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46 Cards in this Set

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Aspart and Lispro are ____ acting insulins
Rapid
Gargine is a ____ acting insulin
Long
May produce Disulfiram like rxn and may also potentiate the effects of ADH --> hypOnatremia
Sulfonylureas (Tolbutamide, Chlopropamide - both 1st generations with the most SE, Glycuride, Glipizide, Glimepiride- 2nd generations with < SE)
What class of drugs is Tolbutamide in?
1st gen Sulfonylurea
What class of drugs is Chlorpropamide in?
1st gen Sulfonylurea
What class of drugs is Glyburide in?
2nd gen sulfonylurea
What class of drugs is Glipizide in?
2nd gen sulfonylurea
What class of drugs is Glimepiride in?
2nd gen sulfonylurea
Name 2 groups of drugs that bind to a distinct site on the SUR receptor of ATP-sensitive K+ channels resulting in depolarization and Ca++ influx (causing > secretion of pro-insulin)
Sulfonylureas and Meglitinides/Glinides
How are Repaglinidie and Nateglinide different from Sulfonylureas?
Rapid onset and short DOA
Contraindications for using sulfonylureas?
Pts with liver or kidney failure
Name the two long acting sulfonylureas
Chlorpropamide and Glimepiride
What type of diabetes do you use sulfonylureas in?
Type II
Do not use Meglitinides/Glinides in pts with what?
hepatic impairment
What drugs should you NOT use with Meglitinides/Glinides?
Gemfibrozil (hypoglycemia) and sulfonylureas
Azoles, erythromycin/Clarithromycin may do what to do what to the concentration of Meglitinides/Glinides?
> the effects by > the concentration (these drugs inhibit CYP34A that normally metabolizes Repaglinide and Nateglinide)
Barbs, Carbamazepine and Rifampin may do what to do what to the concentration of Meglitinides/Glinides?
May < the effects due to < concentration (these drugs > CYP34A actions)
What is the Biguanide drug?
Metformin
MOA of Metformin
> glucose uptake and use by target tissues; increases peripheral insulin sensitivity; inhibits hepatic gluconeogensis
Drug of choice for newly Dx T2D
Metformin
Name 2 SE of Metformin
Metallic taste and Lactic acidosis, also < weight, GI
Metformin is CONTRA in which pts?
Renal/Hepatic disease, ETOH use, elderly and in pts with DKA
When should you D/C Metformin?
In cases of MI, CHG, infection, contrast dyes
MOA of Thiazolidinediones "Glitazones"
Bind to PPAR-y, a nuclear hormone receptor and regulates adipocyte production and secretion of FA and glucose metabolism--> > insulin sensitivity in adipose tisse, liver and skeletal muscle
What drug class are Rosiglitazone and Pioglitazone in?
Thiazolidinediones
How do the Thiazolidinediones increase glucose uptake and utilization?
> synthesis and transport of GLUT4 and GLUT2 transporters in muscle, adipose and liver
Thiazolidinediones require what for action?
Insulin
PPARy receptor agonists
Rosiglitazone and Pioglitazone
Thiazolidinediones are CONTRA in who?
nursing mammas
SE of Thiazolidinediones?
Edema, URI, headache, Hepatotoxic?
Rosiglitazone has an MI risk
Synthetic amylin Analog
Pramlintide
MOA of Pramlintide
< carb absorption, < glucose production by th eliver; inhibits glucose sythesis in the liver
When may Pramlintide induce severe hypOglycemia?
When used with insulin and not adjusting the does of insulin (Thus, reduce the dose of SAI by 50% prior to meals!)
Name the 2 alpha-glucosidase inhibitors
Acarbose and Miglitol
MOA of Acarbose and Miglitol?
Reversibly inhibit membrane bound alpha-glucosdiase in the intestinal BB which is responsible for the hydrolyisis of oligosaccharids to tglucose and other monosaccharides; delay digestion of carbs
In what way are Acarbose and Miglitol unlike any of the other Diabetes drugs?
they neither stimulate insulin relase nore increase insulin action in target tissues; just delay the digestion of carbs
Of the two alpha glucosidase inhibitors, which is metabolized by intestinal bacteria?
Acarbose (not absorbed); Miglitol is very well absorbed but has no systemic effects
Alpha glucosidase inhibitors (Acarbose and Miglitol) are CONTRA in which pts?
IBD, colonic ulceration or intestinal obstruction
What drug group is Exenatide in?
Incretin Analog (GLP-1 analog)
MOA of Exenatide
Incretin analog; > insulin and < glucagon secretion
What group of drugs are Sitagliptin and Saxagliptin in?
DDP-IV Inhibitors
What enzyme degrades GLP-1?
Dipeptidyl peptidase-4
MOA of Sitagliptin and Saxagliptin?
DDP-IV Inhibitors
Inhibits Dipeptidyl Peptidase 4
Sitagliptin and Saxagliptin, thus < glucagon and glucose
SE of Sitagliptin and Saxagliptin
usually well tolerated, but nasopharyngitis, headache and pancreatitis
Target Blood Glucose and A1C
115 mg/Dl or less and 7% or less