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35 Cards in this Set
- Front
- Back
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AGI
α-glucosidase inhibitor |
acarbose (precose)
miglitol (glyset) |
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DPP4
dipeptidyl-peptidase-4 inhibitor |
sitagliptin (januvia)
saxagliptin (onglyza) |
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GLP-1
incretin mimetics (glucagonlike peptide-1 agonist) |
exenatide (byetta)
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biguanide
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Metformin (glucophage XR, glumetza, riomet, fortamet)
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sulfonylurea
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glyburide (diabeta, glynase, micronase)
glipizide (glucotrol, glucotrol XL) glimepiride (amaryl) |
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TZD
thiazolidinedione |
rosiglitazone (avandia)
pioglitazone (actos) |
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types of rapid acting insulin
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aspart (novolog)
lispro (humalog) glulisine (apidra) |
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rapid acting insulin comments
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more rapid onset than human insulin
reduced risk of hypoglycemia 2-5 hours after a meal/overnight |
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premixed insulin/protamine
aspart + aspart-protamine lispro + lispro-protamine comments |
BID, before breakfast and dinner
provides postprandial coverage less flexible than basal-bolus |
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types of long acting insulin
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glargine (lantus)
detemir (levemir) |
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Metformin risks
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gastrointestinal symptoms
use with renal insufficincy contraindicated in liver failure contraindicated in predisposition of lactic acidosis |
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metformin benefit
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no weight gain
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DPP4 risks
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reduce dose in renal insufficiency
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GLP-1 benefit
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postprandial glucose lowering
no weight gain |
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GLP-1 risks
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gastrointestinal symptoms
use with renal insufficincy |
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sulfonylurea risks
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hypoglycemia
use with renal insufficiency contraindicated in liver failure or predisposition to lactic acidosis mild weight gain drug interactions |
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TZD risks
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contraindicated in CHF class 3,4
contraindicated in liver failure or predisposition to lactic acidosis moderate weight gain fractures |
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AGI risks
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GI symptoms
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Insulin benefits
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postprandial glucose lowering
fasting glucose lowering |
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insulin risks
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hypoglycemia
use with renal insufficiency mild to moderate weight gain |
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sulfonylurea risks
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hypoglycemia
use with renal insufficiency contraindicated in liver failure or predisposition to lactic acidosis mild weight gain drug interactions |
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TZD risks
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contraindicated in CHF class 3,4
contraindicated in liver failure or predisposition to lactic acidosis moderate weight gain fractures |
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AGI risks
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GI symptoms
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Insulin benefits
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postprandial glucose lowering
fasting glucose lowering |
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insulin risks
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hypoglycemia
use with renal insufficiency mild to moderate weight gain |
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initial Tx A1C 6.5-7.5%
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monotherapy
METFORMIN DPP4 GLP-1 TZD AGI |
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Tx of A1c 6.5-7.5% if monotherapy fails after 2-3 months
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dual therapy
MET + GlP-1 or DDP4 or TZD or glinide or SU TZD + GLP-1 or DPP4 |
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Tx of A1c 6.5-7.5% if dual therapy fails after 2-3 months
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triple therapy
MET + GLP-1 or DPP4 + TZD or glinide or SU |
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tx of A1c 6.5-7.5% if triple therapy fails after 2-3 months
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insulin +/- other agents
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initial tx of A1c 7.5-9%
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dual therapy
MET + GlP-1 or DDP4 or TZD or glinide or SU |
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Tx of A1c 7.6-9% if dual therapy fails after 2-3 months
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triple therapy
MET + GLP-1 or DPP4 + TZD or SU or MET + TZD + SU |
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Tx of A1c >9% in a drug naive patient with symptoms
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insulin +/- other agent
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Tx of A1c >9% in a drug naive patient without symptoms
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MET + GLP-1 or DPP4 + TZD or SU
or MET + TZD + SU |
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Tx of A1c >9% in a patient with DM treatment
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insulin +/- other agents
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when to favor using a TZD
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metabolic syndrome
and/or NAFLD |
