Diabetes & Weight Loss Pharmacology Master Drill

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🧪 Mode of Action

Mechanisms & Drug Classes.
Focus on "How it works".

jq Clinical Use

Indications & Guidelines.
Focus on "When to use it".

⚠️ Adverse Effects

Side Effects & Toxicity.
Focus on "What goes wrong".

🚫 Other Considerations

Contraindications, Boxed Warnings, Interactions & Tips.

📚 Full Drill

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Reference: Diabetes & Weight Loss Drugs

Class / Drug	Mode of Action	Clinical Use	Adverse Effects	Notes / Contraindications
Biguanides Metformin	Inhibits hepatic gluconeogenesis; increases insulin sensitivity.	First-line T2DM; PCOS.	GI upset, B12 deficiency. Boxed Warning: Lactic Acidosis.	Contraindicated: eGFR < 30. Tip: "Meta-formin" -> Metallic taste.
GLP-1 Agonists Semaglutide, Liraglutide, Dulaglutide, Exenatide	Mimics GLP-1: Stimulates insulin, inhibits glucagon, slows gastric emptying.	T2DM, Weight Loss, CV risk reduction.	Nausea/Vomiting, Pancreatitis risk.	Boxed Warning: Thyroid C-cell tumors (MEN2). Contraindicated: Hx of Medullary Thyroid Cancer.
Dual Agonists Tirzepatide	Agonist at GLP-1 and GIP receptors.	T2DM, Weight Loss.	GI effects similar to GLP-1s.	"Twin-cretin". Targets 2 receptors.
SGLT2 Inhibitors Empagliflozin, Dapagliflozin, Canagliflozin	Inhibits SGLT2 in kidney; blocks glucose reabsorption.	T2DM, Heart Failure, CKD.	UTIs, Yeast infections, Osmotic diuresis, Euglycemic DKA. Fournier's Gangrene.	Tip: "Flowing" urine. Warning: DKA with normal blood sugar.
Amylin Analogs Pramlintide	Mimics amylin: slows gastric emptying, suppresses glucagon.	T1DM and T2DM adjunct.	Severe hypoglycemia (with insulin), nausea.	Warning: Reduce mealtime insulin by 50% when starting.
Lipase Inhibitors Orlistat	Inhibits lipases; blocks fat absorption.	Long-term Weight Management.	Steatorrhea, fecal urgency, Vit A,D,E,K deficiency.	Warning: Bleeding risk (Vit K deficiency).
Sympathomimetics Phentermine	Stimulates norepinephrine release.	Short-term Weight Loss.	Tachycardia, HTN, Insomnia. Abuse potential.	Contraindicated: CVD, Uncontrolled HTN, Hyperthyroidism.
Combinations Qsymia, Contrave	Qsymia: NE release + GABA mod. Contrave: Opioid antag + DA/NE reuptake.	Chronic Weight Management.	Qsymia: Paresthesia, Teratogenic. Contrave: Seizure risk (Bupropion).	Contrave: CI in Seizure disorder / Opioid use. Qsymia: Pregnancy Category X.

Class / Drug

Mode of Action

Clinical Use

Adverse Effects

Notes / Contraindications

Biguanides
Metformin

Inhibits hepatic gluconeogenesis; increases insulin sensitivity.

First-line T2DM; PCOS.

GI upset, B12 deficiency. Boxed Warning: Lactic Acidosis.

Contraindicated: eGFR < 30.
Tip: "Meta-formin" -> Metallic taste.

GLP-1 Agonists
Semaglutide, Liraglutide, Dulaglutide, Exenatide

Mimics GLP-1: Stimulates insulin, inhibits glucagon, slows gastric emptying.

T2DM, Weight Loss, CV risk reduction.

Nausea/Vomiting, Pancreatitis risk.

Boxed Warning: Thyroid C-cell tumors (MEN2).
Contraindicated: Hx of Medullary Thyroid Cancer.

Dual Agonists
Tirzepatide

Agonist at GLP-1 and GIP receptors.

T2DM, Weight Loss.

GI effects similar to GLP-1s.

"Twin-cretin". Targets 2 receptors.

SGLT2 Inhibitors
Empagliflozin, Dapagliflozin, Canagliflozin

Inhibits SGLT2 in kidney; blocks glucose reabsorption.

T2DM, Heart Failure, CKD.

UTIs, Yeast infections, Osmotic diuresis, Euglycemic DKA. Fournier's Gangrene.

Tip: "Flowing" urine.
Warning: DKA with normal blood sugar.

Amylin Analogs
Pramlintide

Mimics amylin: slows gastric emptying, suppresses glucagon.

T1DM and T2DM adjunct.

Severe hypoglycemia (with insulin), nausea.

Warning: Reduce mealtime insulin by 50% when starting.

Lipase Inhibitors
Orlistat

Inhibits lipases; blocks fat absorption.

Long-term Weight Management.

Steatorrhea, fecal urgency, Vit A,D,E,K deficiency.

Warning: Bleeding risk (Vit K deficiency).

Sympathomimetics
Phentermine

Stimulates norepinephrine release.

Short-term Weight Loss.

Tachycardia, HTN, Insomnia. Abuse potential.

Contraindicated: CVD, Uncontrolled HTN, Hyperthyroidism.

Combinations
Qsymia, Contrave

Qsymia: NE release + GABA mod.
Contrave: Opioid antag + DA/NE reuptake.

Chronic Weight Management.

Qsymia: Paresthesia, Teratogenic.
Contrave: Seizure risk (Bupropion).

Contrave: CI in Seizure disorder / Opioid use.
Qsymia: Pregnancy Category X.