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