8: DM Meds Flashcards
Which med is contraindicated in treated CHF?
Metformin
This incretin mimetic is administered orally and can be used as monotherapy or added to metformin, thiazolidendione, or sulfonylurea. It raises both endogenous incretins.
DPP-4 Inhibitors (-gliptins)
Which drug class?
- Restores GLP-1 levels
- Promotes satiety
- Decreases glucagon release, stimulates insulin release
- Delays gastric emptying
- Used with caution in patients with impaired renal and hepatic function
- Major side effect is diarrhea
- DPP-4 Inhibitors:
- Sitagliptin (Januvia)
- Saxogliptin (Onglyza)
Which drug class?
Incretins and incretin mimetics.
- DPP-4 Inhibitors (-gliptins like Januvia)
- GLP-1 receptor analogue (-natides and -glutides like Byetta, Victoza, Trulicity)
Which drug class?
Contraindicated in class 3 and 4 CHF?
Thiazolidinediones (-glitazones)
Which drug?
Injectible that increases satiety.
Amlin analogue: Pramlintide (Symlin)
Which drug?
- Used to improve glycemic control in patients with type 2 DM taking oral agents
- Once daily dosing
- Not recommended in patients with end-stage renal disease, severe renal impairment or severe GI disease
- Nausea most common side effect
- Contraindicated in patients with gastroparesis
Exenatide (Byetta)
T/F Monotherapy of DM is associated with hypoglycemia.
False. Not associated.
Where does this oral med work?
Rosiglitazone
Muscle
What are advantages and disadvantages to this treatment?
Lifestyle modifications
- Advantages:
- Low cost
- Additional health benefits
- Disadvantages:
- Fails for most within a year
Which drug class?
- Most effective
- No maximum dose
- Can be combined with oral agents in DMT2
Insulin
What are advantages and disadvantages to this treatment?
Exenatide (Byetta)
- Advantages:
- Weight loss
- Disadvantages:
- Injections
- GI side effects
- Expensive
What are advantages and disadvantages to this treatment?
Sulfonylureas
- Advantages:
- Inexpensive
- Disadvantages:
- Weight gain
- Hypoglycemia
What are advantages and disadvantages to this treatment?
Metformin
- Advantages:
- Weight neutral
- Inexpensive
- Disadvantages:
- GI side effects
- Lactic acidosis risk (rare)
Which drug classes?
Slows absorption of glucose by the gut.
- Alpha glucosidase inhibitors (Miglitol and Acarbose)
- Pramlintide (Symlin)
- GLP-1 receptor analogs (-natides and -glutides like Byetta, Victoza, and Trulicity)
What medication should be prescribed for all DM patients at risk of severe hypoglycemia?
Glucagon
Which drug class?
Decrease glucagon levels.
- DPP-4 Inhibitors (-gliptins like Januvia)
- Pramlintide (Symlin)
What 2 health conditions cause increased risk of hypoglycemia?
- Active cardiac disease
- Neurological disease
Which med is contraindicated in binge alcohol drinking?
Metformin
This incretin mimetic is administered subQ and can be added to metformin, thiazolidendione, and/or sulfonylurea (singly or in combination).
GLP-1 Receptor Analogues (-natides and -glutides like Byetta, Victoza, and Trulicity)
What is the treatment for hypoglycemia?
- 15-20 g glucose
- Repeat if hypoglycemia remains
- Eat meal or snack after blood sugar returns to normal
Which drug class?
Contraindicated if transaminase is 2.5x the upper normal limit at baseline.
Thiazolidinediones (-glitazones)
Which drug?
Contraindicated in renal insufficiency.
Metformin
Which drug classes?
Insulin sensitizers.
- Biguanides (Metformin)
- Thiazolididnediones (-glitazones)
- GLP-1 receptor analogues (-natides and -glutides such as Byetta, Victoza, and Trulicity)
Where does this oral med work?
Metformin
Liver
What are advantages and disadvantages to this treatment?
Insulin
- Advantages:
- No dose limit
- Inexpensive
- Improved lipid profile
- Disadvantages:
- Injections
- Monitoring
- Hypoglycemia
- Weight gain
Which 4 drugs or classes specifically target postprandial hyperglycemia?
- Meglitinides (Prandin/Repaglinide and Starlix/Nateglinide)
- Acarbose (Alpha Glucosidase Inhibitor)
- GLP-1 Analogs (-natides and -glutides such as Byetta, Victoza, and Trulicity)
- DPP-4 Inhibitors (-gliptins such as Januvia)
Which drug?
- Once daily dosing
- Increased risk of pancreatitis
- Contraindicated with medullary thyroid carcinoma
Liraglutide (Victoza, a GLP-1 Analogue)
What is the leading limiting factor in glycemic management of DM?
Hypoglycemia
What are advantages and disadvantages to this treatment?
Alpha Glucosidase Inhibitors (Acarbose/Precose and Miglitol/Glyset)
- Advantages:
- Weight neutral
- Disadvantages:
- GI side effects
- TID dosing
- Expensive
What are advantages and disadvantages to this treatment?
TZDs (-glitazones)
- Advantages:
- Improved lipid profile
- Disadvantages:
- Fluid retention
- Weight gain
- Expensive
Where does this oral med work?
Acarbose (Alpha Glucosidase Inhibitor)
Gut (carb metabolism)
Which drug class?
Contraindicated in pancreatitis?
GLP-1 Analogs (-natides and -glutides such as Byetta, Victoza, and Trulicity)
What are advantages and disadvantages to this treatment?
Glinides (Meglitinides such as Prandin/Repaglinide and Starlix/Nateglinide)
- Advantages:
- Short duration
- Disadvantages:
- TID dosing
- Expensive
Where does this oral med work?
Pioglitazone
Muscle
Where does this oral med work?
Repaglinide
Pancreas
Which 3 drug classes cause weight gain?
- Sulfonylureas (Glimepiride, Glipizide, Glyburide)
- Thiazolidinediones (-glitazones)
- Insulin
Which drug class?
Contraindicated in active liver disease.
Thiazolidinediones (-glitazones)
Which drug class?
Contraindicated in gastroparesis.
GLP-1 Analogs (-natides and -glutides such as Byetta, Victoza, and Trulicity)
Where does this oral med work?
Miglitol (Alpha Glucosidase Inhibitor)
Gut (carb metabolism)
What are advantages and disadvantages to this treatment?
Pramlintide (Symlin)
- Advantages:
- Weight loss
- Disadvantages:
- Injections
- TID dosing
- GI side effects
- Expensive
Where does this oral med work?
Sulfonylureas (Glimepiride, Glipizide, and Glyburide)
Pancreas
Where does this oral med work?
Nateglinide (-glinides)
Pancreas
Which drug class?
Increase insulin secretion.
- Secretagogues
- Sulfonylureas: Glimepiride, Glipizide, Glyburide.
- Meglitinides: Repaglinide, Nateglinide.