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Pharm 2 > Class 11 Deck 2 > Flashcards

Class 11 Deck 2 Flashcards

1
Q

When are oral hypoglycemics used?

A

-Control glucose in type 2

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2
Q

What are sulfonylureas MOA?

A
  • Act at pancreas to release insulin

- Decreases insulin resistance

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3
Q

What are the failure rates of sulfonylureas?

A
  • 20% primary

- 10-15% secondary

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4
Q

When should sulfonylureas be avoided?

A

-With a patient with a sulfa allergy

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5
Q

What are the pharmocokinetics of sulfonylureas?

A
  • Metabolized by liver
  • Excreted by kidneys
  • Active and inactive metabolites
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6
Q

Sulfonylureas most severe side effect? and what drugs have the greatest risk?

A
  • Hypoglycemia

- One’s w/ longest half life (glyburide and chlorproamide)

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7
Q

can Sulfonylureas cross the placenta?

A

yes

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8
Q

besides hypoglycemia, What are the other Sulfonylureas side effects?

A
  • Increase CV mortality by inhibiting ischemic preconditioning and less effect on lipids
  • GI disturbances (N/V, abnormal LFT’s, cholestasis)
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9
Q

Sulfonylureas should be avoided in patients with liver disease except for what drug?

A

acetohexamide

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10
Q

Tolbutamide (orinase) tidbits. {1st gen}

A
  • Shortest acting and least potent

- Fewest side effects (less potent metabolites)

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11
Q

Acetohexamide tidbits {1st gen}

A
  • hypoglycemic action from its metabolite

- Uricosuric

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12
Q

Chlorpropamide (diabinese) tidbits {1st gen}

A
  • Longest acting
  • Prolonged w/ impaired kidneys
  • Disulfiram reactions
  • Hyponatremia
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13
Q

Glyburide {2nd gen} tidbits

A
  • Single daily dose for 24 hour effects
  • Increase sensitivity to insulin
  • Decrease hepatic glucose production
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14
Q

Glipizide {2nd gen} tidbits

A
  • Stimulates insulin secretion for 12 hrs
  • increase peripheral glucose uptake
  • Suppress hepatic glucose output
  • no metabolite
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15
Q

Glimepiride {2nd gen} tidbits

A
  • Stimulate insulin secretion

- decrease hepatic glucose production

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16
Q

Name the 2 meglitinides.

A
  • Repaglinide

- Nateglinide

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17
Q

What do meglitinides do?

A

-Increase insulin secretion from islet cells

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18
Q

When should meglitinides be administered? and when should they not be administered?

A
  • 15-30 mins before meals

- While fasting

19
Q

how do meglitinides compare to sulfonylureas?

A

-Faster onset, shorter duraton

20
Q

When are meglitinides active?

A

-When in presence of glucose

21
Q

How do Alpha-Glucosidase Inhibitors work?

A
  • Decrease carbohydrate digestion

- slows absorption of glucose from GI tract

22
Q

When are Alpha-Glucosidase Inhibitors useful as monotherapy?

A

-when postprandial hyperglycemia is problem

23
Q

Name 2 Alpha-Glucosidase Inhibitors.

A
  • Acarbose

- Miglitol

24
Q

What are the benefits of Biguanides?

A
  • Inhibit glucose production by liver
  • Positive effect on lipids
  • Mild weight loss
  • Low risk of hypoglycemia
25
Q

What is the drawback of biguanides?

A

-Lactic acidosis

26
Q

Metformin is a _______ while sulfonylureas are _______.

A
  • Antihyperglycemic

- Hypoglycemic

27
Q

_____________ produces satisfactory results in 50% of the sulfonylurea failures

A

Metformin

28
Q

What are the intraop metformin considerations?

A
  • Lactic acidosis

- Increased nephrotoxicity (IV contrast)

29
Q

How is metformin eliminated?

A
  • Not plasma bound or metabolized

- Excreted by kidneys (cautious in renal patients)

30
Q

What is metformins MOA?

A
  • Inhibits gluconeogenisis in kidney and liver
  • Requires insulin (does not stimulate insulin secretion)
  • Decreases triglycerides and cholesterol
31
Q

What are the metfromin side effects?

A
  • Anorexia
  • Nausea
  • Diarrhea
  • Lactic acidosis (rare)
32
Q

Name 2 Thiazolidinediones.

A
  • Pioglitazone (actos)

- Rosiglitazone (avandia)

33
Q

how do Thiazolidinediones work?

A
  • decrease insulin resistance in skeletal muscle and adipose tissue (more glucose to tissue and out of blood)
  • Requires insulin
  • Decrease hepatic glucose output
  • Decrease triglycerides and increase HDL and LDL
  • Effective in the obese
34
Q

side effects of Thiazolidinediones

A
  • Weight gain

- Liver dysfunction

35
Q

name the 3 Dipeptidyl Peptidase 4 (DPP-4) Inhibitors

A

-The gliptins

36
Q

what are the Dipeptidyl Peptidase 4 (DPP-4) Inhibitors MOA

A
  • Increase pancreas insulin secretion
  • Limit glucagon
  • Slow gastric emptying
  • Promote satiety
37
Q

side effects of Dipeptidyl Peptidase 4 (DPP-4) Inhibitors

A
  • URI ad UTI
  • Headache
  • Pancreatitis
  • angioedema
  • Stevens johnson
  • anaphylaxis
38
Q

Name the 2 types of incretin mimetics

A
  • GLP-1 (byetta and victoza)

- Amylin analogs (Symlin)

39
Q

What do GLP1 do?

A
  • Prolong gastric emptying

- Reduce postprandial glucagon secretion

40
Q

What do amylin analogs do?

A
  • Increase insulin
  • slow gastric emptying
  • increase beta cell growth
  • appetite suppression
41
Q

name the Sodium-Glucose co-Transporter 2 (SGLT2) Inhibitor. and what does it do?

A
  • Invokana

- Increase urinary glucose secretion

42
Q

when is invokana contraindicated?

A
  • CrCl < 30
  • ESRD
  • dialysis
43
Q

When should Byetta be avoided? Victoza?

A
  • Renal failure

- Thyroid carcinoma

Pharm 2 (23 decks)

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