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Flashcards in Exam 7: Diabetes Deck (33)
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1
Q

Thiazolidinediones uses

A

Type 2 diabetes
Pioglitazone is only one commonly prescribed
Taken daily in combo with other drugs for diabetes
Effects are mediated by gene expression, so it may take 1-3 months to see benefits

2
Q

Name 1 alpha-glucosidase inhibitor

A

Acarbose

3
Q

Acarbose

A

Alpha-glucosidase inhibitor
Used for type 2 DM, pre diabetes
Slowly titration up to desired dose
Inhibits enzymes that break down complex carbs
Delays and spreads out absorption of glucose after meals
Minimally absorbed
If a patient on Acarbose gets hypoglycemic, they need to get glucose or dextrose, not sucrose which requires alpha-glucosidase to be broken down

4
Q

Acarbose adverse effects

A

GI disturbances
Flatulence, diarrhea, abdominal pain
Side effects get less prominent over time due to up regulation of alpha-glucosidases in the distal small intestines

5
Q

Acarbose contraindications

A

IBD
Renal impairment
Other GI problems

6
Q

Which bile acid sequesterant can be used in treatment of DM?

A

Colesevelam

7
Q

Pramlintide

A

Amylin analog, acts on receptor in hindbrain
Suppresses Glucagon release, delays gastric emptying….
Can cause nausea, weight loss, hypoglycemia.
Adjunct to insulin therapy, must be injected separately
Lowers amount of insulin need, mealtime insulin doses should be reduced by about 50%

8
Q

Pramlintide contraindications

A

Gastroparesis or any other GI motility disorder

9
Q

GLP-1 agonist

A

Exenatide

10
Q

Exenatide

A

Synthetic exenidin 4, an incretin
Glucagon like peptide 1 receptor agonist
Therapy for type DM
Causes increased insulin synthesis and secretion in a glucose dependent manner (as opposed to sulfonureas). Less likely to cause hypoglycemia
Also causes delayed gastric emptying and decreased appetite
Also suppresses post prandial glucagon release
Rapidly absorbed after injection
GI disturbances are a common side effect

11
Q

Liraglutide

A

GLP1 agonist
Like Exenatide, but is more slowly absorbed. It also binds to albumin, slowing its metabolism
Black box warning, not for use in patients with family history of medullary cancer or multiple endocrine neoplasia type 2

12
Q

GLP1 agonist adverse effects

A
GI disturbances
Weight loss
Hypoglycemia maybe 
Pancreatitis
Can alter pharmacokinetics of drugs that require Rapid GI absorption
13
Q

GLP1 contraindication

A

Pancreatitis

14
Q

DPP-4 inhibitors

A

Sitagliptin

Other gliptins

15
Q

Sitagliptin

A

DPP-4 inhibitor
Increases levels of circulating incretins
Can be taken orally
Result in increased insulin, decreased glucagon release after meals

16
Q

DPP-4 adverse effects

A
Increased risk of infection
Headache
Hypoglycemia when combined with a sulfonurea
Hyper sensitivities
Pancreatitis
17
Q

Saxagliptin

A

DPP-4 inhibitor that is a prodrug, doses need to be adjusted with CYP inhibitors

18
Q

SGLT2 inhibitors

A

Canagliflozin

Other flozins

19
Q

Canagliflozin

A

SGLT2 inhibitor
Decreased glucose reabsorption in kidneys
Increase risk of genital mycotic infections, UTIs
Contraindication = severe renal impairment

20
Q

Glucagon

A

Peptide produced by pancreatic alpha cells
Used for emergency treatment of severe hypoglycemia when patient is unconscious and intravenous glucose isn’t feasible
Also treats beta blocker overdose
Binds to G protein receptor, increases cAMP
Raises blood glucose (glycogenolysis)
Can cause nausea, vomiting, hypertension, tachycardia

21
Q

Contraindications for Thiazolidinediones

A

Pregnancy
Hepatic impairment (periodic liver function tests required)
Heart failure

22
Q

Sulfonureas Mechanism

A

Increase secretion of endogenous insulin

Inhibit K ATP channels in pancreatic Beta cell membranes

23
Q

Name 1 Sulfonurea

A

Glyburide

24
Q

Glyburide

A

Sulfonurea

25
Q

3 Side effects of Sulfonureas (glyburide)

A

Hypoglycemia, weight gain, sulfa allergy

26
Q

Contraindications for Sulfonureas (glyburide)

A

Hepatic or renal impairment could compromise metabolism or excretion of the drug
Pregnant/breastfeeding women (teratogenic)
Patients especially susceptible to hypoglycemia (elderly, acute cardiovascular disease)

27
Q

Clinical Uses of Sulfonureas

A

Glyburide
Used to treat DM type II.
They get less effective as pancreatic beta cells lose function
Widely used, often with metformin, thiazolidones.

28
Q

Name one Meglitinide

A

Repaglinide

29
Q

Repaglinide

A

Meglinitide
Like sulfonureas, increases endogenous insulin secretion by inhibiting K ATP channels
May cause hypoglycemia, weight gain
Use with caution in patents with renal/hepatic impairment
Nateglinide may be safer for those with renal/hepatic impairment

30
Q

Meglinitide Uses/Advantages

A

(Repaglinide, nateglinide)
Treats DM type II
Pre-prandial delivery because they are more rapidly acting than sulfonureas.
Safe for those with sulfa allergies

31
Q

Name two Thiazolidinedione

A

Pioglitazone

Rosiglitazone

32
Q

Thiazolidinedione Mechanism

A

Increase insulin sensitivity in tissues by being Peroxisome proliferator-activated receptor gamma (PPARγ) agonists
These are nuclear receptors that regulate genes involved in glucose and lipid metabolism

33
Q

What are the two most common side effects of Thiazolidinedione?

A

Weight gain and edema (edema may lead to CHF)
May also increase risk of osteoporosis in women.
Pioglitazone may increase risk of bladder cancer