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31 Cards in this Set

  • Front
  • Back
Metformin
Trade Name: Glucophage
FIRST LINE for T2 Diabetes
Decreases TG, LDL, & Increases HDL
Metformin MOA
Decreases liver production of glucose
Enhances muscles sensitivity to insulin
Does NOT Stimulate Insulin release
Metformin ADRs
Nausea, Diarrhea, Bloating, Anorexia, "metallic taste"
No wight loss or hypoglycemia
Macrocytic anemia (B12 def.), lactic acidosis
----Less common with Met. XR
Metformin Precautions
Hypoxemia
Liver impairment
Sepsis
CHF (d/t hypoperfusion)
Metformin CI
SCr ≥ 1.5mg/dL in males or ≥ 1.4mg/dL in females
Elderly >80yo
LOW and SLOW
Metformin excreted via ____________ system
Renal System
Build up in kidneys, but typically not harmful
1st Generation Sulfonylureas
NOT typically USED ANYMORE!
(-amide)
acetohexamide (Dymelor)
chlorpropamide (Diabinase)
tolazamide (Tolinase)
tolbutamide (Orinase)
Second Generation T2 Diabetes Meds
(-ide)
glyburide (Diabeta, Micronase)
micronized glyburide (Glynase)
glipizide, glipizide ER (Glucotrol, Glucotrol XL)
glimepiride (Amaryl)
Sulfonylureas MOA
Enhances insulin secretion from functioning β-cells
Minor extra-pancreatic function by increasing insulin receptor sensitivity and/or number
↓ hepatic glucose output
Non-glucose dependent insulin release
CYP2C9
Sulfonylureas ADRs
Hypoglycemia
Lower pre-treatment FBG, skip meals, lose weight, Intense exercise
Weight gain
GI (N/V, heartburn)
SIADH (> with first generation)
Hematologic reactions
Dermatologic reactions
Sulfonylureas CI
Contraindications
DKA, severe liver or renal disease (except glipizide), hypoglycemic unawareness
Glyburide excretion _____ & _____ (2)
Via fecal and renal (50:50)
Glyburide ADRs
Highest rate of hypoglycemia amung 2nd gen.
Meglitinides
Repaglinide (Prandin)
Nateglinide (Starlix)
Meglintinides MOA
Stimulate RAPID insulin secretion from functioning β-cells
Glucose-dependent stimulation of insulin secretion
Dose right before meals
Meglintinides ADRs
Hypoglycemia (< sulfonylureas)
Weight gain (< sulfonylureas)
Thiazolidinediones
(TZD)
(-azone)
Pioglitazone (Actos)
Rosiglitazone (Avandia)
TZDs MOA
increase insulin sensitivity in muscle, fat, & liver
Thiazolidinediones ADRs
Weight gain, anemia, edema, CHF
Class III or IV heart failure (contraindication)
Increased risk of bone fractures (Actos)
Potential MIs (Avandia)
Bladder cancer? (Actos)
Resumption of ovulation
Hepatotoxicity: troglitazone
Amylin Analog
Pramlintide (Symlin)
Amylin Analog MOA
Slows gastric emptying
Reduced food intake
Suppress glucagon
Amylin Analog Indications
Indicated as adjunct therapy for Type 1 or 2 DM
Uncontrolled patients using mealtime insulin
With or without sulfonylurea and/or metformin in T2DM
Pramlintide
Trade: Symlin
Class: Amylin Analog
INJECTION ONLY
Pramlintide (Symlin) ADRs and CIs
Nausea (T1DM 40-50%; T2DM 20%)
Vomiting, anorexia
Hypoglycemia
Need 30-50% prandial insulin dose reduction
***CIs***
Gastroparesis
Hypoglycemia unawareness
A1C >9%
Unwilling to measure BG
DPP-IV Inhibitors
(-liptin)
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Januvia MOA
DPP-IV MOA
↑ glucose-mediated insulin secretion
Suppress glucagon secretion
DPPV-IV ADRs & CIs
Sinusitis
URIs, UTIs, HA
Weight neutral (no +/-)
No hypoglycemia as monotherapy
***CIs***
Pancreatitis history
DKA
T1DM
GLP-1 Agonists
(Dr. Murfin's Favorite)
Exenatide (Byetta)
Exenatide (Bydureon)
Liraglutide (Victoza)
GLP-1 Agonist ADRs
WEIGHT LOSS
GI-N/V
Hypoglycemia
Antibody formation – 2.5%
Precaution: pancreatitis?
GLP-1 CIs
Gastroparesis
Pancreatitis