Antidiabetics Flashcards
Which medication is used with an unconscious hypoglycemic patient?
Glucagon (GlucaGen) IV
MOA of Glucagon?
stimulates hepatic production of glucose from glycogen stores (glycogenolysis)
Adverse effects of Glucagon?
N/V
Precautionary measures when giving Glucagon?
Position patient in a side lying position d/t potential V and have suction available
Can IV Glucagon be administered through a line containing D5W?
No
What should be the rate of administration of Glucagon?
not exceeding 1mg/min
Biguanides are oral agent that act on which organ?
liver to decrease glucose production
What is the 1st line Biguanide medication?
Metformin (Glucophage)
Therapeutic use of Metformin?
T2DM, pre-diabetes, gestational diabetes, and POS
MOA of Metformin?
- Decreases hepatic glucose production.
- Decreases intestinal glucose absorption.
- Increases sensitivity to insulin.
Adverse effects of Metformin?
GI: Abdominal bloating, N/V/D
unpleasant metallic taste, decreased vitamin B12 levels
What is the black box warning for Metformin?
risk of lactic acidosis (chills, diarrhea, ↓BP ↓ HR, dyspnea, weakness)
Interactions with Metformin?
acute/chronic alcohol ingestion or iodine contrast media, and cimetidine (Tagamet)
What is the interaction of iodine contrast media with Metformin?
increases risk of lactic acidosis
Dosing schedule for Metformin administration?
immediate release (BID) and extended release (QD) w/ meals d/t GI upset
High risk patients for Metformin use?
renal insufficiency, liver disease, severe infection, HF, hx of lactic acidosis, shock or other conditions that cause hypoxemia, ETOH use
What does it mean that Metformin is weight neutral?
It will not cause patient’s to gain weight. Weight may actually decrease
T/F. Metformin will not cause hypoglycemia when given alone?
True
What causes reduced vitamin B12 levels when taking Metformin?
altered absorption
How can severe lactic acidosis be treated?
hemodialysis
Sulfonylureas and Meglitinides act on which organ?
the pancreas to increase the secretion of insulin
What is the prototype for Sulfonylureas?
Glyburide (DiaBeta)
Therapeutic use of Glyburide?
blood sugar control in T2DM when diet therapy fails.
MOA of Glyburide?
- Lowers blood sugar by stimulating the release of insulin from the pancreas.
- Increasing the sensitivity to insulin at receptor sites.
Adverse effects of Glyburide?
hypoglycemia, photosensitivity, and weight gain
Interactions with Glyburide?
beta blockers, NSAIDs, sulfonamide abx all which will increase hypoglycemia
T/F. Any drug that increases insulin secretion will cause increased weight gain.
True
Glyburide contraindications?
pregnancy and lactation
Why should you avoid alcohol use with Glyburide?
increase risk of disulfiram like reactions (abdominal cramps, N, flushing, HA, and hypoglycemia)
Should Glyburide be taken with or without food?
with food
T/F. Kidney and liver dysfunction are high risk patients with Glyburide use?
True
Prototype for Meglitinides “Glinides”?
Repaglinide (Prandin)
Therapeutic use of of Repaglinide (Prandin)?
T2DM with diet and exercise, may be used with Metformin, rosiglitazone, or pioglitazone
MOA of Repaglinide?
stimulates the release of insulin from the pancreatic beta cells by closing K channels, which results in the opening of Ca channels in the beta cells
Adverse effects of Repaglinide?
Hypoglycemia
Interactions with Repaglinide?
Gemfribrozil (Lopid), multiple interactions
Why should patients with liver impairment be cautious if taking Repaglinide?
May increase risk of hypoglycemia
Does Repaglinide need to be taken with a meal?
yes, 30 minutes or less before eating
What is the interaction of Gemfibrozil with Repaglinide?
slows metabolism of glinides → increasing levels → risk of hypoglycemia
Alpha-glucosidase inhibitors (AGI) act on which system?
The GI tract to decrease absorption of glucose
Prototype for AGIs?
Acarbose (Precose)
Therapeutic use of Acarbose ?
management of T2DM
MOA of Acarbose?
inhibits the enzyme alpha-glucosidase in the GI tract → delays and reduces glucose absorption
Adverse effects of Acarbose?
ABDOMINAL PAIN, diarrhea, flatulence, and liver dysfunction
Interactions with Acarbose?
Several
Acarbose contraindications?
hypersensitivity, DKA, and cirrhosis
Should Acarbose be taken with meals?
with 1st bite of each meal TID
Is Acarbose used in the US?
No d/t side effects
T/F. All oral agents are contraindicated in T1DM
True
Dipeptidyl Peptidase 4 (DPP-4) inhibitors act on which organ?
pancreas to prolong the action of incretin hormones
Prototype for DPP-4 inhibitors?
Sitagliptin (Januvia)
MOA of Sitagliptin?
prolong the action of incretin hormones → increases insulin release → decreases glucagon levels
Therapeutic use of Sitagliptin?
T2DM glycemic control. May be used as monotherapy or combination therapy.
Adverse effects of SitagliptiN?
HA, N, acute renal failure, URI, stuffy or runny nose, ST, drug induced pancreatitis. Serious hypersensitivity rxns (anaphylaxis, angioedema, Steven-Johnson syndrome).
Sitagliptin contraindications?
DKA and hypersensitivity
Does Sitagliptin need to be taken with food?
With or without food
Symptoms of pancreatitis?
severe and persistent abdominal pain w/ or w/o vomiting.
Interactions with Sitagliptin?
Glyburide, Glipizide, or Glimepiride → can increase risk of hypoglycemia
Prototype for Glucagon-like peptide 1 receptor Agonist (GLP-1RA)?
Exenatide (Byetaa)
Therapeutic use of Exenatide?
T2DM management as adjunct to diet and exercise
MOA of Exenatide?
mimics the action of incretin which promotes endogenous insulin secretion and promotes other mechanisms of glucose lowering
Adverse effects of ExeNatiDe?
N/V/D (most common), dyspepsia, weight loss, decreased appetite, hypoglycemia, acute renal failure, and pancreatitis
Interactions with Exenatide?
will slow absorption of oral medications like oral contraceptives and abx
What are benefits of Exenatide?
protective factors for atherosclerotic CVD, HF, and CKD. Will help minimize hypoglycemia or promote weight loss.
Exenatide contraindications?
severe renal impairment
Exenatide precautions?
kidney transplant recipients
Route and dosing schedule for Exenatide?
Route: subcut
60 min before morning and evening meals, not PC
Can Exenatide be mixed with insulin?
No
Can patients still take oral contraceptives or abx with Exenatide?
yes but 1hr before Exenatide
