Pharmacology Diabetes (oral drugs)
What do sulfanolyureas dp?
stimulates the secretion of insulin
What kind of patients take sulfanolureas (glyburide)?
patients that still have beta cell production in pancreas (T2)
What are sulfonylureas known to be?
the oldest group of oral medications for T2DM
What does a patient need to have with them at ALL times if they take glyburide?
carry a rapid acting carb (juice, sugar cube, etc.)
What is an effect of glyburide?
decreasing BP and managing postprandial hyperglycemia
When should a person take glyburide?
30 minutes before meals to prevent hypoglycemia
glyburide contraindications
sulfa allergy, severe renal/hepatic impairment, pregnant/lactating, pituitary/thyroid disorders.
What are biguanides?
the initial drug of choice for T2D
what is biguanide's prototype drug
metformin
Metformin is?
THE FIRST LINE FOR DM THERAPY
Does metformin bind to plasma proteins in the SI for circulation?
NO
what does metformin do?
decreased the production of glucose in the liver/intestinal absorption of glucose to increase insulin sensitivity = increased uptake of glucose
Metformin BBW
risk for lactic acidosis (so WITH HOLD DAY OF SURGERY)
When should we hold metformin?
if the patient has SEVERE KIDNEY DYSFUNCTION
What would you tell a patient taking metformin?
take with meals whole and discontinue if diagnosed with an MI
what is the prototype drug for alpha glucosid(ase) inhibitors?
acarbase
What does acarbose do?
delay digestion of carbs
are alpha glucosidase good by them selves?
NO they need to be combined with sulfonylurea to be effective
side effects of acarbose?
gas, bloating, diarrhea
Which type of patients should NOT be using acarbose?
any patient's with an intestinal disorder (ie. IBD, Celiac)
what is the prototype drug for thiazolidinediones?
rosiglitazone maleate
What does rosiglitazaone do?
decreases insulin resistance
how would you recognize a thiazolidinedione?
"-glitazone"
how long do glitazones take to work?
12 weeks
bbw for glitazones?
risk of congestive heart failure
glitazones are?
hepatotoxic
what is the prototype drugs for meglitinides?
repaglinidine
repaglinidine is similar to ______ due to similar_____, which is _______.
sulfonylureas; mechanisms of action; stimulate secretion of insulin
what is the prototype drug for SGLT2 inhibitors?
canagliflozin, empagliflozin
what does canagliflozin do?
inhibits renal SGLT-2 (blocking reabsorption of glucose in kidneys) and promotes excess glucose excretion in the urine (it makes ya go pee more). also protects the kidneys n heart.
when ya flo?
ya gotta go
for SGLT2 inhibitors, the higher the glucose, ______?
the better they work
what are some adverse effects of SGLT2 inhibitors?
balanitis, candida, vulvovaginal candidiasis. bc of the extra glucose in urine (ie more sugar) puts ya at more risk for infection since bacteria loveeee glucose
what is SGLT2 not recommended for?
pts with a GLR <45 mL/min
dd4-enzyme
inactivates incretins (BAD)
glp-1
stimulates insulin release and inhibits glucagon release (GOOD)
what is the prototype drug for dipepidyl peptidase 4 inhibitors?
sitagliptin
What is the mechanism of action for dipepidyl peptidase 4 inhibitors (sitagliptin)?
decreases rate of inactivation of incretin hormones (GLP-1) to increase hormone levels and prolong activity
what is the prototype drug for glucagon-like peptide-1 receptor agonist (GLP-1)?
exenatide
other drugs in GLP-1 drug class?
dulaglutide (trulicity), and semaglutide (wegovy)
BBW for dulagluticide
thyroid cancer and contraindicated in pts with a family history of endocrine neoplasia type 2
what is the bbw for amylin analogs?
pramlintide acetate
what does pramlinitide acetate do?
decreases gastric emptying and postprandial secretion leading to an increased sense of satiety
renal protection for diabetes
ACE/ARBS in pts who have proteinuria
lipid management for dm
statins
HYPOGLYCEMIC EFFECT
diabetic women regardless of T2 or gestational shld
always be on REGULAR insulin
don't give drugs to kids, unless T1, give
insulin
What kind of adjustment do some drugs need?
renal adjustment, all depends on renal function