Diabetes medications

Question 1

glipizide, glimepiride, glyburide

Answer 1

sulfonylureas
insulin secretagouge
stimulate ATP sensitive K channels-> depolarization-> Ca influx->insulin secretion
intermediate-long lasting, taken with meals
glucose independent
AE Hypoglycemia

Question 2

Meglitinides

Answer 2

secretagouge
see sulfonylureas for mechanism
short acting, taken just before meal
glucose independent
AE Hypoglycemia

Question 3

Etanatide, liraglutide

Answer 3

GLP-1 agonist
secreteagouge
glucose dependent
slows gastric emptying and causes 5 pound weight loss
no hypoglycemia
AE nausea, pancreatitis

Question 4

sitagliptin, saxagliptin, linagliptin

Answer 4

DPP-IV inhibitors
secretagouge
block enzyme that degrades GLP-1-> lengthens half life
glucose dependent
no weight loss
no hypoglycemia
pancreatitis

Question 5

metformin

Answer 5

biguanides
blocks mGPD (Glycerophosphate dehydrogenase)
decreases liver gluconeogenesis
increases lactate
first line for DM2
does not effect sensitivity in muscle or fat
no weight gain
no hypoglycemia
AE Nausea, abdominal pain, bloating diarrhea
theoretical lactate damage with heart failure or renal failure

Question 6

pioglitazone

Answer 6

thiazolidinediones
insulin sensitizer
PPAR gamma agonist
primarily in adipose: increase FA uptake and storage, increased glucose uptake
skeletal muscle: increased glucose uptake
decrease in plasma FFA
no hypoglycemia
AE Weight gain (mostly in extremities, drop in visceral fat), fluid retention (CI CHF), increased CVD

Question 7

canagliflozin

Answer 7

sodium-glucose cotransporter 2 (SGLT2) inhibitors
increases excretion in the urine
acts on PCT
no hypoglycemia
decreases BP
5 pound weight loss
AE vulvovaginal candidiasis, uti
Diabetic ketoacidosis

Question 8

Acarbose

Answer 8

Alpha glucosidase inhibitors
block breakdown of complex carbohydrates
tx post pradrial hyperglycemia
no associated hypoglycemia
AE flatuents and diarrhea

Question 9

Long acting insulin

Answer 9

Glargine (lantis)

determir

Question 10

Medium acting

Answer 10

NPH

Question 11

Short acting

Answer 11

Regular (6 hours)
aspart (novolog)
lispro (humalog)
glulisine

Question 12

DM tx goal

Answer 12

A1c less than 7
DM2 treat CV risk
BP less than 140/90
lipids less than 70
smoking cessation
ASA prophylaxis
statin for all
ACEI