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W14 Diabetes Drugs Flashcards

(55 cards)

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1
Q

What are the 10 classes of diabetes medication

A 
Biguanides 
Alpha-glucosidase inhibitors 
Sulfonylureas 
SGLT2 inhibitors 
Insulin 
meglitinides 
Thiazolidinediones 
Dipeptidyl peptidase-4 (DPP-4) inhibitors 
GLP-1 receptor agonists 
Weight loss agents
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2
Q

What are the actions of insulin on the liver ?

A

Increase glycogen synthesis
Decrease gluconeogenesis
Increase lipogenesis

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3
Q

What promotes the transport of GLUT4 ?

A

Insulin

Exercise

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4
Q

When is basal insulin used ?

A

Between meals and overnight

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5
Q

What are some short acting insulin analogues ?

A

Lispro
Aspart
Glulisine

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6
Q

What are some examples of long acting insulin analogues?

A

Glargine
Detemir
Degludec

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7
Q

What type of insulin is insulin glargine ?

A

Basal

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8
Q

What type of insulin is insulin glargine U300?

A

Basal

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9
Q

What type of insulin is insulin detemir ?

A

Basal

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10
Q

What type of insulin is insulin degludec ?

A

Basal

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11
Q

What type of insulin is regular human insulin and what are some examples ?

A

bolus
Humulin R
Novolin Toronto

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12
Q

What type of insulin are analogue rapid insulins and what are some examples ?

A

Bolus
Aspart (novorapid)
Lispro (humalog)
Glulisine (apidra)

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13
Q

What type of insulin are analogue ultra-rapid insulins and what are some examples?

A

Bolus

Ultra rapid aspart (FiAsp)

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14
Q

What is the primary site of action of biguanide ?

A

Liver

  • decrease glucose output
  • decrease insulin resistance
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15
Q

What is the primary site of action of sulfonylureas/meglitinides ?

A

Pancreas

- increase insulin secretion

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16
Q

What is the primary site of action of thiazolidinediones ?

A

Liver, stomach, adipocytes (?)

- decrease insulin secretion

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17
Q

What is the primary site of actions of DPP-4i, GLP-1 RAs

A

Pancreas, stomach, liver

  • increase insulin secretion
  • decrease glucose output
  • decrease gastric emptying
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18
Q

What is the primary site of action of SGLT2 inhibitors ?

A

Kidneys

- increase urinary glucose excretion

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19
Q

What is the primary site of action of a-glucosidase inhibitors ?

A

Intestines

- decrease carb breakdown and absorption

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20
Q

What class of diabetes medication does metformin belong to?

A

Biguanide

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21
Q

What are some examples of sulfonylureas ?

A

Glyburide
Gliclazide
Glimepiride

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22
Q

What is the mechanism of action of metformin?

A

Liver:
Decrease gluconeogenesis, glycogenolysis, fatty acid oxidation
Intestines:
- increase anaerobic glucose metabolism
Skeletal muscle:
- decrease glucose uptake, glycogenolysis, fatty acid oxidation

Anti-oxidant properties on endothelial cells

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23
Q

Advantages of metformin

Study These Flashcards
A

Glucose lowering
Durable effect
No weight gain, CV side effects, hypoglycaemia

24
Q

Side effects of metformin

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A

GI side effects (start low, go slow)

Rare lactic acidosis

25
Metformin dose
250-500 mg BID | Maximum 1000 mg BID or 2500 mg in divided doses
26
Examples of short acting secretogogues
Repaglinide | Nateglinide
27
Mechanism of action of sulfonylureas
``` Block K(ATP) channel —> stimulate insulin secretion ```
28
Advantages of sulfonylureas ?
Inexpensive Easy to administer Effective glucose lowering
29
Disadvantages of sulfonylureas ?
Weight gain Hypoglycaemia Durability ? Effects beta cell function ?
30
Examples of DPP-4 inhibitors
Alogliptin Linagliptin Saxagliptin Sitagliptan
31
Examples of short acting GLP-1 receptor agonists
Exenatide Lixisenatide Liraglutide
32
Long acting GLP-1 RAs
Exenatide LAR Dulaglutide Semaglutide
33
Mechanism of action of incretins
- reduce gastric emptying - reduce appetite - increase insulin secretion - decrease glucagon secretion - decrease hepatic glucose output
34
Advantages of DPP-4 inhibitors
Glucose lowering | No weight gain
35
Advantages of GLP-1 RAs
Possible weight loss Glucose lowering CV benefit
36
Disadvantages of GLP-1 RAs ?
Cost/coverage Injectable Nausea Cholelithiasis
37
Disadvantages of DPP-4 inhibitors
Cost/coverage Nasal stuffiness Increased risk of heart failure (saxagliptin)
38
Examples of SGLT2 inhibitors
Canagliflozin Dapagliflozin Empagliflozin Ertugiflozin
39
Mechanism of action of SGLT2 inhibitors
Urinary glucose excretion
40
Advantages of SGLT2 inhibitors
``` Easy to administer Effective glucose lowering Weight loss Lowers BP Low risk of hypoglycaemia CV benefit in high risk patients ```
41
Disadvantages of SGLT2 inhibitors
``` Polyuria Volume depletion Hyperkalemia Orthostatic hypotension Yeast infections Euglycemic DKA Increase risk of amputation (canagliflozin) ```
42
Mechanism of action of thiazolidinediones (TZDs)
- reduce insulin resistance - modifies adipocyte differentiation - inhibits VEGF-induced angiogenesis - reduces lepton levels —> reduced appetite
43
Advantages of TZDs?
Easy to administer Effective glucose lowering Durable
44
Disadvantages of TZDs
``` Cost/coverage Weight gain Edema Worsening CHF Distal bone fractures ```
45
Examples of TZDs
Pioglitazone | Rosiglitazone
46
Example of a-glucosidase inhibitor
Acarbose
47
Mechanism of action of a-glucosidase inhibitors
Inhibits breakdown of non-absorbable complex poly-saccharides Reduces mono-saccharide absorption
48
Advantages of a-glucosidase inhibitors
Not systemically absorbed | Targets post prandial glucose
49
Disadvantages of a-glucosidase inhibitors
Modest A1C lowering GI side effects (gas, bloating, flatulence) Multiple daily dosing
50
What is first line treatment for T2D?
Metformin
51
What are the A1C target guidelines ?
Adults, T2D, low risk of hypoglycaemia: <6.5% Most adults, T1D or T2D: <7% Frail elderly, limited life expectancy, recurrent hypoglycaemia: 7.1-8.5%
52
When after diagnosis should A1C target be reached?
3-6 months
53
Initial therapy choice if A1C <1.5% over target
Heathy behaviour, start metformin if not at target in 3 months Or Metformin + healthy behaviour
54
Initial therapy if A1C>1.5% over target
Metformin + healthy behaviour And Consider second concurrent agent
55
When should initial therapy for T2D include insulin +/- metformin?
Symptomatic Hyperglycaemia And/or Metabolic decompensation

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