Sketchy Pharm: Metformin, Thiazolidinediones, Pramlintide, SGLT2 Inhibitors Flashcards
The first line treatment for type 2 diabetes is _____________.
metformin
What is the mechanism of metformin?
It decreases hepatic gluconeogenesis by inhibiting the mitochondrial enzyme glycerophosphate dehydrogenase (think of the girl –whom the METaphOR-wielding boy is trying to woo –who is biting a mitochondria-shaped candy).
Also, it activates AMPK, an enzyme that also works to inhibit gluconeogenesis. (Think of the AMPKandy bag.)
Lastly, it increases peripheral insulin sensitivity (like the open Valentine’s mailbox on the bench by the metformin metaphor boy).
What side effects can metformin cause?
Lactic acidosis from impaired gluconeogenesis (think of the spilled, spoiled milk). This needs to be thought of in patients with renal failure, because metformin is just excreted unmodified by the kidneys (think of the cracked, kidney-shaped tray that the lactic acid is on).
Also, GI upset can be caused (like the green-faced girl about to barf at the metformin boy).
What are the thiazolidinedione drugs?
Rosiglitazone and pioglitazone (think of the girl reading “ROSes are red” on the GLITter-covered card)
What is the mechanism of thiazolidinediones?
They act on peroxisome proliferator-activated receptor gamma (PPAR-gamma), an intracellular nuclear receptor that increases glucose uptake and decreases glucose production (like the “life of the PPARy” shirt that the thiazolidinedione boy is wearing). One of the proteins expressed is adiponectin (like his turtleneck). Another protein is GLUT4 (like the GLUT4 mailbox).
Explain the unique relationship between the thiazolidinediones and weight gain.
Thiazolidinediones lead to increased fatty-acid storage in adipocytes differentiation of adipocytes, leading to decreased triglyceride levels and weight gain.
(Think of the boy eating doughnuts to represent fat storage.)
True or false: thiazolidinediones take days to weeks to become effective.
True. Because it works by increasing gene expression, it takes time.
Which non-insulin-raising diabetic meds increases weight gain?
The thiazolidinediones –”they put extra GLIT in your ZONE”
What big side effect do you need to worry about with the thiazolidinediones (not related to weight gain)?
Peripheral edema due to increased fluid retention (like the thiazolidinedione boy’s baggy pants) – do not give to patients with CHF (like the baggy heart being crushed by the boy’s chair)
The non-insulin-raising drug that acts on the peroxisome proliferator-activator receptor gamma can cause which side effect that is especially common in older women?
Osteoporosis (think of the boy’s chair, which has a femur-shaped leg that is breaking)
What cells normally secrete amylin?
The pancreatic islet cells that also secrete insulin! Amylin is secreted with insulin and acts to decrease glucagon and delay gastric emptying (just like the full, stomach-shaped water cooler and torn glucagon packets next to the furious AMY and LyNn who were asked out by the same boy).
The analogue is pramlintide.
Pramlintide can be used to treat the _______________ in both types of diabetes.
postprandial glucose spike
The two main side effects with pramlintide are _____________.
hypoglycemia (the falling candy jar that AMY is kicking) and nausea (Brayden getting sick at the embarassment)
These two drugs work by inhibiting intestinal-brush-border alpha glucosidase: _________________.
acarbose (A-Carb candies) and miglitol (wIgGLer candies)
The alpha glucosidase work to ____________.
delay glucose absorption (just like the frustrated boy is delayed in eating his Wiggler gummy worms)
