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Pharmacology > Unit 5-Diabetes > Flashcards

Unit 5-Diabetes Flashcards

1
Q

Metformin

Drug class

A

Biguanide

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2
Q

Metformin

Mechanism

A

Activates AMP-kinase and inhibits mitochondrial isoform of glycerophosphate dehydrogenase => decreases hepatic glucose production

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3
Q

Metformin

Uses

A

First-line therapy in diabetes due to no weight gain or hypoglycemia, reduction in cardiovascular events and mortality

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4
Q

Metformin

Side effects

A

Lactic acidosis (rare)

GI (diarrhea, abdominal discomfort, N & V), B12 deficiency

Contraindicated in renal impairment; low cost

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5
Q

Glipizide

Drug class

A

Sulfonylurea

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6
Q

Glipizide

Mechanism

A

Closure of ATP-sensitive K+ channels on β-cell plasma membrane –> stimulation of insulin release

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7
Q

Glipizide

Side effects

A

Weight gain; hypoglycemia

May blunt myocardial ischemic preconditioning

Generally well-tolerated; low cost

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8
Q

Glyburide

Drug class

A

Sulfonylurea

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9
Q

Glyburide

Mechanism

A

Closure of ATP-sensitive K+ channels on β-cell plasma membrane –> stimulation of insulin release

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10
Q

Glyburide

Side effects

A

Weight gain; hypoglycemia

May blunt myocardial ischemic preconditioning

Long-acting (in general, avoid)

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11
Q

Glimepiride

Drug class

A

Sulfonylurea

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12
Q

Glimepiride

Mechanism

A

Closure of ATP-sensitive K+ channels on β-cell plasma membrane –> stimulation of insulin release

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13
Q

Glimepiride

Side effects

A

Weight gain; hypoglycemia

May blunt myocardial ischemic preconditioning

Generally well-tolerated; low cost

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14
Q

Repaglinide

Drug class

A

Meglitinide

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15
Q

Repaglinide

Mechanism

A

Closure of ATP-sensitive K+ channels on β-cell plasma membrane –> stimulation of insulin release

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16
Q

Repaglinide

Uses

A

Short-acting; dose with meals

Generic repaglinide available

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17
Q

Repaglinide

Side effects

A

Weight gain; hypoglycemia (less than sulfonylureas)

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18
Q

Nateglinide

Drug class

A

Meglitinide

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19
Q

Nateglinide

Mechanism

A

Closure of ATP-sensitive K+ channels on β-cell plasma membrane –> stimulation of insulin release

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20
Q

Nateglinide

Uses

A

Short-acting; dose with meals

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21
Q

Nateglinide

Side effects

A

Weight gain; hypoglycemia (less than sulfonylureas)

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22
Q

Pioglitazone

Drug class

A

Thiazolidinedione

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23
Q

Pioglitazone

Mechanism

A

Binds PPAR-γ, a nuclear transcription factor; increases peripheral insulin sensitivity

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24
Q

Pioglitazone

Uses

A

No hypoglycemia; increases HDL cholesterol, decreases triglycerides

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25
Q

Pioglitazone

Side effects

A

Weight gain; edema; heart failure; bone fractures; macular edema

Increased risk of bladder cancer; possible reduction in myocardial infarctions

Generic available

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26
Q

Rosiglitazone

Drug class

A

Thiazolidinedione

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27
Q

Rosiglitazone

Mechanism

A

Binds PPAR-γ, a nuclear transcription factor; increases peripheral insulin sensitivity

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28
Q

Rosigitazone

Uses

A

No hypoglycemia

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29
Q

Rosiglitazone

Side effects

A

Weight gain; edema; heart failure; bone fractures; possible increase in cardiovascular events

Increased LDL cholesterol

Expensive; contraindicated in heart disease

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30
Q

Exenatide (Byetta, extended release Bydureon); Liraglutide (Victoza); Albiglutide (Tanzeum); Dulaglutide (Trulicity)

Drug class

A

GLP-1 receptor agonist

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31
Q

Exenatide (Byetta, extended release Bydureon); Liraglutide (Victoza); Albiglutide (Tanzeum); Dulaglutide (Trulicity)

Mechanism

A

Activates GLP-1 receptor in β-cells in the pancreas and brain; increases insulin secretion and decreases glucagon secretion in a glucose-dependent fashion; slows gastric emptying, increases satiety; can cause weight loss

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32
Q

Exenatide (Byetta, extended release Bydureon); Liraglutide (Victoza); Albiglutide (Tanzeum); Dulaglutide (Trulicity)

Uses

A

SubQ injection only (exenatide twice daily, extended release once weekly,liraglutide once daily, others once weekly

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33
Q

Exenatide (Byetta, extended release Bydureon); Liraglutide (Victoza); Albiglutide (Tanzeum); Dulaglutide (Trulicity)

Side effects

A

GI (nausea, vomiting, diarrhea); acute panceatitis

Hypoglycemia (less than sulfonylureas; caution with renal insufficiency; C cell hyperplasia/medullary thyroid tumors in rodents

expensive

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34
Q

Sitagliptin (Januvia); Alogliptin (Nesina); Saxagliptin (Onglyza); Linagliptin (Tradjenta)

Drug class

A

DPP-4 inhibitor

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35
Q

Sitagliptin (Januvia); Alogliptin (Nesina); Saxagliptin (Onglyza); Linagliptin (Tradjenta)

Mechanism

A

Inhibition of GLP-1 metabolism; increases insulin and decreases glucagon secretion

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36
Q

Sitagliptin (Januvia); Alogliptin (Nesina); Saxagliptin (Onglyza); Linagliptin (Tradjenta)

Uses

A

No hypoglycemia, weight neutral

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37
Q

Sitagliptin (Januvia); Alogliptin (Nesina); Saxagliptin (Onglyza); Linagliptin (Tradjenta)

Side effects

A

Well tolerated; rarely urticaria/angioedema & pancreatitis; arthralgias

Expensive

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38
Q

Canagliflozin (Invokana); Dapaglifloxin (Farxiga); Empaglifloxin (Jardiance)

Drug class

A

SGLT2 inhibitor

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39
Q

Canagliflozin (Invokana); Dapaglifloxin (Farxiga); Empaglifloxin (Jardiance)

Mechanism

A

Reduces glucose resorption in the kidney; increases urinary glucose excretion; alpha cell agonist (increases glucagon)

40
Q

Canagliflozin (Invokana); Dapaglifloxin (Farxiga); Empaglifloxin (Jardiance)

Uses

A

No hypoglycemia; weight loss possible

41
Q

Canagliflozin (Invokana); Dapaglifloxin (Farxiga); Empaglifloxin (Jardiance)

Side effects

A

UTIs; genital mycotic infections; volume depletion; hyperkalemia; hypersensitivity; reduced bone density; ketoacidosis

Avoid in renal insufficiency

Expensive

42
Q

Colesevelam

Drug class

A

Bile acid sequestrant

43
Q

Colesevelam

Mechanism

A

Binds bile acids/cholesterol

44
Q

Colesevelam

Uses

A

Modest reduction in A1c; no hypoglycemia; decreased LDL cholesterol

45
Q

Colesevelam

Side effects

A

Increase in triglycerides

Constipation; may interfere with absorption of other medications

Expensive

46
Q

Bromocriptine

Drug class

A

Dopamine-2 agonist

47
Q

Bromocriptine

Mechanism

A

Alters hypothalamic regulation of metabolism; increases insulin sensitivity

48
Q

Bromocriptine

Uses

A

Modest reduction in A1c; no hypoglycemia

49
Q

Bromocriptine

Side effects

A

Dizziness/syncope

Rhinitis, nausea, fatigue

Rarely used

50
Q

Pramlintide

Drug class

A

amylin analog

51
Q

Pramlintide

Mechanism

A

Mimics amylin: slows gastric emptying, suppresses postprandial glucagon secretion, may reduce appetite

52
Q

Pramlintide

Uses

A

SubQ injection only; used with short or rapidly acting insulin with meals; reduces post-prandial glucose levels; may promote weight loss

53
Q

Pramlintide

Side effects

A

Hypoglycemia (significant risk)

GI side effects (especially nausea)

54
Q

Lispro

Drug class

A

Rapid-acting insulin

55
Q

Lispro

Mechanism

A

OoA: 5-30 min; PA: 0.5-3 hrs; DoA: 3-5 hrs

56
Q

Lispro

Uses

A

Bolus insulin; subQ injection

57
Q

Lispro

Side effects

A

Hypoglycemia, weight gain

Lipohypertrophy, rare allergic reaction

Expensive; U-200 available

58
Q

Aspart

Drug class

A

Rapid-acting insulin

59
Q

Aspart

Mechanism

A

OoA: 5-30 min; PA: 0.5-3 hrs; DoA: 3-5 hrs

60
Q

Aspart

Uses

A

Bolus insulin; subQ injection

61
Q

Aspart

Side effects

A

Hypoglycemia, weight gain

Lipohypertrophy, rare allergic reaction

Expensive

62
Q

Glulisine

Drug class

A

Rapid-acting insulin

63
Q

Glulisine

Mechanism

A

OoA: 5-30 min; PA: 0.5-3 hrs; DoA: 3-5 hrs

64
Q

Glulisine

Uses

A

Bolus insulin; subQ injection

65
Q

Glulisine

Side effects

A

Hypoglycemia, weight gain

Lipohypertrophy, rare allergic reaction

Expensive

66
Q

Oral inhaled Afrezza

Drug class

A

Rapid-acting insulin

67
Q

Oral inhaled Afrezza

Mechanism

A

OoA 15 minutes; PA 50-60 minutes; DoA 2-3 hours

68
Q

Oral inhaled Afrezza

Uses

A

Bolus insulin; oral/inhaled; requires periodic pulmonary function tests; doses 4-8 unit increments

69
Q

ORal inhaled Afrezza

Side effects

A

Decreases FEV; do not use with chronic lung disease.

70
Q

Regular insulin

Drug class

A

Short-acting insulin

71
Q

Regular insulin

Mechanism

A

OoA: 30-60 min; PA: 1-5 hrs; DoA: 6-8 hrs

72
Q

Regular insulin

Uses

A

Bolus insulin; subQ injection or iv

73
Q

Regular insulin

Side effects

A

Hypoglycemia, weight gain

Lipohypertrophy; rare allergic reaction

U-500 available; longer DoA

74
Q

NPH

Drug class

A

Intermediate insulin

75
Q

NPH

Mechanism

A

OoA: 1-4 hrs; PA: 4-10 hrs; DoA: 14-24 hrs

76
Q

NPH

Uses

A

SubQ injection; can mix with regular

77
Q

NPH
Side effects

A

Hypoglycemia, weight gain

Lipohypertrophy; rare allergic reaction

78
Q

NPL

Drug class

A

Intermediate insulin

79
Q

NPL

Mechanism

A

OoA: 1-4 hrs; PA: 4-10 hrs; DoA: 14-24 hrs

80
Q

NPL

Uses

A

SubQ injection; available premixed with lispro

81
Q

NPL

Side effects

82
Q

NPA

Drug class

A

Intermediate insulin

83
Q

NPA

Mechanism

A

OoA: 1-4 hrs; PA: 4-10 hrs; DoA: 14-24 hrs

84
Q

NPA

Uses

A

SubQ injection; available premixed with aspart

85
Q

NPA

Side effects

A

Hypoglycemia, weight gain

Lipohypertrophy; rare allergic reaction

86
Q

Detemir

Drug class

A

Intermediate insulin

87
Q

Detemir

Mechanism

A

OoA: 3-4 hrs; PA: 4-8 hrs; DoA: 6-24 hrs

88
Q

Detemir

Uses

A

Basal insulin; at higher doses, longer DoA

89
Q

Detemir

Side effects

A

Hypoglycemia, weight gain

Lipohypertrophy; rare allergic reaction

Expensive; should not be mixed

90
Q

Glargine

Drug class

A

Long-acting insulin

91
Q

Glargine

Mechanism

A

OoA: 2-3 hrs; PA: none; DoA: 24-30 hrs

92
Q

Glargine

Uses

A

Basal insulin

93
Q

Glargine

Side effects

A

Hypoglycemia, weight gain

Lipohypertrophy; rare allergic reaction

Expensive; should not be mixed; U-300 available (longer DoA)

94
Q

Degludec

Drug class

A

Ultra long-acting

95
Q

Degludec

Mechanism

A

DoA up to 42 hrs +; half life 25 hrs

96
Q

Degludec

Uses

A

Basal insulin

97
Q

Degludec

Side effects

A

Hypoglycemia, weight gain

Rare lipohypertrophy; rare allergic reaction

Expensive; U-200 available

Pharmacology (26 decks)

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