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Pharmacology > Antidiabetic Drugs II > Flashcards

Antidiabetic Drugs II Flashcards

1
Q

mechanism of action of sulfonylureas and their use in diabetes

A
  • binds to SUR1 subunit –> blocks ATP sensitive K channel in beta cell membrane –> depolarization –> opening of voltage gated calcium channel –> influx of calcium –> release of preformed insulin from beta cells
  • reduction of serum glucagon levels
  • both of the above leads to reduction of fasting glucose levels and HbA1c
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2
Q

what is AE of the first generation sulfonylurea (name it)

A

Chlorpropamide (SHHJ)

SIADH (potentiates action of vasopressor)
Hyperemic Flush (increased acetaldehyde conc)
Hematological toxicity
Jaundice if given in excess

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3
Q

who is the first generation of sulfonylurea contraindicated in (name it)

A

Chlorpropamide (HER)

Hepatic insufficiency
Elderly
Renal insufficiency

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4
Q

what are the second generation sulfonylureas and how they differ from first generation

A

Glyburide (Glibenclamide)
Glimepiride
Glipizide

second generation lack some of the adverse effects and drug interactions seen in first generation Chlorpropamide and are more potent

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5
Q

which of the second generation sulfonylurea is most likely to cause hypoglycemia

A

Glyburide (Glibenclamide)

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6
Q

AE of second generation sulfonylurea

A

Glyburide, Glimepiride, Glipizide

Hypoglycemia
Weight gain

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7
Q

what are the meglitinides

A

Repaglinide

Nateglinide

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8
Q

mechanism of meglitinides (name them)

A

repaglinide and nateglinide

same as sulfonylurea: binds to different location on SUR1 –> inhibit beta cell ATP sensitive K+ channel –> depolarization –> opening of voltage gated calcium channel –> influx of calcium –> release of insulin

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9
Q

when are meglitinides taken (name them)

A

repaglinide and nateglinide

they are post prandial glucose regulators which are rapid onset and short duration so must be taken right before a meal

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10
Q

who are meglitinides indicated for

A

repaglinide and nateglinide

those with sulfur or sulfonylurea allergy

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11
Q

how do you get rid of meglitinides

A

metabolized by CYP3A4 and excreted in bile

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12
Q

AE of meglitinides (name them)

A

repaglinide and nateglinide

same AE as sulfonylurea:
Hypoglycemia
Weight gain

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13
Q

what is the bigaunides

A

Metformin

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14
Q

mechanism of action of biguanides

A
  • metformin reduces blood glucose by inhibiting gluconeogenesis by reducing the expression of gluconeogenic enzymes
  • increases insulin mediated glucose utilization by peripheral tissues such as liver and muscle after meals
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15
Q

first line therapy in type II DM

A

metformin

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16
Q

what are some big difference between biguanide (metformin) and insulin secretagogues (meglitinides and sulfonylureas)

A
  • metformin causes weight loss while insulin secretagogues cause weight gain
  • metformin inhibits gluconeogenesis and increases uptake of glucose of peripheral tissues after meals while insulin secretagogues increase insulin release by inhibiting ATP K channels leading to depolarization and opening of Ca channels
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17
Q

AE of metformin

A

LBL

Largely GI: anorexia, vomiting, nausea etc
B12 malabsorption if long term use
Lactic acidosis –> MI, heart failure

18
Q

what should be avoided if taking metformin

A

alcohol

19
Q

contraindications of metformin

A

HHAR

Hepatic disease
Hypoxia
Alcoholism
Renal disease

20
Q

best treatment for polycycstic ovarian syndrome and what has become the leading treatment

A

best: clomiphene
leading: metformin

21
Q

what are the thiazolidinediones (TZDs)

A

Pioglitazone

Rosiglitazone

22
Q

mechanism of action of thiazolidinediones (name them)

A

pioglitazone and rosiglitazone

  • decrease insulin resistance
  • agonist of peroxisome proliferator activated receptor-gamma found in muscle, fat, liver
23
Q

what are thiazolidinediones slower onset (name them)

A

pioglitazone and rosiglitazone

because they work on gene regulations which takes weeks or even months to see their results

24
Q

AE of thiazolidinediones (name them)

A

pioglitazone and rosiglitazone

WERC

Weight gain
Edema
Retention of fluid
Congestive Heart Failure

25
Q

contraindication of thiazolidinediones (name them)

A

pioglitazone and rosiglitazone

class III and IV heart failure

26
Q

what is the alpha glucosidase inhibitor

A

Acarbose and Miglitol

27
Q

mechanism of alpha glucosidase inhibitor (name it)

A

acarbose and miglitol –> competitive inhibitor of intestinal alpha glucosidase –> reduces the post prandial digestion and absorption of starch and disaccharides –> inhibits upper intestinal digestion and absorption –> defer it to distal SI –> reduce post prandial hyperglycemia and hyperinsulinemia

28
Q

AE of alpha glucosidase inhibitor

A

acarbose and miglitol

mainly GI: flatulence, diarrhea, abdominal pain,

this is due to the fact that the undigested carbs from the upper GI are getting into the colon but eventually the distal SI start to express alpha glucosidase and the AEs are no longer an issue

29
Q

what would you give a patient who expresses hypoglycemia because they are taken sulfonylurea along with acarbose

A

you give them glucose and not sucrose because the disaccharide breakdown might be blocked with the acarbose

30
Q

contraindication of acarbose and miglitol

A

chronic or IBD
intestinal conditions
Kidney diease
Hepatic disease

anything that might be worsened with gas or flatulence

31
Q

what is the incretin analogue

A

Exenatide

32
Q

mechanism of incretin analogue

A

exanatide is an agonist of glucagon like peptide-1 receptor –> enhances glucose dependent insulin secretion, suppresses post prandial glucagon release, slows gastric emptying which slows nutrients entry into circulation, decreases appetite, and stimulates beta cells proliferation

33
Q

AE of exenatide

A

VAND

Vomiting
ACUTE PANCREATITIS
Nausea
Diarrhea

34
Q

contraindication of exenatide

A

gastroparesis (spontaneous movement of muscle in stomach not functioning properly)

35
Q

DPP IV inhibitor

A

Sitagliptin

36
Q

mechanism of DPP IV inhibitor

A

Sitagliptin –> increases circulating GLP-1 and insulin levels and decreases glucagon levels

37
Q

AE of DPP IV inhibitor

A

Sitagliptin

Pancreatitis
Hypersensitivity reaction

38
Q

amylin analogue

A

Pramlintide

39
Q

mechanism of amylin analog

A

Pramlintide inhibits food intake, gastric emptying, and glucagon release

40
Q

AE of amylin analog

A

Pramlintide

ANOREXIA
nausea
headache
vomiting

41
Q

Contraindication of Pramlintide

A

gastroparesis just like Exenatide

Pharmacology (79 decks)

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