Anemia, PO DM meds Flashcards
first line if A1C is <7.5%
metformin
site of action: Alpha Glucosidase Inhibitors
intestines
class: Acarbose, miglitol
Alpha Glucosidase Inhibitors
site of action: Meglitinides
pancreas
class: Repaglinide, nateglinide
Meglitinides
main SE of Repaglinide, nateglinide
hypoglycemia (severe if also on gemfibrozil)
site of action: Sulfonylureas
pancreas
class: Glyburide, glipizide, glimepiride
Sulfonylureas
MOA: blocks ATP sensitive K channels – insulin release from functional beta cells, decreased efficacy w/ time
o Increases insulin secretion
Sulfonylureas
AEs: **Hypoglycemia
o Weight gain
o Nausea, dyspepsia, diarrhea
Sulfonylureas
cautions: Sulfonylureas
elderly, renal and hepatic dysfunction
CI: Sulfonylureas
pregnancy, sulfa allergy, type 1 DM
site of action: Biguanides
liver, muscle
class: metformin
Biguanides
initial dosing for metformin
IR 500mg Qd or bid / XR 500mg QD
MOA: reduces liver gluconeogenesis and glycogenolysis
o Decreases liver glucose formation/release
o Increase glucose uptake by skeletal muscle and adipose tissue à increases insulin sensitivity
metformin
metformin - hypoglycemia risk as monotherapy?
no
AEs: ovulation, N/V/**D, flatulence, macrocytic anemia / peripheral neuropathy – must monitor renal function and Vit B12
metformin
BBW: metformin
LACTIC ACIDOSIS
§ in pts w/ CHF, hepatic or renal dysfunction, elderly, alcohol abuse
stie of action: Thiazolidinediones (Glitazones)
liver, muscle, adipose tissue
class: Pioglitazone, rosiglitazone
Thiazolidinediones (Glitazones)
MOA: PPARg agonist à increase GLUT-4 transporters, increase insulin sensitivity of tissues. decreases gluconeogenesis
Thiazolidinediones (Glitazones)
AEs: Weight gain, URI, HA
o Fluid retention
o Risk of bone fracture
o **Risk of BLADDER CANCER
can induce ovulation
Thiazolidinediones (Glitazones)
BBW: Thiazolidinediones (Glitazones)
fluid retention in CHF
which Thiazolidinediones (Glitazones) causes bladder cancer?
pioglitazone
site of action: Dipeptidyl peptidase-4 Inhibitors (DPP-4)
intestines
MOA: blocks breakdown of GLP-1 – increases endogenous GLP-1
o “Incretin enhancer”
Dipeptidyl peptidase-4 Inhibitors (DPP-4)
AEs: **URI, sore throat
o **Hypersensitivity rxn
o **Pancreatitis
o HA, diarrhea, joint pain
Dipeptidyl peptidase-4 Inhibitors (DPP-4)
class: Sitagliptin, saxagliptin, linagliptin, alogliptin
Dipeptidyl peptidase-4 Inhibitors (DPP-4)
cautions: Dipeptidyl peptidase-4 Inhibitors (DPP-4)
HF, pancreatitis
CI: Dipeptidyl peptidase-4 Inhibitors (DPP-4)
type 1 DM, use w/ GLP1 receptor agonists
site of action: Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)
kidneys
class: Canaglifozin, dapaglifozin, empaglifozin, ertuglifozin
Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)
MOA: Inhibits glucose reabsorption in proximal tubule of kidneys à excess glucose excreted in urine
Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)
AEs: **hyperK
Polyuria, constipation, hypotension
o Increased risk of UTI and genital fungal infections
o Increased risk of bone fracture and pancreatitis
Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)
BBW: Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)
lower limb amputation risk
cautions: Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)
bladder / breast cancer hx
dopamine agonist indicated for DM
bromocriptine
class: Colesevelam
bile acid sequestrant
AEs: GI disturbances – constipation, bloating, gas
o Impaired absorption of lipid soluble vitamins and drugs
Colesevelam
iron deficiency causes ____ anemia
microcytic
Vit B12 and folate defic cause ____ anemia
macrocytic
anemia of chronic dz causes ____ anemia
normocytic
Low ferritin means ___ iron
low
High transferrin means ___ iron
low
High TIBC means __ iron
low
1st line for iron defic anemia
PO iron
counseling for PO iron
counseling: Take on an empty stomach but if you
have GI upset you can take with food
except dairy or caffeine. You may experience
dark stools or constipation
take w/ orange juice or vitamin C
Take separately from calcium-containing foods/beverages/supplements, cereals, dietary fiber, tea, coffee,
eggs
PO iron
4 meds iron impairs absoprtion of:
Levothyroxine
§ Levodopa/methyldopa
§ Fluroquinolones
§ Tetracycline and doxycycline
AEs: GI side effects common: metallic taste, nausea, flatulence, constipation, N/V/D, epigastric discomfort
o Black/green or tarry stools staining clothing or cause anxiety about bleeding
PO iron
tx for iron toxicity
IV fluids
o Whole bowel irritation w/ polyethylene glycol
o Deferoxamine (Desferal)
AEs: flushing, rash, abdominal pain, hypotension
IV irons: Ferric carboxylmaltose (Injectafer), iron sucrose (Venofer)
long term metformin use can cause vitamin ___ defic
B12
folate DIs
Phenytoin – reduces absorption of folic acid, may lead to deficiency. Folic acid may decrease serum concentration of phenytoin
* DNA synthesis inhibitors: Azathioprine, 6-MP, 5-FU, hydroxyurea, zidovudine. May cause folate deficiency
* Folate antagonists: methotrexate, trimethoprim, pentamidine, triamterene. Leucovorin (folinic acid) used to circumvent action of methotrexate – reduces toxicity of high dose methotrexate
class: Epoetin, darbepoetin
Erythropoiesis-Stimulating Agents (ESAs) – ALL IV
