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M4 Pharm B2 > 3.2 - Drugs used in DM (Part 2) > Flashcards

3.2 - Drugs used in DM (Part 2) Flashcards

(48 cards)

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1
Q

Type II DM Drugs Class: Insulin Secretagogues (2 subclasses)

A

Sulfonylureas

Glitinides

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2
Q

Type II DM Drugs Class: Insulin sensitizers (2 subclasses)

A

Biguanides

Thiazolidinediones

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3
Q

Type II DM Drugs Class: alpha-glucosidase inhibitors (2 subclasses)

A

Acarbose

Miglitol

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4
Q

Type II DM Drugs Class: DPP-4 Inhibitors (2 subclasses)

A

Sitagliptin

Saxagliptin

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5
Q

Type II DM Drugs Class: GLP-1 Analogs (2 subclasses)

A

Exenatide

Liraglutide

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6
Q

Type II DM Drugs Class: Amylin Analog (1)

A

Pramlintide

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7
Q

Type II DM Drugs Class: SGLT Inhibitor (1)

A

Canagliflozin

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8
Q

Type II DM Drugs Class: Insulin Secretagogues - First Generation Sulfonylureas (3)

A

Tolbutamide

Tolazamide

Chlorpropramide

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9
Q

Type II DM Drugs Class: Insulin Secretagogues - Second Generation Sulfonylureas (3)

A

Glipizide

Glyburide

Glimepiride

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10
Q

Type II DM Drugs Class: Insulin Secretagogues - Sulfonylurea MOA

A

Beta cells

Promoting closure of K+ channls in b-cell membrane to cause hyperpolarization

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11
Q

Type II DM Drugs Class: Insulin Secretagogues - Sulfonylurea General Effect (2)

A

Increase insulin secretion

Decrease glucagon secretion

Extrapancreatic tissues increase response to insulin

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12
Q

Type II DM Drugs Class: Insulin Secretagogues - Sulfonylurea First Generation (3, and their MOAs)

A

Tolbutamide - safe in elderly and renal dysfunction

Tolazamide - short half life

Chlorpropramide - long duration (60 hours), disulfiram rxn, SIADH, jaundice, leukopenia, and thrombocytopenia

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13
Q

Type II DM Drugs Class: Insulin Secretagogues - Sulfonylurea First Generation: Contraindication

A

Hepatic and renal insufficiency

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14
Q

Type II DM Drugs Class: Insulin Secretagogues - Sulfonylurea Second Generation (3 and there MOAs)

A

Glipizide (decrease dose in hepatic dysfunction)
Short acting : C/I: renal & hepatic impairment

Glyburide (Decrease dose in renal dysfunction)
Long acting : C/I: renal & hepatic impairment

Glimepiride
Long acting- once daily dose

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15
Q

Type II DM Drugs Class: Insulin Secretagogues - Sulfonylurea Second Generation Uses (3)

A

To control hyperglycemia in type 2 DM patients who cannot achieve appropriate control with changes in diet alone

Most effective when pancreatic ß cells are functioning

Most appropriate in non-obese

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16
Q

Type II DM Drugs Class: Insulin Secretagogues - Sulfonylureas Adverse Effects (4)

A

Hypoglycemia

Severe hypoglycemia
Overdose
Most common with glyburide

Weight gain, Rashes, hypersensitivity

Drug interactions:     hypoglycemia with
Cimetidine
Insulin
Salicylates
Sulfonamides
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17
Q

Type II DM Drugs Class: Insulin Secretagogues - (Me)Glitinides Drugs (2) and no what?

A

Repaglinide

Nateglinide (D-phenylalanine) –> safe in renal insufficiency

NO SULFUR

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18
Q

Type II DM Drugs Class: Insulin Secretagogues - (Me)Glitinides MOA

A

Binds to 2 common sites of SUR, one unique site of meglitinides on beta cells of pancrease

Closure of ATP-sensitive K+ channels

Restoration of more normal insulin secretion

Decrease glucagon secretion and hepatic glucose production

Rapid onset and short duration of action

Taken just before meal s

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19
Q

Type II DM Drugs Class: Insulin Secretagogues - (Me)Glitinides Use

A

Alone or with biguanides in Type 2 DM and patients with S or SU alergy

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20
Q

Type II DM Drugs Class: Insulin Secretagogues - (Me)Glitinides Nateglinide is safe in?

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A

Renal insufficiency and lower incidence of hypoglycemia

21
Q

Type II DM Drugs Class: Insulin sensitizers - Biguanides: Metformin (3 things)

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A

Euglycemia

Does not cause hypoglycemia

No weight gain

22
Q

Type II DM Drugs Class: Insulin sensitizers - Biguanides: Metformin MOA (9!)

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A
  1. **Inhibits hepatic glucose production (through activating AMPKinase)
  2. Decrease renal gluconeonegenesis
  3. ***Direct stimulation of glycolysis in tissues
  4. Converts glucose to lactate by enterocytes
  5. Increase removal of glucose from blood
  6. ***Increase the hepatic sensitivity to insulin
  7. Reduction of plasma glucagon levels
  8. Slowing the glucose absorption from GIT
  9. Decreases triglycerides
23
Q

Type II DM Drugs Class: Insulin sensitizers - Biguanides: Metformin Use (2)

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A

Appropriate for obese Type II diabetics

Decreases insulin resistance

PCOS

24
Q

Type II DM Drugs Class: Insulin sensitizers - Biguanides: Metformin Side Effects (3)

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A

Anorexia, nausea, vomiting, diarrhea

Lactic acidosis (Increase blood lactate & anion gap; decrease pH HCo3)

Vitamin B12 deficiency

25
Type II DM Drugs Class: Insulin sensitizers - Biguanides: Metformin Contraindications (4)
Acoholism Renal and hepatic disease Chronic cardiopulmonary dysfunction Radiographic contrast studies, seriously ill patients, acidosis
26
Type II DM Drugs Class: Insulin sensitizer - Thiazolidinediones Drugs (2)
Pioglitzaone and Rosiglitazone
27
Type II DM Drugs Class: Insulin sensitizer - Thiazolidinediones MOA (6)
1. Bind to peroxisome proliferator-activating receptor (PPAR-gamma) involved in transcription of insulin- responsive genes 2. Sensitizes tissue to insulin 3. Decreases hepatic gluconeogenesis 4. Increases the glucose uptake in muscle and adipose tissue 5. Pioglitazone - activates PPAR-alpha and PPAR-gamma 6. Triglyiceride lowering activity from PPAR-alpha
28
Type II DM Drugs Class: Insulin sensitizer - Thiazolidinediones Pharmacokinetics
Absorption decreased with bile acid sequestrants Pioglitazone is meatbolized by CYP268 and CYP3A4 to active metabolites - combined with OCP, additional methods of contraception are adviced
29
Type II DM Drugs Class: Insulin sensitizer - Thiazolidinediones Adverse Effects (6)
Fluid retention Edema *Increased risk of heart failure (Rosi > Pio) Weight gain *Loss of bone mineral density Hepatotoxicity (troglitazone discontinued by FDA)
30
Type II DM Drugs Class: alpha-glucosidase inhibitors: Acarbose and Miglitol MOA (3)
Inhibitor of alpha-glucosidase in the brush borders of small intestine and inhibits amylase Delay carbohydrate digestion and absorption Decreased demand for insulin
31
Type II DM Drugs Class: alpha-glucosidase inhibitors: Acarbose and Miglitol Clinical Use (1)
To control postprandial hyperglycemia
32
Type II DM Drugs Class: alpha-glucosidase inhibitors: Acarbose and Miglitol Side Effects (4)
GI Discomfort Flatulence Diarrhea Hepatotoxicity
33
Type II DM Drugs Class: Amylin Analog - Pramlintide Defined (2)
Modullates postprandial glucose levels Preprandial use in individuals with Type 1 and 2 DM
34
Type II DM Drugs Class: Amylin Analog - Pramlintide MOA (3)
Suppresses glucagon release Delays gastric emptying CNS mediated anorectic effects
35
Type II DM Drugs Class: Amylin Analog - Pramlintide Risk of?
Hypoglycemia
36
Type II DM Drugs Class: GLP-1 Agonist: GLP-1 is what?
An incretin released from small intestine
37
Type II DM Drugs Class: GLP-1 Agonist: Exenatide and Liraglutide (5)
Synthetic analog of GLP-1 Adjunctive therapy with metformin or sulfonylreas Potentiation of glucose-nediated insulin secretion, suppression of postprandial glucagon release Slowed gastric emptying, loss of appetite Increased beta cell mass result from decreased beta cell apoptosis
38
Type II DM Drugs Class: GLP-1 Agonist: Side Effects (3)
Nausea Hypoglycemia with sulfonylureas Necrotizing and hemorrhagic pancreatitis
39
Type II DM Drugs Class: DPP-4 Inhibitors: Sitagliptin and Saxagliptin Defined (3)
Inhibitor of DPP-4 Inhibit activation of GLP-1 Increase levels of GLP-1, GIP (increasing glucose mediated insulin secretion and decreasing glucagon levels)
40
Type II DM Drugs Class: DPP-4 Inhibitors: Sitagliptin and Saxagliptin: Adverse Effects (6)
Naso-pharyngitis Upper Respiratory Infections Headaches Hypoglycemia Acute pancreatitis Joint Pain
41
Bile Acid Sequestrants: Colesvelam MOA (3)
Decrease FXR activation Decrease glucose absorption Decrease A1c by .5% and LDL by 15%
42
Bile Acid Sequestrants: Colesvelam Side Effects (3)
Constipation Indigestion Flatulence
43
Bile Acid Sequestrants: Colesvelam Contraindications (3)
Hypertriglyceridemia Pancreatitis Esophagial, gastric, and duodenal disorders
44
New Drugs for Diabetes (3)
Canagliflozin Dapagliflizon Emphagliflozin
45
New Drugs for Diabetes: MOA
SGLT2 inhibitors: inhibits glucose reabsorption
46
New Drugs for Diabetes: Adverse Effects (3)
Hypotension Dehydration Genital mycotic infections
47
New Drugs for Diabetes: Contraindications (1)
Severe renal impairment
48
Other New Drugs for Diabetes: 4
Inhaled insulin Insulin peglispro (long acting) Glimins Islet cell transplantation

M4 Pharm B2 (7 decks)

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