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anti DM tables Flashcards

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1
Q

Biguanides

A

metformin

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2
Q

Biguanides Moa

A

Liver (primary) – decreases glucose production
Muscle/adipose tissue - decreases insulin resistance

metoformin moa

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3
Q

Metformin comments

 risk hypoglycemia?
 Weight ?
 first line??
 role with insulin?
 Beneficial in the treatment of?
 vitamin deficiency risk?
 ADRs common in what system
 metabolic adr? rare in?

A

 Low risk of hypoglycemia when used as monotherapy
 Weight neutral
 One of the first line drug therapy options added to diet and exercise
 Ameliorates insulin- associated weight gain
 Beneficial in the treatment of prediabetes
 B12 deficiency risk
 GI ADRs (e.g., diarrhea, nausea, cramping)
 Lactic acidosis (rare) in patients with cardiovascular, renal, or hepatic dysfunction

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4
Q

Glucagon-like peptide-receptor agonists (GLP1-RA)

A

dulaglutide
exenatide
liraglutide
lixisenatide
semaglutide

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5
Q

Glucagon-like peptide-receptor agonists (GLP1-RA) moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying

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6
Q

dulaglutide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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7
Q

exenatide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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8
Q

liraglutide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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9
Q

lixisenatide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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10
Q

semaglutide moa

A

incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses
inappropriately elevated glucagon secretion, and slows gastric emptying

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11
Q

Glucagon-like peptide-receptor agonists (GLP1- RA)

 risk of hypoglycemia
 nausea?
 Weight?
 CV/ renal? agents?
 Injection site?
 Pancreatitis (rare)
 May be associated with dx of what GI organ?
 Risk of tumors where?

A

 Low risk of hypoglycemia when used as monotherapy
 Nausea
 Weight loss
 CV benefit (albiglutide, dulaglutide, liraglutide, semaglutide) and renal
benefit (liraglutide, semaglutide)
 Injection site reactions
 Pancreatitis (rare)
 May be associated with gallbladder disease
 Risk of Thyroid-C cell tumors

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12
Q

Glucagon-like, peptide-1 (GLP-1) agonist and glucose- dependent insulinotropic polypeptide (GIP) agonist (a “twincretin”):

A

tirzepatide

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13
Q

Glucagon-like, peptide-1 (GLP-1) agonist and glucose- dependent insulinotropic polypeptide (GIP) agonist moa

A

increases insulin secretion in response to elevated glucose, decreases glucagon
secretion, slows gastric emptying

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14
Q

tirzepatide moa

A

increases insulin secretion in response to elevated glucose, decreases glucagon
secretion, slows gastric emptying

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15
Q

tirzepatide

 risk of hypoglycemia?
 weight?
 A1c reduction?
 CV/renal?
 May delay absorption of?

A

 Low risk of hypoglycemia
 More weight loss than GLP-1 agonists
 More A1c reduction than most GLP-1 agonists.
 No CV or kidney outcomes data yet.
 May delay oral contraceptive absorption

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16
Q

Sodium glucose cotransporter-2 inhibitors (SGLT-2

A

bexagliflozin
canagliflozin
dapagliflozin
empagliflozin
ertugliflozin

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17
Q

Sodium glucose cotransporter-2 inhibitors (SGLT-2) moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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18
Q

bexagliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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19
Q

canagliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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20
Q

dapagliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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21
Q

empagliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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22
Q

ertugliflozin moa

A

Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks
the reabsorption of glucose in the kidney, increases glucose excretion, and lowers
blood glucose levels

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23
Q

Sodium glucose cotransporter-2 inhibitors (SGLT-2)

risk of hypoglycemia?
 Weight?
 CV and renal? agents?
 Genital side effects?
 BP?
 lipid profile?
 urine?
 pancreas?
 May be associated with rare? agent?
 bones?
 Increased risk of what gangrene?

A

 Low risk of hypoglycemia
 Weight loss
 CV and renal benefit (canagliflozin, dapagliflozin, empagliflozin)
 Genital fungal (yeast) infections (male/female)
 UTI
 Dizziness, hypotension,
 Increased LDL
 Increased urination
 Acute pancreatitis (rare)
 May be associated with rare amputations (canagliflozin
 Increases fracture risk (rare)
 Increased risk of Fournier’s gangrene - infection in the scrotum (which includes the testicles), penis, or perineum (rare)

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24
Q

Dipeptidyl-
Peptidase-4
Inhibitors (DPP-4

A

alogliptin
linagliptin
saxagliptin
sitagliptin

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25
Dipeptidyl- Peptidase-4 Inhibitors (DPP-4 )moa
Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels
26
alogliptin moa
Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels
27
linagliptin moa
Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels
28
saxagliptin moa
Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels
29
sitagliptin moa
Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels
30
# DPP-4 inhibitors  risk of hypoglycemia?  Weight?  May be associated with?  CV?  joints?
 Low risk of hypoglycemia when used as monotherapy  Weight neutral  May be associated with pancreatitis  New or worsening heart failure  May cause severe joint pain
31
Thiazolidinedione (TZD)
pioglitazone rosiglitazone
32
TZD moa
Muscle and adipose – peroxisome proliferator- activated receptor γ(gamma) - (PPARγ) agonist, makes tissues more sensitive to endogenous insulin and enhances glucose uptake into the tissues. Does not increase pancreatic insulin secretion
33
rosiglitazone moa
Muscle and adipose – peroxisome proliferator- activated receptor γ(gamma) - (PPARγ) agonist, makes tissues more sensitive to endogenous insulin and enhances glucose uptake into the tissues. Does not increase pancreatic insulin secretion
34
pioglitazone moa
Muscle and adipose – peroxisome proliferator- activated receptor γ(gamma) - (PPARγ) agonist, makes tissues more sensitive to endogenous insulin and enhances glucose uptake into the tissues. Does not increase pancreatic insulin secretion
35
# Thiazolidinedione  risk of hypoglycemia?  peripheral tissues?  Weight ?  CV? bones?
 Low risk of hypoglycemia when used as monotherapy  Edema  Weight gain  Heart failure. Avoid in patient with symptomatic heart failure  Increased fracture risk
36
Sulfonylureas (SU) | Note: 1st generation not included since not commonly used in practice
glimepiride (2nd Gen) glipizide (2nd Gen) glyburide(2nd Gen) | Start with ”g” and end in “ide” - glipizide, glyburide, glimepiride
37
Sulfonylureas (SU) moa
Secretagogue Pancreas - Stimulates beta cells causing insulin secretion
38
glimepiride moa
Secretagogue Pancreas - Stimulates beta cells causing insulin secretion
39
glipizide moa
Secretagogue Pancreas - Stimulates beta cells causing insulin secretion
40
glyburide moa
Secretagogue Pancreas - Stimulates beta cells causing insulin secretion
41
# Sulfonylureas (SU)  Hypoglycemia?  Weight?  “Durability”
 Hypoglycemia, especially with renal dysfunction (usually discontinue with use of insulin)  Weight gain  “Durability” declines over time
42
metformin
Biguanides
43
Liver (primary) – decreases glucose production Muscle/adipose tissue - decreases insulin resistance
Biguanides Moa
44
dulaglutide exenatide liraglutide lixisenatide semaglutide
Glucagon-like peptide-receptor agonists (GLP1-RA)
45
incretin mimetic – Glucagon-like peptide 1 (GLP-1) receptor agonist that enhances glucose- dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying
Glucagon-like peptide-receptor agonists (GLP1-RA) moa
46
tirzepatide
Glucagon-like, peptide-1 (GLP-1) agonist and glucose- dependent insulinotropic polypeptide (GIP) agonist (a “twincretin”):
47
increases insulin secretion in response to elevated glucose, decreases glucagon secretion, slows gastric emptying
Glucagon-like, peptide-1 (GLP-1) agonist and glucose- dependent insulinotropic polypeptide (GIP) agonist moa
48
bexagliflozin canagliflozin dapagliflozin empagliflozin ertugliflozin
Sodium glucose cotransporter-2 inhibitors (SGLT-2
49
Inhibition the protein, Sodium glucose cotransporter-2 in the proximal tubules, blocks the reabsorption of glucose in the kidney, increases glucose excretion, and lowers blood glucose levels
Sodium glucose cotransporter-2 inhibitors (SGLT-2) moa
50
alogliptin linagliptin saxagliptin sitagliptin
Dipeptidyl- Peptidase-4 Inhibitors (DPP-4
51
Inhibits the action of DPP- 4, an enzyme which destroys incretin hormones (Glucagon-like peptide 1 (GLP-1 and Gastric inhibitory polypeptide GIP) The inhibition causes decreased glucagon release which results in increased insulin secretion, decreased gastric emptying and decreased blood glucose levels
Dipeptidyl- Peptidase-4 Inhibitors (DPP-4 )moa
52
pioglitazone rosiglitazone
Thiazolidinedione (TZD)
53
Muscle and adipose – peroxisome proliferator- activated receptor γ(gamma) - (PPARγ) agonist, makes tissues more sensitive to endogenous insulin and enhances glucose uptake into the tissues. Does not increase pancreatic insulin secretion
TZD moa
54
glimepiride glipizide glyburide
Sulfonylureas (SU) | Note: 1st generation not included since not commonly used in practice
55
Secretagogue Pancreas - Stimulates beta cells causing insulin secretion
Sulfonylureas (SU) moa
56
rapid acting insulins
Humalog, Amelog*, Lyumjev* (insulin lispro) NovoLog, Fiasp* (insulin aspart) Apidra (insulin glulisine)
57
use of rapid acting insulins
Bolus dosing(meals) and insulin pumps (administration ranges 5-15 minutes before meals –see specific product information)
58
short acting insulins
Humulin R or Novolin R - Regular insulin -
59
use of short acting insulins
Bolus dosing(meals) (administration ranges 15-30 minutes before meals –see specific product information)
60
intermeadiate acting insulins
Humulin N or Novolin N - NPH
61
intermeadiate acting insulins use
~ “Basal-like” (administration Q day to BID)
62
long acting insulins
Lantus, Basaglar* Rezvoglar*, Semglee*, (insulin glargine) – 100 units/mL Toujeo (insulin glargine) – 300 unitls/mL Levemir (insulin detemir) – to be discontinued in 2024
63
long acting insulin uses
Basal (administration Q day)
64
ultra long acting insulins
Tresiba (insulin degludec)
65
# ultra long acting insulins use
Basal (administration Q day, anytime of day)
66
Humalog, Amelog*, Lyumjev* (insulin lispro) NovoLog, Fiasp* (insulin aspart) Apidra (insulin glulisine)
rapid acting insulins
67
Bolus dosing(meals) and insulin pumps (administration ranges 5-15 minutes before meals –see specific product information)
use of rapid acting insulins
68
Humulin R or Novolin R - Regular insulin -
short acting insulins
69
Bolus dosing(meals) (administration ranges 15-30 minutes before meals –see specific product information)
use of short acting insulins
70
Humulin N or Novolin N - NPH
intermeadiate acting insulins
71
~ “Basal-like” (administration Q day to BID)
intermeadiate acting insulins use
72
Lantus, Basaglar* Rezvoglar*, Semglee*, (insulin glargine) – 100 units/mL Toujeo (insulin glargine) – 300 unitls/mL Levemir (insulin detemir) – to be discontinued in 2024
long acting insulins
73
Basal (administration Q day)
long acting insulin uses
74
Tresiba (insulin degludec)
ultra long acting insulins
75
Basal (administration Q day, anytime of day)
# ultra long acting insulins use ultra long lasting insulin
76
which DM rx have CV benefits
GLP-RA and SGLT-2 inhib
77
which DM rx have renal benefits
SGLT-2 inhib
78
which DM rx have risk of hypoglycemia
SU and insulins
79
which DM Rx cause weight gain
SU and TZD
80
which DM Rx cause weight loss
SGLT2 inhib trizepatide GLP1RA
81
which DM rx can cause new/worse HF
DPP4 inhib and TZD

pharm 2 (20 decks)

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