Antidiabetic Drugs

Question 1

insulin lispro
insulin aspart
insulin glulisine
inhaled insulin

Answer 1

Rapid acting insulin
Key feature: aa alteration in C-terminal tail of B peptide preventing insulin complex formation
Onset: 10-30 min
Peak: 30 min-3 hrs
Duration: 3-5 hrs
Adverse effects: hypoglycemia, hypersensitivity, resistance, lipohypertrophy (at site of injection), lipoatrophy (at site of injection)

Question 2

regular insulin

Answer 2

Short acting insulin
Key feature: identical to human insulin–>forms complexes
Onset: 30-60 min
Peak: 2.5-5 hrs
Duration: 4-12 hrs
Adverse effects: hypoglycemia, hypersensitivity, resistance, lipohypertrophy (at site of injection), lipoatrophy (at site of injection)

Question 3

NPH

Answer 3

Intermediate acting insulin
Key feature: protamine-insulin complex
Onset: 1-2 hrs
Peak: 4-8 hrs
Duration: 10-20 hrs
Adverse effects: hypoglycemia, hypersensitivity, resistance, lipohypertrophy (at site of injection), lipoatrophy (at site of injection)

Question 4

glargine

detemir

Answer 4

Long-lasting insulin
Key feature: aa substitution that result in precipitate formation at a more neutral pH in body
Onset: 1-4 hrs
Peak: relatively flat or none
Duration: 12-20 hrs or 22-24 hrs
Adverse effects: hypoglycemia, hypersensitivity, resistance, lipohypertrophy (at site of injection), lipoatrophy (at site of injection)

Question 5

glucagon

Answer 5

Peptide–>injected
MOA: catabolism of stored glycogen
Use: hypoglycemia
Adverse effects: very safe, nausea, vomiting

Question 6

metformin

Answer 6

Oral antidiabetic-biguanide
MOA: decrease hepatic glucose output, increase peripheral glucose utilization, activate hepatic enzyme AMP-activated protein kinase
Use: 1st line agent for type II diabetes
NO hypoglycemia
NOT dependent on beta-cell function
Adverse effects: GI disturbances, vitamin B12 deficiency

Question 7

glimepiride
glipizide
glyburide

Answer 7

Oral antidiabetic- sulfonylureas
2nd generation-more often used b/c of less side effects
MOA: inhibit ATP-sensitive K+ channels of beta cells–>insulin release
Use: type II diabetes
Adverse effects: weight gain, hypoglycemia

Question 8

repaglinide

nateglinide

Answer 8

Oral antidiabetic- meglitinides
MOA: inhibit ATP-sensitive K+ channels of beta cells–>insulin release
Use: type II diabetes
Adverse effects: weight gain, hypoglycemia

Question 9

acarbose

miglitol

Answer 9

Oral antidiabetics-glucosidase inhibitors
MOA: inhibit brush border glucosidase enzyme and absorption of glucose
Use: type II diabetes
Taken with meal
Contraindicated for pts w/ GI disease
Treat hypoglycemia
Adverse effects: abdominal pain, diarrhea, flatulence

Question 10

pioglitazone

rosiglitazone

Answer 10

Oral antidiabetic- thiazolidinediones (TZDs)
MOA: decrease peripheral resistance by activating peroxisome proliferator-activated receptor-gamma–>increase GLUT4 gene transcription
Use: type II diabetes
Adverse effects: peripheral edema, weight gain, hepatotoxicity, bone fractures, hypoglycemia, cardiovascular

Question 11

pramlintide

Answer 11

Amylinomimetic
MOA inhibit glucagon release; inhibit gastric emptying; anoretic effect
Use: Type I and II diabetes
Must be injected
Adverse effects: nausea, vomiting, anorexia, hypoglycemia, delayed absorption

Question 12

exenatide

liraglutide

Answer 12

incretins
MOA: potentiate insulin secretion; inhibit glucagon release; inhibit gastric emptying; anorectic effect
Use: Type II diabetes
Must be injected
Adverse effects: nausea, vomiting, diarrhea, hypoglycemia, acute pancreatitis, delayed drug absorption

Question 13

sitagliptin
saxagliptin
linagliptin

Answer 13

Dipeptidyl peptidase inhibitor (DPP)
MOA: inhibit incretin degradation–> increase insulin secretion
Use: type II diabetes
Adverse effects: nasopharyngitis, URI, headaches, acute pancreatitis, hemorrhagic or necrotizing pancreatitis