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Drugs for Diabetes
| Term | Definition |
|---|---|
| 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
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