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Drugs for Diabetes

Type I Diabetes develops during childhood, causes destruction of pancreatic beta cells
Type II Diabetes insulin resistance and impaired insulin secretion
Diabetic Ketoacidosis severe insulin deficiency, causes hyperglycemia, ketoacids, acidosis, and coma
Bicarbonate treats acidosis in DK
Diagnosis of DM HgbA1C >6.5%, fasting glucose >= 126, casual glucose >= 200, OGTT 2hr glucose >=200
Primary goal of DM tx prevent long-term complications, control glucose, control BP and lipids levels
Step 1 in tx of Type II DM initiate lifestyle changes with metformin
Step 2 in tx of Type II DM initiate lifestyle changes with metformin and add a 2nd drug
Step 3 in tx of Type II DM 3 drug combination
Step 4 in tx of Type II DM more complex insulin regimen
Rapid Acting Insulin short duration: Lispro, Aspart, Glulisine
Slower Acting Insulin short duration: regular
Intermediate duration Insulins NPH, Detemir
Long duration Insulins Glargine
Mixing Insulin Only NPH with short-acting & short-acting should be drawn first
Non-DM uses of insulin hyperkalemia (promote updake of K+) and dx of GH deficiency
Complications of Insulin Tx hypoglycemia, lipohypertrophy, allergic rxn, hypokalemia, drug interactions
Drugs that interact with Insulin sulfonylureas, glinides, ETOH, thiazide diuretics, glucocorticoids, sympathomimetics, and beta blockers
Biguanides Prototype Metformin
Metformin decrease insulin resistance by inhibiting glucose production in the liver, reducing glucose absorption in gut, and increasing glucose uptake
Side effects of Metformin GI disturbances, lactic acidosis, has NO WEIGHT GAIN
Drug interactions for Metformin ETOH-can intensify lactic acidosis
1st Generation Sulfonylureas tolbutamide, Tolazamide, Chlorpropamide
2nd Generation Sulfonylureas glyburide, glipizide, glimepride
Sulfonylurea MOA promote insulin release from pancreas
Sulfonylureas Side Effect hypoglycemia, WEIGHT GAIN, cardiotoxicity....avoid in pregnancy and lactation
Drugs that interact with Sulfonylureas ETOH, beta-blockers, hypoglycemic-inducing drugs
Meglitinide Drugs Repaglinide (Prandin), Nateglinide (Starlix)
Meglitinide MOA stimulate beta cells to release insulin
Meglitinide side effects well tolerated, can cause hypoglycemia
Drugs that interact with Meglitinides Gemfibrozil (Lopid)-inhibits metabolism of repaglinide and cause hypoglycemia
Thiazolidinediones Drugs Rosiglitazone (Avandia), Pioglitazone (Actos)
Thiazolidinediones MOA reduce glucose by decreasing insulin resistance. Increases the number of glucose transporters by stimulating transcription of PPARs.
Side Effects of Thiazolidinediones low risk of hypoglycemia when used alone, WEIGHT GAIN, liver toxicity, heart failure
Alpha-Glucosidase Inhibitors Acarbose (Precose) and Miglitol (Glyset)
MOA of Alpha-Glucosidase Inhibitors inhibits alpha-glucosidase, an enzyme that breaks down starch to glucose so it can be absorbed, delays absorption of carbohydrates
Side effects of Alpha-Glucosidase Inhibitors flatulence, cramps, abd distention, borborygmus, diarrhea, and liver dysfunction
DPP-4 Inhibitors (Gliptin) Drugs Sitaglipitin, saxagliptin, vildagliptin, linagliptin, alogliptin
DPP-4 Inhibitors MOA promote glycemic control by enhancing the actions of incretin hormones
Side effects of DPP-4 Inhibitors well tolerated, NO WEIGHT GAIN, NO HYPOGLYCEMIA
SGLT-2 Inhibitor Drugs Canagliflozin, dapagliflozin, empagliflozin
SGLT-2 Inhibitor MOA block reabsorption of filtered glucose int he kidney, leading to glucosuria
SGLT-2 Inhibitor Side effects genital fungal infections in females, urinary tract infections, increased urination
Pramlintide (Symlin) Amylin mimetic....synthetick analog of amylin, peptide hormone co-released with insulin (NON-INSULIN INJECTABLE)
Pramlintide MOA reduces post-prandial levels of glucose, delays gastric emptying and increases full sensation. Compliments the effects of insulin
Pramlintide Side effects severe hypoglycemia and nausea
Incretin Mimetics (GLP-1 receptor agonists) Exanatide, liraglutide, dulaglutide, albiglutide
Incretin Mimetics (GLP-1 receptor agonists) side effects hypoglycemiia, GI effects, pancreatitis
HGB A1C average of blood glucose levels over the past 2-3 months
Created by: julzbanks