycemia in combo with insulin
