oral diabetic drugs

MOA of biguanides

Decrease glucose production in the liver, decreases intestinal glucose absorption, and improves insulin sensitivity of peripheral tissues

MOA of sulfonylureas

block the ATP sensitive potassium channel in pancreatic beta cells and this lead to increased release of insulin

MOA of meglitinides

block the ATP sensitive potassium channel in pancreatic beta cells and this lead to increased release of insulin

MOA of thiazolidinediones

increase the effects of insulin on fat tissue by binding to the PARP-gamma nuclear receptor and increasing transcription of insulin responsive genes

MOA of DPP-4 inhibitors

increase the amount of incretin peptides available to stimulate insulin release by inhibiting the dipeptidyl peptidase 4 (DPP-4) which degrades incretin

MOA of SGLT2 inhibitors

increase excretion of glucose from the blood to the urine in the kidneys by blocking the sodium-glucose co-transporter that resorbs glucose in the kidneys

MOA of alpha-glucosidase inhibitors

reduces breakdown of starch and other poly-, oligo-, and disaccharides in the GI by blocking glucosidase enzymes

MOA of bile acid sequestrant for glucose control

unknown

MOA of dopamine agonist for glucose control

unknown

examples of biguanides

Metformin

Glucophage

Metformin

boxed warning of metformin

lactic acidosis

examples of sulfonyureas

Glyburide

Glipizide

Glimepiride

Glucotrol

glipizide

Amaryl

glimepiride

Micronase

glyburide

Examples of Meglitinides

Repaglinide

Nateglinide

Prandin

repaglinide

Starlix

nateglinide

examples of thiozolidinediones

-pioglitozone

-rosiglitazone

boxed warning of thiazolidinediones

CHF

Actos

pioglitazone

Avandia

rosiglitazone

examples of DPP-4 inhibitors

Sitagliptin

Saxagliptin

Linagliptin

Alogliptin

Januvia

sitagliptin

Onglyza

saxagliptin

Tradjenta

linagliptin

Nesina

alogliptin

examples of SGLT2 inhibitors

Canagliflozin

Dapagliflozin

Empagliflozin

Invokana

canagliflozin

Farxiga

dapagliflozin

Jardiance

empagliflozin

examples of alpha-glucosidase inhibitors

Acarbose

Miglitol

Precose

acarbose

Glyset

miglitol

examples of bile acid sequestrant

colesevelam

Welchol

colesevelam

examples of dopamine agonists

Bromocriptine

Cycloset

Bromocriptine

in what section of the prescribing information is pregnancy interactions listed

section 8

where is metformin's major effect

liver

metformin has little effect on _____ persons

normoglycemic

true or false: metformin stimulates insulin release

false

indication of metformin

adjunct to diet and exercise to improve glycemic control in diabetic patients

contraindications of metformin

renal impairment, acute or chronic acidosis

sulfonylureas ______ the release of insulin from pancreatic beta cells

increases

what is the binding site of sulfonyl ureas

SUR1 subunit (sulfonyl urea unit)

what subunits form the pore and facilitate ion flux

Kir6.2

what generation of sulfonylureas are glyburide, glipizide, and glimepiride a apart of

second

what part of the sulfonylureas makes second generations more favorable

cyclohexane ring

what are sulfonylureas bound to in plasma

proteins (albumin)

drugs that could potentiate the effects of sulfonylureas

sulfonamides, clofibrate, dicumarol, salicylates, phenylbutazone

contraindications of sulfonylureas

-type 1 DM

-significant hepatic or renal insufficiency

why do we take sulfonylureas before a meal

we can counteract the glucose drop with a meal

precautions of glipizide

-hypoglycemia

-hemolytic anemia with G6PD deficiency

-pregnancy

-lactation

meglitinides have no ____ and ____ in their structures

urea, sulfonyl chemical group

what drug class can be used with sulfonylurea allergy

meglitinides

meglitinides are metabolized hepatically by

CYP3A4

adverse reactions of meglitinides

hypoglycemia if meal not taken

thiazolidinediones affect _____ homeostasis in the liver, fat, and muscle tissue

glucose

what are selective agonists for nuclear peroxisome proliferator-activated receptor-gamma (PPAR-gamma)

thiazolidinediones

What is PPAR-gamma?

nuclear receptor for fatty acid and prostaglandin metabolites

what does PPAR-gamma regulate

transcription of insulin-responsive genes that regulate carbohydrate and lipid metabolism

major site of thiazolidinediones

adipose tissue

thiazolidinediones require _____ to be present for their action

insulin

drug interactions of Actos

-strong CYP2C8 inhibitors (gemfibrozil) increase pioglitazone concentrations

-CYP2C8 inducers (rifampin) may decrease pioglitazone concentration

what inactivates GLP1 and GIP

DDP-4

contraindication of januvia

-acute pancreatitis

-renal failure

-hypoglycemia

-joint pain

adverse reactions of januvia

URIs, nasopharyngitis, and headache

true or false: alpha glucosidase inhibitors can be used in both type 1 and 2 DM

true

alpha glucosidase inhibitors (do or do not) stimulate insulin release and do not cause hypoglycemia

do not

side effects of alpha glucosidase inhibitors

bacterial fermentation of undigested carbohydrates

contraindications of alpha glucosidase inhibitors

-hypersensitivity

-diabetic ketoacidosis

-cirrhosis

-IBD

-colonic ulcer

-partial intestinal obstruction

where is SGLT2 located

proximal tubule

______ inhibitors allows more glucose to pass into the urine and to be excreted

SGLT2

contraindications of SGLT2 inhibitors

severe renal impairment

adverse effects of SGLT2 inhibitors

-female genital mycotic infections

-UTIs

contraindications of bile acid sequestrants

-bowel obstruction

-hypertriglyceridemia induced pancreatitis

drug interactions of bile acid sequestrants

reduces levels of glyburide, levothyroxine, and oral contraceptives containing ethinyl estradiol and norethindrone

contraindications of Cycloset

-syncopal migraines

-breastfeeding (inhibits lactation)