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Pharm - Endo - Diabetes Mellitus T2

Diabetes Mellitus T2 (Chapter 56) Oral Hypoglycemic Agents for Type 2 Diabetes
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What is the mechanism of action for Alpha-glucosidase inhibitors?
Acts on Small Intestines
Works by reducing the amount of glucose that the intestines absorb from food. This prevents the sharp rise in blood sugar levels that people with diabetes typically experience after meals. One medication in this class, acarbose, may also help increase the body's insulin sensitivity, further helping to reduce blood sugar levels.
What is the mechanism of action for Sulfonylureas?
The "Ides"
Acts on Beta Cells of Pancreas & Tissues
↑insulin release from pancreas,
↑tissue response to insulin
[as the duration of diabetes ↑, beta cell function ↓ and these drugs become ↓effective]
What is the mechanism of action for Meglitinides?
The "Ides"
Acts on Beta Cells of Pancreas
↑insulin release from pancreas,
acts more rapidly and ↓duration of action than Sulfonylureas
What is the mechanism of action for Thiazolidinediones (TZDs)?
Acts on Liver & Target Cells
Decreases hepatic blood glucose production
Improves target cell response to insulin
↑insulin sensitivity of adipose tissue, skeletal muscle,
liver (↓ insulin resistance at receptor sites on cells)
What are the side effects of Sulfonylureas?
Hypoglycemia (especially with elderly with renal or liver failure), cardiac ischemia, weight gain
What is the mechanism of action for Biguanides?
Acts on Liver, Small Intestines, & Target Cells
Biguanides work by:
decreasing the liver's production of glucose
decreasing the small intestines' absorption of glucose
improving your body's ability to use insulin, improves glucose transport into cells.
What type of drug is tolbutamide (Orinase)?
Sulfonylureas
1st Generation
What type of drug is chlorpropamide (Diabinese)?
Sulfonylureas
1st Generation
What type of drug is tolazamide (Tolinase)?
Sulfonylureas
1st Generation
What type of drug is glyburide (Micronase)?
Sulfonylureas
2nd Generation
What type of drug is glipizide (Glucotrol)?
Sulfonylureas
2nd Generation
What type of drug is glimepiride (Amaryl)?
Sulfonylureas
2nd Generation
What type of drug is Repaglinide (Prandin)?
Meglitinide
Repaglinide (Prandin) Nateglinide (Starlix)
Contraindicated for patients with liver failure.
Must be taken before each meal (do not take if meal skipped), eat within 30 minutes of administration
What type of drug is Nateglinide (Starlix)?
Meglitinide
Repaglinide (Prandin) Nateglinide (Starlix)
Must be taken before each meal (do not take if meal skipped), eat within 30 minutes of administration
What type of drug is rosiglitazone (Avandia) --- *restricted access?
Thiazolidinediones (TZDs)
often used as second or third agent with metformin
takes 6-14 weeks to achieve effect
What type of drug is pioglitazone (Actos)?
Thiazolidinediones (TZDs)
often used as second or third agent with metformin
takes 6-14 weeks to achieve effect
What type of drug is metformin (Glucophage)?
Biguanide
metformin (Glucophage) metformin XL (Glucophage XL)
What type of drug is metformin XL (Glucophage XL)?
Biguanide
metformin (Glucophage) metformin XL (Glucophage XL)
It is the first-line drug of choice for the treatment of type 2 diabetes, in particular, in overweight and obese people and those with normal kidney function.

Metformin is the only antidiabetic drug that has been conclusively shown to prevent the cardiovascular complications of diabetes. It helps reduce LDL cholesterol and triglyceride levels, and is not associated with weight gain.
What type of drug is acarbose (Precose)?
Alpha-glucosidase inhibitors
What type of drug is miglitol (Glyset)?
Alpha-glucosidase inhibitors
Which drug type for Diabetes Type 2 has GI effects due to bacterial fermentation of unabsorbed carbohydrates?
Alpha-glucosidase inhibitors
miglitol (Glyset)
acarbose (Precose)
Which drug type for Diabetes Type 2 ↑risk of MI's?
Thiazolidinediones (TZDs)
rosiglitazone (Avandia) --- *restricted access pioglitazone (Actos)
Which drug type for Diabetes Type 2 has the side effect of hepatotoxicity and ↑risk of bone fractures?
Thiazolidinediones (TZDs)
rosiglitazone (Avandia) --- *restricted access pioglitazone (Actos)
Which drug type for Diabetes Type 2 has side effects such as Anorexia, N, V, weight loss, diarrhea, ↓absorption B12 and folic acid?
Biguanides
metformin (Glucophage) metformin XL (Glucophage XL)
Which drug type does not cause hypoglycemia b/c does not stimulate insulin secretion?
Biguanides
metformin (Glucophage) metformin XL (Glucophage XL)
Which drug type for Diabetes Type 2 has side effects such as hypoglycemia and weight gain?
Meglitinides
Repaglinide (Prandin) Nateglinide (Starlix)
Which drug type for Diabetes Type 2 has side effects such as hypoglycemia (especially with elderly with renal or liver failure), cardiac ischemia, weight gain
Sulfonylureas
Patients who don't responds to sulfonylureas, don't respond to this class
Meglitinides
Repaglinide (Prandin) Nateglinide (Starlix)
Which drug type for Diabetes Type 2 must be taken before each meal (do not take if meal skipped), eat within 30 minutes of administration?
Meglitinides
Repaglinide (Prandin) Nateglinide (Starlix)
Which drug type for Diabetes Type 2 is contraindicated for MI, acute CHF, alcohol, kidney and liver disease?
Meglitinides
Repaglinide (Prandin) Nateglinide (Starlix)
Which drug type for Diabetes Type 2 does not cause hypoglycemia? Why doesn't it cause hypoglycemia?
Biguanides
b/c it does not stimulate insulin secretion from the pancreas
Which drug type for Diabetes Type 2 can expand blood volume and cause edema (fluid retention and wt gain) - contraindicated with mild and severe CHF?
Thiazolidinediones (TZDs)
rosiglitazone (Avandia) --- *restricted access pioglitazone (Actos)
Which drug type for Diabetes Type 2 is often used as second or third agent with metformin because of the delay in its onset?
Thiazolidinediones (TZDs)
rosiglitazone (Avandia) --- *restricted access pioglitazone (Actos)
Which drug type for Diabetes Type 2 takes 6-14 weeks to achieve effect?
Thiazolidinediones (TZDs)
rosiglitazone (Avandia) --- *restricted access pioglitazone (Actos)
While taking this drug for type for Diabetes Type 2 a patient is treated for a ↓BG with glucose tablets or milk (not table sugar). Why?
Alpha-glucosidase inhibitors
Table sugar prevents absorption of sucrose
Which drug type for Diabetes Type 2 is the most widely used oral?
Biguanides
metformin (Glucophage) metformin XL (Glucophage XL)
Which drug type for Diabetes Type 2 ↓gluconeogenesis (decreases glucose production)?
Biguanides
metformin (Glucophage) metformin XL (Glucophage XL)
Which drug type for Diabetes Type 2 can cause weight loss to occur due to nausea and ↓appetite? It must be taken with food.
Biguanides
metformin (Glucophage) metformin XL (Glucophage XL)
Which drug type for Diabetes Type 2 is indicated for patients with normal fasting BG but ↑PP BG (Postprandial Blood Glucose, after meal BG)
Alpha-glucosidase inhibitors
Table sugar prevents absorption of sucrose
A patient taking this drug type for Diabetes Type 2 must have Liver function closely monitored (LFT)because of increasing lipid levels.
Alpha-glucosidase inhibitors
acarbose (Precose) miglitol (Glyset)
Incretins
Naturally occurring hormones in the GI tact that act on the pancreas to ↑insulin secretion in response to ↑glucose.
Which drug type for Diabetes Type 2 slows gastric emptying (pt feels full and eats less)?
Incretin Mimetics
exenatide (Byetta)
liraglutide (Victoza)
Which drug type for Diabetes Type 2 is exenatide (Byetta)?
Incretin Mimetics
SC injection - prefilled pen
exenatide (Byetta)
liraglutide (Victoza)
Which drug type for Diabetes Type 2 is liraglutide (Victoza)?
Incretin Mimetics
SC injection - prefilled pen
exenatide (Byetta)
liraglutide (Victoza)
Which drug type for Diabetes Type 2 is an alternative to starting insulin in Type II patients, but its not a first line treatment.
Incretin Mimetics
SC injection - prefilled pen
exenatide (Byetta)
liraglutide (Victoza)
Which drug type for Diabetes Type 2 has an off label use for weight loss?
Incretin Mimetics
SC injection - prefilled pen
exenatide (Byetta)
liraglutide (Victoza)
What drug type is sitagliptin (Januvia)?
Oral Incretin Mimetic
What drug type is linagliptin (Tradjenta)?
Oral Incretin Mimetic
What drug type is saxagliptin(Onglyza)?
Oral Incretin Mimetic
Which drug type for Type 2 Diabetes can cause Hypoglycemia and has an ↑risk when combined with insulin?
Amylin analog
pramlintide (Symlin)
SC injection
Which drug type for Type 2 Diabetes is an adjunct to insulin therapy, but not a replacement?
Amylin analog
pramlintide (Symlin)
SC injection
Which drug type for Type 2 Diabetes ↓gastric emptying, ↑satiety, ↓PP glucagon and hepatic glucose production?
Amylin analog
pramlintide (Symlin)
SC injection
Which drug type for Type 2 Diabetes HA, stuffy nose, sore throat, modest weight gainHypersensitivity rxs
Oral Incretin Mimetic
Synthetic analog of a hormone, like insulin, secreted by the beta cells to control glucose levels, for Type I and Type II patients.
Amylin Analog
pramlintide (Symlin)
Which drug type for Type 2 Diabetes should be taken 2x/day within 60 min before morning and evening meals
Incretin Mimetics
SC injection - prefilled pen
exenatide (Byetta)
liraglutide (Victoza)
What are the 5 M's of Diabetes Self-Management (ADA)?
Meter: monitoring blood glucose
Meds: taking medications
Meals: healthful eating
Move: being active
More: problem solve special situations
Indicated for insulin overdose - used in emergencies to restore consciousness in diabetics experiencing extreme hypoglycemia
Glucagon
After Glucagon is administered to a diabetic experiencing extreme hypoglycemia, what is the Nurse's priority?
Monitor blood glucose before and after administration and up to four hours after patient regains consciousness
Synthetic analog of human amylin, a hormone like insulin secreted by the beta cells to control glucose
levels, for Type I and Type II patients
Amylin Analog
pramlintide (Symlin)