Endo drugs Rotation prep

Exogenous and Endogenous Insulin

Sulfonylureas 1st Gen (-amides), 2nd Gen (-ride): Increase insulin release

Chloropromide (Diabenese)

Tolbutamide

Glimeprimide (Amaryl)

Gilbenclamide (Daonil)

Glipizide (Glibenese, Glucotrol, Minodiab)

Meglitinides:

Repaglinide: (Prandin, Novonorm, Enyglid)

Nateglinide: (Starlix)

Depolarizes beta cell in pancreas by blocking Potassium channels on Beta cell.

Causes Calcium influx

A/E: Hypoglycemia

Insulin (short acting, intermediate and long term)

Short Acting given post prandial: Glulisine, Aspart and Lispro

Intermediate: NPH and Regular (for DKA- Caused by inadequate insulin replacement. Lots of glucose present, but insulin not present for the body the be able to use the glucose. The body is starved for glucose, so liver releases ketones. Elevated glucose and ketones in the body).

Only regular given IV.

Long term: Detemir and Glargine.

Diabetics often need a post prandial short acting insulin like glulisine, aspart or lispro and a basal long acting insulin (glargine and detemir) for that constant background insulin activity throughout the day.

GLP-1 analogues: released by L-cells in intestine to release insulin from pancreas

Exenatide (Byetta, Bydureon)

Liraglutide (Saxenda, Victoza)

MOA: decrease glucagon release, decrease gastric emptying, increase glucose dependent insulin release

A/E: Weight loss, satiety, vomiting, pancreatitis

DPP-4 inhibitors: prevents DPP-4 from deactivating GLP-1

Sitagliptin (Januvia)

Sitagliptin and metformin (Janumet)

Saxagliptin (Onglyza)

A/E: Respiratory and urinary infections, weight neutral

Signs of hypoglycemia:

Autonomic hyperactivity: Sypmathetic: tachycardia, sweating, palpatations and nausea.

Er sympathetic: nausea and hunger, can lead to convulsions and coma.

Biguanide: Metformin (Fortamet and Glumetza)- increases insulin sensitivity

Inhibits mitochondrial enzyme to stop hepatic gluconeogenesis. It increases glycolysis and peripheral glucose uptake

A/E: Lactic acidosis, renal insufficiency, weight loss, vitamin B12 deficiency

Thiazolidinediones: -glits - increases insulin sensitivity and adiponectin levels

Pioglitazone (Actos)

Rosiglitazone (Avandia) - can cause MI and cardiac death

Activates PPAR-y to regulate glucose metabolism and fatty acid storage.

A/E: Weight gain, Edema, fractures.

SGLT-2 inhibitors: -glifs- blocks reabsorption of glucose in PCT

Canagliflozin (Invokana)

Dapagliflozin (Farxiga)

Empagliflozin (Jardiance)

A/E: Glucosuria (UTIs, candidiasis), dehydration (Orthostatic hypotension), weight loss

Use in caution with renal insufficiency

Alpha glucosidase inhibitors - inhibits intestinal alpha glucosidase to stop glucose reabsorption

Acarbose (Precose)

Miglitol (Glyset)

Decreases post prandial hyperglycemia and delays carbohydrate hydrolysis.

C/I: Renal insufficiency

Amylin analogue - decreases glucagon release and gastric emptying

Pramlintide (Symlin)

A/E: increases satiety, hypoglycemia, nausea