173 DM drugs Flashcards Preview

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Flashcards in 173 DM drugs Deck (18):
1

insulin receptor type and mechanism of action once bound

receptor tyrosine kinase --> tyrosine phosphorylation activates...

1) phophoinositide-3 kinase pathway --> glycogen synthesis AND GLUT4 into membrane

2) Ras/MAP kinase pathway --> cell growth and differentiation

2

is insulin anabolic or catabolic? what transporter is insulin dependent? what tissue has it?

anabolic in liver, muscle, fat

GLUT4

muscle and adipose

3

what happens to glycogen, triglycerides, and proteins with an insulin deficiency?

broken down to provide fuel --> hyperglycemia --> osmotic diuresis, dehydration --> low cerebral bloodf low --> coma and death

also get ketone bodies --> metabolic acidosis

4

short acting insulins names? Difference?

regular + "LAG"
lispro
aspart
glulisine

the bottom 3 are faster onset - take before meal and last while meal is digested

asapart and gluilisine are used for CSII

5

longer acting insulin

NPH (neutral protamine hagedorn) - protamine slows absorption

Glargine - acidic so can't mix

detemir - binds albumin

1-2 x day w/ short acting insulin

6

insulin regimens

basal/bolus - long acting at night or morning w/ premeal short acting insulin

split-mixed - pre breakfast and pre dinner injections - combo of short and long acting

6

insulin SE

hypoglycemia

7

ketoacidosis rx

hyperglycemia responds more rapidly than acidosis

8

insulin-induced hypoglycemia rx

#1 glucose - oral,iv

alternatives:

glucagon - sc, im, iv --> GPCR --> cAMP --> increases hepatic glucose production

diazoxide - opens K channel, decreases insulin

9

sulfonylureas
-suffix
-mechanism
-use
-toxicity

_ride (glyburide)
_amide
_zide (glipizide)

blocks K channel --> depol --> insulin release

DM2 (requires islet fxn)

hypoglycemia (esp old with bad liver/kidney)

10

DPP-4 inhibitors
-suffix
-mechanism
-use
-toxicity

_agliptin

--I serine protease dpp-4 which stops it from blocking GLP-1 (thus allows GLP-1 to fxn) --> increases Insulin AND lowers glucagon

DM2

UTI, respiratory infections

11

Biguanides
-drug
-mechanism
-use
-toxicity

metformin

AMP kinase --> decreases gluconeogenesis, increases glucose uptake

monotherapy, 1st line for DM2 (can be used in those without islet fxn)

GI upset, lactic acidosis (careful in those w/ renal failure)

12

GLP mimetics
-suffix
-mechanism
-use
-toxicity

__tide (NOT _lintide) - exenatide, liraglutide

GPCR --> cAMP --> PKA --> Ca --> insulin release AND lowers glucagon release

DM 2

nausea, vomiting, pancreatitis

13

thiazolidinediones
-suffix
-mechanism
-use
-toxicity

_litazone (pioglitazone)

binds PPAR --> promotes transcription of insulin sensitive genes in liver, muscle, adipose --> increases insulin sensitivity

DM2

weight gain, edema, hepatotoxicity, heart failure

14

a-glucosidase inhibitors
-drugs
-mechanism
-use
-toxicity

acarbose
miglitol

--I glucosidase at brush border --> decreased glucose absorption

DM2

GI pain

15

amylin analogs
-drug
-mechanism
-use
-toxicity

pramlintide

mimics amylin in hindbrain --> slows gastric emptying --> decreases glucose concentrations after meals AND decreases glucagon

DM1 and 2

hypoglycemia, nausea, diarrhea

16

what increases glucose excretion?

SGLT2 inhibitor - canagliflozin

17

what drug is used first in DM?

metformin

if A1C not <7% at 3-4 months, add 2nd drug