Pharmacotherapeutics Type 2 Diabetes Tx

Front 1

Sulfonylureas mean A1c reduction

Back 1

1.5-2%

Front 2

Sulfonylureas AE's

Back 2

-hypoglycemia
-weight gain
-hyponatremia w/ 1st gen agents

Front 3

Sulfonylureas monitoring

Back 3

Efficacy
-A1c quaterly
-SMBG at each visit

Safety
-wt. and sx of hypoglycemia at each visit
-renal function at baseline, if suspected change, atleast annually

Front 4

Sulfonylureas administration

Back 4

20-30 mins prior to a meal

Front 5

Sulfonyureas precautions

Back 5

-glyburide should not be used if CrCl <50

-glipizide and glimeperide should not be used if CrCl <30

-sulfa allergy

Front 6

Sulfonylureas clinical pearls

Back 6

-1st line agents for non-overweight or elderly patients

-glipizide or glimeperide in elderly because of lower CrCl

Front 7

Meglitinides mean A1c reduction

Back 7

0.6-1%

Front 8

Meglitinides AE's

Back 8

-hypoglycemia (less than SU)
-weight gain

Front 9

Meglitinides drug interactions

Back 9

-Gemfibrozil more than doubles t1/2 of repaglinide

Front 10

Meglitinides monitoring

Back 10

Efficacy
-A1c quarterly
-SMBG at each visit

Safety
-signs and sx of hypoglycemia at each visit

-renal function baseline, if suspected change, atleast annually

Front 11

Meglitinies administration

Back 11

Just prior to each meal 3-4 times/day, skip dose if meal skipped

Front 12

Meglitinides precautions

Back 12

elderly and malnourished more likely to develop hypoglycemia

Front 13

Meglitinides clinical pearls

Back 13

-advantage = decreased incidence of hypoglycemia

-disadvantage = less efficacy than SU, expensive, and require TID/QID dosing

Front 14

Biguanides A1c reduction and lipid effects

Back 14

1.5-2%

-decrease TGs=16%
-decrease LDL-C=8%
-increase HDL=2%

Front 15

Biguanides AE's

Back 15

-Weight loss
-GI (diarrhea, NV, abdominal cramps, flatulence) may subside after 2-3 weeks of use

Lactic acidosis (muscle pain, weakness, fatigue, shortness of breath, slowed heartbeat)

Front 16

Biguanides lactic acidosis risk factors

Back 16

PHARMDS

Front 17

Biguanides monitoring

Back 17

Efficacy
-A1c quarterly
-SMBG at each visit
-Weight at each visit

Safety
-Renal function at baseline, if recent change suspected, atleast annually
-Hepatic function at baseline, if recent change suspected and atleast annually
-Electrolytes if suspected acidosis and atleast annually

Front 18

Biguanidies contraindications

Back 18

-Renal dysfunction
*SCr >1.5 males; >1.4 females
*CrCl <30

-medically managed CHF

Front 19

Biguanides clinical pearls

Back 19

-1st line agent for overweight/obest patients

-only medication shown to decrease macrovascular complications in obese DM patients

-Does not generally cause hypoglycemia

Front 20

Thiazolidinediones A1c reduction

Back 20

1.5%

Front 21

Thiazolidinediones lipid effects

Back 21

-Both drugs increase HDL 3-9mg/dl

-Rosiglitazone increases LDL 5-15%

-Pioglitazone decrease TG 10-20%

Front 22

Thiazolidinediones AE's

Back 22

-weight gain
-edema
-headache
-increased liver transaminases
-anemia

Front 23

Thizolidinediones contraindications

Back 23

-CHF class III or IV

-AST or ALT > 3x UNL at baseline

Front 24

Alpha glucosidase inhibitors A1c reduction

Back 24

0.25-0.5%

Front 25

Alpha glucosidase inhibitors AE's

Back 25

-abdominal cramping
-flatulence

Front 26

Alpha glucosidase inhibitors monitoring

Back 26

Efficacy
-A1c quarterly
-SMBG at each visit

Safety
-renal function at baseline, if suspect recent change, atleast annually

Front 27

Incretin (GLP1) mimetic MOA

Back 27

enhances glucose-dependent insulin secretion, slows gastric emptying

Front 28

Incretin efficacy

Back 28

-most effective for reducing PPG
-A1c reduction by 0.5-1.5% when in combo with metformin or SU

Front 29

Incretin AE's

Back 29

-NV
-Weight loss

Front 30

Incretin monitoring

Back 30

Efficacy
-A1c quarterly
-SMBG at each visit

Front 31

Incretin clinical pearls

Back 31

-approved for use in combo with metformin and SU only

-advantages = glucose-dependent insulin release and weight loss

Front 32

Amylinomimetic MOA

Back 32

-slows gastric emptying, prevents postprandial glucagon secretion, promotes satiety

Front 33

Amylinomimetic efficacy

Back 33

-most effective for reducing PPG

-decreases A1c by about 0.5%

Front 34

Amylinomimetic monitoring

Back 34

Efficacy
-A1c quarterly
-SMBG at each visit

Front 35

Amylinomimetic contraindications

Back 35

-gastroparesis
-hypoglycemic unawareness

Front 36

Amylinomimetic clinical pearls

Back 36

-approved for use ONLY in combo with mealtime insulin (+/- SU and/or metformin)

-Advantage = potential for weight loss

Front 37

Insulin AE's

Back 37

-hyperglycemia
-weight gain
-lipohypertrophy
-lipoatrophy

Front 38

Insulin drug interactions

Back 38

-Corticosteroids
-thiazides
-Beta-blockers

Front 39

Insulin monitoring

Back 39

A1c quarterly, SMBG for every patient on insulin, weight at each visit

Front 40

Sulfonylureas (Glipizide) starting dose and maximum dose

Back 40

Starting dose = 5mh po BID before meals

Max dose = 40mg/day (20mg BID)

Front 41

Meglitinide (Nateglinide) starting dose and maximum dose

Back 41

Starting dose = 120mg with each meal (TID)

Max dose = 120mg TID

Front 42

Biguanide (Metformin) starting dose and maximum dose

Back 42

Starting dose = 500mg w/ evening meal; increase to 500mg BID in one week

Max dose = 2550mg/day (divided doses either BID or TID)

Front 43

TZD (Pioglitazone) starting dose and maximum dose

Back 43

Starting dose = 15mg po daily

Max dose = 45mg po daily

Front 44

Alpha glucosidase inhibitor (Acarbose) starting dose and maximum dose

Back 44

Starting dose= 25mg daily to TID (titrate slowly)

Max dose= 100mg TID

Front 45

Incretin mimetic (Exenatide) starting dose and maximum dose

Back 45

Starting dose = 5mcg subcutaneously BID

Max dose = 10mcg subcutaneously BID