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Pharm II > Exam 1 - oral diabetic agents > Flashcards

Exam 1 - oral diabetic agents Flashcards

(51 cards)

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1
Q

Sulfonylureas

A

1: tolbutamide*, tolazamide, chlorpropamide
2: glyburide, glipizide, glimeperide

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2
Q

why are 2nd generation sulfonylureas better than 1st generation?

A
  • less side effects
  • less protein binding & drug interactions
  • more potent
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3
Q

why use tolbutamide if using 1st generation sulfonylureas?

A
  • shortest duration of effect (6-12 hours)

- SE gone faster than others

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4
Q

DOA of chlorpropamide & 2nd generations

A

chlorpropamide - more than 46 hours

2nd generation - 12-24 hours

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5
Q

MOA of sulfonylureas?

A
  • bind receptor to increase insulin secretion
  • increase insulin sensitivity
  • decrease hepatic glucose production
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6
Q

ADRs of sulfonylureas?

A
  • severe hypoglycemia
  • weight gain (2-12 lbs)
  • anemia
  • sun sensitivity, itch, rash
  • disulfiram (chloropropamide & tolbutamide)
  • metallic taste
  • GI (N, V, dyspepsia)
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7
Q

contraindications of sulfonylureas?

A
  • advanced kidney or liver disease
  • T1DM
  • pregnancy
  • sulfa-allergy
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8
Q

problem with long term use of sulfonylureas? causes?

A

secondary failure due to:

  • decreased beta cells
  • decreased physical activity
  • increased fat
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9
Q

meglitinides

A

nateglinide* (less hypoglycemia)

repaglinide

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10
Q

moa of meglitinides

A

bind receptor to increase insulin secretion during/after meals

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11
Q

peak of meglitinides? when to take meglitinides?

A

peak at 1 hour

take 30 minutes prior to meal

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12
Q

ADRs of meglitinides

A

hypoglycemia
weight gain
URI

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13
Q

MOA of metformin

A

increases #/affinity of insulin receptors in periphery:

  • decrease hepatic glucose production
  • decreases glucose uptake in gut
  • increase glucose uptake
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14
Q

Definition of euglycemic? Two euglycemic drugs?

A

Decreases high sugar without causing low sugar: No hypoglycemia!

Metformin &

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15
Q

High AM sugars?

A

metformin inhibits gluconeogenesis of liver at night and will reduce AM sugars

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16
Q

side effect of metformin inhibiting gluconeogenesis?

A

decrease ability to metabolize lactic acid

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17
Q

Drugs that do not cause weight gain?

A

metformin

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18
Q

ADRs of metformin

A
  • B12 deficiency
  • lactic acidosis
  • GI (N, V, D, bloating, flatuence)
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19
Q

what to do when giving radio contrast dye while pt is on meformin?

A

stop 1 day before and hold until 2 days after

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20
Q

contraindications of metformin

A
  • hepatic insufficiency
  • SCr greater than 1.5 (M) and 1.4 (F)
  • CrCl less than 30
  • over 80 (check renal fxn)
  • tissue hypoxia prone (old or CVD)
  • ETOH (increase hypoglycemia)
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21
Q

when to use metformin?

Study These Flashcards
A
  • pre - diabetes

- overweight T2DM

22
Q

benefits of metformin?

Study These Flashcards
A

decrease macrovascular events (MI & CVA)

23
Q

examples of thiazolidinediones

Study These Flashcards
A
  • pioglitazone

- rosiglitazone

24
Q

MOA of thiazolidinediones

Study These Flashcards
A

Bind fat cells to increase adiponectin & decrease resisting:
- increase insulin sensitivity

25
ADRs of thiazolidinediones
- hepatotoxicity (BL LFTs) * - heart failure (BBW) * - hypoglycemia with other drugs - anemia & low WBC (first 4-8 weeks) - increase HDL, decrease LDL and TG - fluid retention (increase weight and edema) * - bladder cancer (pioglitazone) - bone fractures (no osteoporosis pt)
26
contraindications of thiazolidindiones
- hepatic impairment - pregnancy - fluid retention - class 3 or 4 HF
27
alpha-glucodiase inhibitors
- acarbose | - miglitol
28
MOA of alpha-glucodiase inhibitors
inhibit digestion/absorption of starches and sucrose
29
ADRs
- GI (gas, D, pain) | - hypoglycemia with other SUs
30
contraindications
- colonic ulcers - inflammatory bowel - renal failure - partial obstruction
31
DDP-4
- sitagliptin - saxagliptin - linagliptin - alogliptin
32
MOA DDP-4
inhibit breakdown of GLP-1 - decreases glucagon - slows gastric emptying - increases satiety - increases insulin release
33
ADRs DDP-4
- hypoglycemia with SUs - URIs - UTIs - HA - sitagliptin: pacreastitis, angioedema, SJS, anaphylaxis
34
contraindications of DDP-4
pancreatitis | hypersensitivity rxn
35
MOA of GLP-1 analogs
bind GLP-1 receptor - decrease glucagon - increase satiety - slow gastric emptying - increase insulin secretion
36
GLP-1 analogs
linaglutide duraglutide exenatide
37
how to administer GLP-1 analogs
inject 1 hour before meal (as an adjunct to SU or metformin)
38
ADRs of GLP-1 analogs
- hypoglycemia with SUs | - GI: N, V, GERD (up to 4 weeks)
39
contraindications of GLP-1 analogs
- GI disorders (gastroparesis) | - CrCl
40
sodium glucose cotransporter 2
- canagliflozin (w/ metformin) - dapagliflozin (w/ metformin) - empagliflozin (w/ linagliptin)
41
MOA of SGLT2
block/delay reabsorption of glucose in PCT
42
ADRs of SGLT2
- UTIs - yeast infections - polyuria
43
contraindications SGLT2
CrCl
44
amylin MOA
slows the rate of BG rise - decreasing glucagon - increasing satiety (targets brain) - slows gastric emptying - *decreases hepatic output of glucose
45
amylin
pramlinitide
46
ADRs
- hypoglycemia (BBW) - GI: N, V, anorexia - HA (2-3 go away in 1st month)
47
contraindications
- gastroparesis - BG noncompliance - hypoglycemia unaware/freq. - A1C >9%
48
Goals for T2DM
- A1c less than 7 - FPG 70-130 - 1 hour postprandial 180 - 2 hour postprandial 150 - BP less than 140/80 - LDL less than 100 (CVD less than 80) - TG less than 150
49
drugs than only lower A1C by 0.5%
nateglinide acarbose miglitol
50
drugs that cause weight gain
SUs, meglinides, thiazoldinediones
51
drugs that don't cause weight gain
metformin, alpha-glucosease inhibitors, GLP-1

Pharm II (6 decks)

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