TYPE 2 diabetes drugs

Question 1

What are the two Thiazolidinediones

Answer 1

Pioglitazone and Rosiglitazone

Question 2

What do thiazolidinediones do? What are their MOA?
what are the AE?

Answer 2

They decrease insulin resistance

MAO: they target adipocytes and activate the transcription factor PPAR gamma which will increase the reuptake of glucose in the liver and skeletal muscle.
AE: they are contraindicated in NY heart association class 3 and class 4 heart failure

Question 3

What does Metformin do?
what is its MOA in the liver and skeletal muscle?
What are the AE?

Answer 3

It decreases insulin resistance

MAO LIVER: Metformin is transported into the liver cell and binds to complex 1 which causes and increase in AMP kinase which will block the release of glucose from the liver and decrease blood glucose levels.

MAO SKELETAL MUSCLE: Accumulation of AMP causes the activation of AMP kinase. AMPK phosphorylates TBC1D4 which promotes activity from Rab. Rab then disassociates from the GLut 4 receptor and allows for it to translocate to the membrane and increase glucose uptake in the skeletal muscle.

AE: Decrease vitamin B-12, GI discomfort,

Question 4

What are the 6 Sulfonylureas drugs

Answer 4

Tolbutamide, Tolazamide, Chlorpropamide, Glyburide, Glipizide, Glimepiride

Question 5

What do Sulfonylureas do?
What is their MOA?
What are the AE?

Answer 5

There will enhance insulin secretion (Glucose Independent)

MOA: Sulfonylureas will bind to the sulfonylurea receptor on the Katp channel and cause it to close. This closure will cause the depolarization of the membrane and cause the Ca channel to open which allows Ca into the cell and this increases excocytosis of granules containing insulin (Increase the release of insulin from the liver)

AE: Weight gain, long term use can result in decrease insulin secretion, hypoglycemia

Question 6

What are the two Meglitinides

Answer 6

Nateglinide and Repaglinide

Question 7

What do meglitinides do?
What is the MOA?
What are the AE?

Answer 7

They will increase the release of insulin (glucose independent)

MOA: Bind to Katp channel and block it. Cause depolorization of membrane and stimulate Ca channel allowing for ca in the cell and increasing insulin release.

AE: Weight gain, hypoglycemia

Question 8

What are the 5 GLP-1R agonists

Answer 8

Exenatide, Liraglutide, Lixenatide, Dulaglutide, Semaglutide

Question 9

What do GLP-1R agonists do
What is their MOA
What are the AE

Answer 9

These will enhance the incretin effect

MOA : These will cause amplification of glucose stimulated secretion in the gut (Increase in insulin secretion thru cAMP pathway and increase beta cell proliferation thru ERK 1/2 pathway)

AE:Nausea, Vommiting, pancreatitis, Risk of thyroid tumors
Contraindicated in patients with a family history of medullary thyroid cancer (EXCEPT Liraglutide)

Question 10

What is the one GLP-1 and GIP dual agonist drug

Answer 10

Trizepatide

Question 11

What is the action of GLP-1 and GIP dual agonist drug

Answer 11

reduces internalization of GLP-1 receptor to maintain GLP-1 effect

Question 12

What are the 4 inhibitors of Dipeptidyl Peptidase 4

Answer 12

Sitagliptin, saxagliptin, linagliptin, aloglipitin

Question 13

What do inhibitors of DPP-4 do
What is the MOA
What are the AE

Answer 13

These will inhibit DPP-4 which is the enzyme that degrades GLP-1
MOA: binds to DPP-4 and blocks its activity to reduce hyperglycemia and HgbA1C
(All are excreted in the kidneys except for saxaglipitin which is excreted in the liver (poop))

NOTE: Can cause white blood cell count to be reduces which means potential increased risk of cancer
AE: HF, joint pain, pancreatitis, Nausea, vomiting, constipation, headaches

Question 14

Pramlintide (amylin analog)

Answer 14

Works by slowing gastric emptying, decrease food intake, and inhibits glucagon secretion

• blunts rise in blood glucose after a meal

can be used in both type 1 and 2

Question 15

what are the two alpha-glucosidase inhibitors

Answer 15

acarbose, and miglitol

Question 16

What do alpha glucosidases do
what is their MOA
what are the AEs

Answer 16

These will reduce glucose absorption or increase glucose excretion
MOA: Work in the small intestine and decrease the absorption of carbohydrates by inhibiting alpha glucosidases

AE: GI - diarrhea, nausea, flatulence

Question 17

What are the 4 SGLT2 inhibitors

Answer 17

Canaglifozin, Empagliflozin, Depaglifozin, Ertugliflozin

Question 18

What do SGLT2 inhibitors do
What is their MOA
What are the AEs

Answer 18

Increase glucose excretion

MOA: Bind to SGLT2 in the proximal tubules of the kidney and decrease the threshold for glucose excretion allowing for more glucose to go into the urine

AE: Increased risk of UTI, Increased Urine flow and Increase Ketoacidosis

Question 19

Trick to remember GLP-1R agonists

Answer 19

all end in TIDE

Question 20

Trick to remember DPP4 inhibitors

Answer 20

All end in Glipitin

Question 21

Trick to remeber SGLT2 inhibitors

Answer 21

all end in glifozin