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PDAT2 > 13 - Oral Diabetes Medication 2 > Flashcards

13 - Oral Diabetes Medication 2 Flashcards

1
Q

Signs & SYmptoms of

hypoglycemia

A

Shakey / Sweaty

Blurred Vision / Headache

Hunger / Weakness / Fatigue

CONFUSION

IRRITABILITY

FAST HEART BEAT

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2
Q

Dose

Bile Acid Sequestrant

A

Colesevelam = Welchol

MoA = unknown, maybe incretins and hepatic glucose

3.75g QD WF

may divide into BID

650mg tablets = huge

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3
Q

hypoglycemia

Definition

A

Since some meds can cause hypoglycemia

BG of <70mg/dl

S/S may appear in normal ranges

esp if they had CHRONIC HYPERglycemia

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4
Q

SGL2

Sodium Glucose Co-transporter 2

A

180g of glucose is filtered daily in glomeruli

almost ALL (99%) is REABSORBED

through SGLT2

low-affinity transporter expressed mainly in the KDNEY

inhibition –> glucose in URINE

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5
Q

Advantages / Benefits

SGLT2 Inhibitors​

A

Treat hyperglycemia in a NEW PATHWAY

Once daily Dosing + Weight Loss

EMPAgliflozin = indicated for reducing death in CV DISEASE!

FPG reduction of: 25-40mg/dl

0.5-0.9% A1C reduction

(but with baseline of 8%)

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6
Q

Indication / MoA

Alpha-Glucosidase Inhibitors

Acarbose (precose) / Miglitol (glyset)

A

monotherapy or
in COMBINATION WITH SULFONYLUREA

not recommended for intestinal or liver disease

Competitive inhibitor of :
pancreatic alpha amylase & brush border alpha
glucosidases
delay carb hydrolysis & absorption of glucose

PPG REDUCTION!

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7
Q

Dose

DAPAgliflozin

SGL2-Inhibitor

A

FARXIGA

5mg qd AM

in morning with or w/o food

no dose adj for hepatic impairment

NOT RECOMMENDED for <45ml/min eGFR

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8
Q

Which drugs are OKAY TO USE for pregnancy?

A

Alpha Glucosidase Inhibitors

Bromocriptine mesylate = CYCLOSET

Bile Acid Sequestrant = Colesevelam

all except SGLT inhibitors -gliflozin

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9
Q

Dopamine Receptor Agonist

DOSE

A

Bromocriptine = Cycloset

0.8mg qd

within 2 hours after AWAKENING

Titrated weekly by 1 tablet to therapeutic dose of

1.6-4.8mg qd

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10
Q

Adv / Disadvantages

Dopamine Receptor Agonist

Bromocriptine = Cycloset

A

Appropriately timed daily admin of drug

decreases BOTH FPG & PPG, but ONLY with other t2dm drugs

need to be taken w/ food & weekly titration

NOT TYPICALLY USED TO TO ADR & DIFFICULTY OF USE

nausea / fatigue / dizziness / constipation / headache

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11
Q

Advantages / Benefits

Alpha-Glucosidase Inhibitors

Acarbose (precose) / Miglitol (glyset)

A

PROVIDES PPG CONTROL

does not cause hypoglycemia on its OWN

A1C reduction: 0.5-1%

FPG reduction: 20-40 mg/dl

PPG reduction: 40-70 mg/dl

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12
Q

SEVERE

hypoglycemia treatment

A

GLUCAGON EMERGENCY KIT

0.5-1mg

IM, SC or IV into Buttocks / upper arm / thigh

may be repeated in 15 min if needed

  • if no response in 15 minutes
    • CALL AMBULENCE 911
  • may cause N/V, turn patient on side
    • give CARB SNACK

​DEXTROSE IV 25G okay in inpatient or clinic setting

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13
Q

Dose

ERTUgliflozin

SGLT2-Inhibitor

A

STEGLATRO

5mg qd

  • doesnt have to be AM,* with or without food
  • No dose adj for HEPATIC impairment, but not studied in severe*

not rec for <60ml/min / condraindicated <30ml/min

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14
Q

PK’s

SGLT2 Inhibitors​

A

All 4 Drugs have

>80% Glucuronidation metabolism

Peaks around 1-2 hours

Excreted split in urine & feces

  • no dose adjustment for HEPATIC impairment*
  • except for CANAgliflozin*
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15
Q

Products

Alpha-Glucosidase Inhibitors

A

Acarbose (precose)

Miglitol (glyset)

BOTH SAME DOSE

SLOW TITRATION

TAKE IN MORNING WITH FOOD TID

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16
Q

Disadvantages / ADR

Alpha-Glucosidase Inhibitors

Acarbose (precose) / Miglitol (glyset)

A

GI EFFECTS!

TID Dosing + slow titration (2-4 weeks)

need glucose treatment if taken with hypoglycemic drug

(liver labs) ​LFT testing EVERY 3 MONTHS

  • Contraindications
    • various GI related diseases
      • IBS / Ulcers / Cirrhosis / Intestinal obstruction
    • Liver Disease
  • ​Flatulence / Ab Pain / Diarrhea
17
Q

PK’s

Alpha-Glucosidase Inhibitors

Acarbose (precose) / Miglitol (glyset)

A

Onset: <1 hour

Duration <6 hours

need to take TID

very low bioavailability <2% acarbose

miglitol bioavailability of 100%

18
Q

Examples of Fast Acting Carbs

A

All have ~15g of Carbs

3-4 glucose tablets

5-6 hard candies (chewed)

4 ounces (1/2 glass) of juice/ soda

1 Cup milk

Glucose Gel

19
Q

Dose

CANAgliflozin

SGLT1 Inhibitor

A

Invokana

100mg QD

BEFORE first meal

ONLY SGLT2-I that is

  • NOT recommended for severe hepatic impariment / K+ DI’s*
  • no titration needed for <60ml/min EGFR*

NOT recommended for <45ml/min eGFR

20
Q

Adv / Disadv

Bile Acid Sequestrant

Colesevelam

A

Effects not seen until 4-18 weeks

Reduction of A1C is ONLY 0.3-.54%

TAKES TOO LONG & NOT AS EFFECTIVE

  • also need to SPACE OUT FROM OTHER DRUGS*
  • GI obstruction / Constipation / Headace / Dypepsia*
21
Q

Indication / MoA

SGLT2 Inhibitors

A

Treatment for T2DM as adjunct to diet + exercise

SGLT2 Inhibitors

Block the REABSORPTION of

filtered glucose

leading to glucosuria (urinating glucose)

22
Q

Dose

EMPAgliflozin

SGL2-Inhibitor

A

JARDIANCE

First anti-DM agent –> REDUCE RISK OF CV DEATH​

10mg qd AM

same as DAPA, except for dose

in morning with or w/o food

no dose adj for hepatic impairment

NOT RECOMMENDED for <45ml/min eGFR

23
Q

Disadvantages / ADR

SGLT2 Inhibitor

A

CI = END STAGE RENAL DISEASE

Cost / Need for LAB monitoring

NOT REC pregnancy / breast feeding

  • NUMEROUS Side effects
    • UTI - glucose in urine
    • Kidney injury / decrease in eGFR
    • BONE FRACTURES
    • KETOACIDOSIS
    • CANAgliflozin
      • –> lower limb amputation
        • also hyperkalemia
24
Q

Why Combination Products?

A

Useful when BG is STABLE

can REDUCE Pill BURDEN

usually not recommended for INITIAL Therapy

25
Q

Dose

Alpha-Glucosidase Inhibitors

Acarbose (precose) / Miglitol (glyset)

A

TAKE WITH FIRST BITE OF MEAL

very slow titration,

same dose both drugs

25 mg daily for 2-4 weeks

25 mg BID for 2-4 weeks

25 mg TID for 2-4 weeks

50 mg TID, if needed

26
Q

15/15 Rule

for Hypoglycemia Treatment

A
  • 1st check BG, if <70mg/dl
    • Tak_e 15g of SIMPLE carb_ (FAST acting sugar)
    • monitor the BG in 15 Minutes
  • REPEAT if <70mg/dl STILL
    • but if its <50mg/dl –> GIVE 30g of simple carb
  • Prefer >80mg/dl
  • After initial treatment:
    • patient should eat a meal / snack
      • to maintain BG level
27
Q

Products

SGLT2 Inhibitors

A

C-D-E-E

CANAgliflozin

Invokana - 100mg

DAPAgliflozin

Farxiga - 5mg

EMPAgliflozin

Jardiance - 10mg

ERTUgliflozin

Steglatro - 5mg

PDAT2 (22 decks)

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