NSC 830 ADVANCED PHARM; DIABETES QUESTIONS
BIGUANIDES - Answer -Metformin (Glucophage)
Metformin (Glucophage) MOA - Answer -decreases hepatic glucose production; insulin
sensitizer (decreases insulin resistance)
Metformin (Glucophage) Advantages - Answer -Cheap! No weight gain. No
hypoglycemia. Lowers HgbA1C 1.5-2%. Can be used in pre-diabetes and metabolic
syndrome. Positive effects on lipids, decreases triglycerides and LDL, increases HDL.
ADA goal of HgbA1C - Answer -Less than 7% (correlates to a glucose of approximately
150)
Metformin (Glucophage) dosing - Answer -500 mg BID with meals.
Max: 2,550/day
Start low; go slow!
Metformin (Glucophage) adverse effects - Answer -G.I.:
nausea/diarrhea/bloating/metallic taste
Metformin (Glucophage) contraindications - Answer -Renal impairment
Creatinine of 1.4 to 1.5 must STOP!
Vitamin B 12 deficiency
Iodine-based procedures (hold 48hr before and after)
Lactic acidosis
Sulfonylureas - Answer -glipizide, glyburide, glimepiride
4 F's of Sulfonylureas - Answer -1. Fasting glucose
2. Fail in the long-haul
3. Act Funny
4. Get Fat
Sulfonylureas Adverse Effects - Answer -hypoglycemia, weight gain
Sulfonylureas Contraindications - Answer -Renal problems
Sulfonamide allergy (related to sulfonamide and thiazide)
Do not use in pregnancy or breast-feeding
Glyburide - Answer -Glyburide = a bad ride!
High risk for hypoglycemia
Do not use an elderly or those with history of hypoglycemia.
Sulfonylureas MOA - Answer -Increase insulin secretion from pancreatic beta cells
, Maglitinides - Answer -repaGLINIDE (Prandin)
nateGLINIDE (Starlix)
Maglitinides MOA - Answer -Stimulate insulin released from the beta cells.
Take 20 minutes before meals.
Fast action/Short duration
Glide in/glide out!
Maglitinides Adverse effects - Answer -Hypoglycemia
Weight gain
Maglitinides Cautions/contraindications - Answer -1. severe liver impairment
2. CPY450 (3A4, 2C9 lists)
Thiazolidinediones (TZDs) - Answer -Pioglitazone
Rosiglitazone
Thiazolidinediones (TZDs) MOA - Answer -Insulin sensitizer (similar to Metformin)
Thiazoledinediones (TZDs) Adverse effects - Answer -Liver injury = Monitor LFTs
Fluid retention = bad if having heart failure
Risk for bladder cancer (pioglitazone)
Black box warning
Metabolized by the CYP 450 3A4 isoenzymes
Thiazolidinediones (TZDs) ZONES - Answer -Avoid the zones: liver, bladder cancer,
heart failure
GLP - 1 (What is it?) - Answer -Incretin hormone
Glucagon like peptide
Natural peptide from small intestine after eating
GLP-1 agonists - Answer -Good little peptide!
ALL OF THESE ARE SQ :(
1. Exenatide (Byetta)
2. Liraglutide (Victoza)
3. Albiglutide
4. Dulaglutide
GLP-1 agonists MOA - Answer -BABS!!
Beta cells increase insulin secretion
Alpha cells decrease glucagon released
Brain decreases appetite increases satiety
BIGUANIDES - Answer -Metformin (Glucophage)
Metformin (Glucophage) MOA - Answer -decreases hepatic glucose production; insulin
sensitizer (decreases insulin resistance)
Metformin (Glucophage) Advantages - Answer -Cheap! No weight gain. No
hypoglycemia. Lowers HgbA1C 1.5-2%. Can be used in pre-diabetes and metabolic
syndrome. Positive effects on lipids, decreases triglycerides and LDL, increases HDL.
ADA goal of HgbA1C - Answer -Less than 7% (correlates to a glucose of approximately
150)
Metformin (Glucophage) dosing - Answer -500 mg BID with meals.
Max: 2,550/day
Start low; go slow!
Metformin (Glucophage) adverse effects - Answer -G.I.:
nausea/diarrhea/bloating/metallic taste
Metformin (Glucophage) contraindications - Answer -Renal impairment
Creatinine of 1.4 to 1.5 must STOP!
Vitamin B 12 deficiency
Iodine-based procedures (hold 48hr before and after)
Lactic acidosis
Sulfonylureas - Answer -glipizide, glyburide, glimepiride
4 F's of Sulfonylureas - Answer -1. Fasting glucose
2. Fail in the long-haul
3. Act Funny
4. Get Fat
Sulfonylureas Adverse Effects - Answer -hypoglycemia, weight gain
Sulfonylureas Contraindications - Answer -Renal problems
Sulfonamide allergy (related to sulfonamide and thiazide)
Do not use in pregnancy or breast-feeding
Glyburide - Answer -Glyburide = a bad ride!
High risk for hypoglycemia
Do not use an elderly or those with history of hypoglycemia.
Sulfonylureas MOA - Answer -Increase insulin secretion from pancreatic beta cells
, Maglitinides - Answer -repaGLINIDE (Prandin)
nateGLINIDE (Starlix)
Maglitinides MOA - Answer -Stimulate insulin released from the beta cells.
Take 20 minutes before meals.
Fast action/Short duration
Glide in/glide out!
Maglitinides Adverse effects - Answer -Hypoglycemia
Weight gain
Maglitinides Cautions/contraindications - Answer -1. severe liver impairment
2. CPY450 (3A4, 2C9 lists)
Thiazolidinediones (TZDs) - Answer -Pioglitazone
Rosiglitazone
Thiazolidinediones (TZDs) MOA - Answer -Insulin sensitizer (similar to Metformin)
Thiazoledinediones (TZDs) Adverse effects - Answer -Liver injury = Monitor LFTs
Fluid retention = bad if having heart failure
Risk for bladder cancer (pioglitazone)
Black box warning
Metabolized by the CYP 450 3A4 isoenzymes
Thiazolidinediones (TZDs) ZONES - Answer -Avoid the zones: liver, bladder cancer,
heart failure
GLP - 1 (What is it?) - Answer -Incretin hormone
Glucagon like peptide
Natural peptide from small intestine after eating
GLP-1 agonists - Answer -Good little peptide!
ALL OF THESE ARE SQ :(
1. Exenatide (Byetta)
2. Liraglutide (Victoza)
3. Albiglutide
4. Dulaglutide
GLP-1 agonists MOA - Answer -BABS!!
Beta cells increase insulin secretion
Alpha cells decrease glucagon released
Brain decreases appetite increases satiety
