Diabetes Final Study

Question 1

Metformin

Answer 1

MOA: activates AMPK
(increase AMPK in hepatocytes and SKM –> decrease ATP consumption while increase ATP production –> increase insulin sensitivity –> decrease glucose –> decrease insulin)

AEs:
GI (D/N, metallic taste, decreased B12 abs)
Lactic acidosis (risk factors: decrease kidney function, low O2, liver diseases/XS ETOH)

CI: Pregnancy

*Improves lipid profile
*decreases LDL, decreases, TG, increases HDL

Question 2

Pioglitazone, Rosiglitazone

Answer 2

MOA: PPRA(gamma) agonist –> gene transcription
(increase good adipocytokines, decreases bad adipocytokines, inflammatory cytokines)

AEs: edema (Na/H2O rtn) –> weight gain
bone loss
hepatotoxiciy

CI: HF, bladder CA, bone fractures, liver disease

*Improves lipid profile (Pio)
*Slow onset effects (1-2wk onset, 2-3 months max effect)

Question 3

Glimerpiride, Glipizide, Glyburide, Nateglinide, Repaglinide

Answer 3

MOA: inhibit K channels –> increase insulin secretion
(inhibit/close K channels –> depolarization –> open VG Ca2+ channels –> increase insulin secretion)

AEs:
Hypoglycemia (palpitations, sweating, tremor, anxiety, hunger, etc)
-risk factors: exercise/ skip meal, high drug dose, XS ETOH, impaired renal/liver function
Weight gain

CI: renal impairment

*does not work on T1DM pts

Question 4

Glimerpiride, Glipizide, Glyburide, Nateglinide, Repaglinide

Answer 4

MOA: inhibit K channels –> increase insulin secretion
(inhibit/close K channels –> depolarization –> open VG Ca2+ channels –> increase insulin secretion)

AEs:
Hypoglycemia (palpitations, sweating, tremor, anxiety, hunger, etc)
-risk factors: exercise/ skip meal, high drug dose, XS ETOH, impaired renal/liver function
Weight gain

CI: renal impairment

*does not work on T1DM pts

Question 5

Exenatide, Lixisenatide, Liraglutide, Dulaglutide, Semaglutide

Answer 5

MOA: stimulated glc-mediated insulin secretion (Gs coupled) (dependent on depolarization)

AEs:
GI: (N/V/D)
Weight loss (decrease appetite, decrease gastric emptying) (Lira)

CI: Medullary thyroid cancer, pancreatitis

*administer SC
*decrease CV risk (Lira)

Question 6

Sitagliptin, Linagliptin, Saxagliptin, Alogliptin

Answer 6

MOA: inhibit DPP4 –> decrease breakdown of GLP1

AEs: increase upper respiratory infection
well tolerated

CI: HF

*doesn’t share AEs with GLP1 agonists
*breaks down many peptides

Question 7

Canagliflozin, Dapagliflozin, Empagliflozin

Answer 7

SGLT2 Inhibitor

MOA: inhibits SGLT2 –> increase U(glc)V

AEs:
Amputations (Cana)(neuropathy, foot lesions, etc)
UTIs
Hypotension (acts as osm. diuretics)
AKI
euglycemic DKA

CI: severe renal impairment

*decrease CV risk
*weight loss

Question 8

Insulin

Answer 8

MOA: increase glc uptake into adipose tissue and SKM –> decrease hepatic glc production

AEs:
hypoglycemia
weight gain