Antidiabetic Drugs 2 Flashcards
(47 cards)
chlorpropamide is a ___ generation sulfonylureas; what are some AE’s?
1st; has a long half life: hypoglycemia, hyperemic flush when dirt k alcohol and can potentiate action of vasopressin leading to SIADH
what are the effects of glucagon on:
cardiac ionotropy and chronotropy
intestine
- ↑ cardiac ionotropy and chronotropy
- relaxes the intestine (in large doses)
a typical regiment for managing diabetes in a pregnant patient tarot with a single dose of bedtime _______
NPH insulin
meglitindies are _____ (time) glucose regulators
postprandial; because these have a rapid onset and short duration of action so take them before each meal
both sufonuylureas and meglitinides have the same MOA. what is the difference and which one is more effective?
- meglitinides (repaglinide and nateglinide) hae sorter half life but are NOT AS EFFECTIVE in reducing fasting plasma glucose and HBA1c
meglitinides do not have sulfur and thus can be indicated in patients with sulfur allergy
colesevelam is a bile acid sequestrant used to lower ______
LDL cholesterol; give to type 2 DM patients
what are some scenarios you would give a diabetic patient statins?
should be given REGARDLESS OF LIPID LEVELS:
- patients with CVD
- younger than 40 with CVD risk factors
- older than 40 w/ or w/o CVD risk factors
a patient with type 2 DM tried to change lifestyle but his HBA1c levels did not improve. Doctor prescribes metformin but the levels did not lower by 1%. so he starts a dual combination therapy. What drugs would he prescribe?
oral agent, exenatide (injectable) or insulin
what type of patient is metformin contraindicated in?
those that are more prone to lactic acidosis:
- renal disease
- hepatic disease
- hypoxia
- alcoholism
what is the MOA of canagliflozin to treat diabetes?
- inhibits SGLT-2 and thus ↓ the reabsorption of glucose BUT because there is more glucose in the urinary tract, users of this drug are at more risk for UTI’s
pramlintide is an analog of _______
amylin;
amylin is a peptide that is co-secreted with insulin from β cells and it inhibits food intake, gastric emptying and glucagon secretion
what are two drugs that can cause pancreatitis?
- exenatide
- sitagliptin
what is the MOA and effect of acarbose?
- it reduces post prandial digestion of starch and carbohydrates in the upper intestine (↓ post prandial hyperglycemia and hyperinsulinemia)
- acarbose is a competitive inhibitor to the enzyme α glucosidase with converts disaccharides and trisaccharides to glucose
a diabetic patient presents with albuminuria. what drug would you give them in addition to what they are taking
ACEI or ARB’s
______ therapy should be given as a primary prevention statregy in patient with diebaes and an ↑ cardiovascular risk
low dose aspirin because it is an anti platelet agent
of the 2nd generation sulfonylreuas, which one is most likely to cause hypoglycemia? which one is least likely?
most likely to see hypoglycemia: glyburide
least likely to see hypoglycemia: glipizide (short half life)
any patient placed on ______ (diabetic drug) MUST be placed on liver function monitoring
TZD (glitazones) specifically troglitazone because it can cause severe hepatic toxicity (not seen with pioglitazone or rosiglitazone)
also with acarbose
when is a good time to use metformin?
insulin resistant patients because metformin does not cause secretion of insulin but rather ↓ gene expression of gluconoegenic enzymes
_______ is a drug that affects gene expression as part of its MOA in treating diabetes via activation of AMP activated protein kinase
metformin
weight loss/gain is an AE of metformin
weight loss;
with drugs that cause insulin secretion, the AE would be weight gain because insulin is anabolic
glucose is filtered by the glomerulus and reabsorbed in the proximal tubule by which transporters?
SGLT’s (sodium glucose linked transporter)
thiazolidinediones (TZDs) are used to ________ by ________
TZD’s: pioglitazone and rosiglitazone
↓ insulin resistance (help promote glucose uptake and utilization in adipose tissue) by acting as agonists for PPAR - gamma (peroxisome proliferator activated receptor)
which of the TZD’s have more favorable effects on lipids
- pioglitazone > rosigliazone
significant improvements on HDL, TG, LDL particle size and concentration
2nd generation sulfonylureas drugs that have replaced the 1st generation
2nd generation: glyburide, glipizide, glimepiride
1st generation: chlorpropamide
