diabetes Flashcards
Biguanides
administration, MOA, indications/ contradictions, side effects, adverse effects
METFORMIN
- increases peripheral glucose uptake and utilization - improves inuslin sensitivity
- decreases hepatic glucose production
- decreases intestinal absorption of glucose
- very effective.
- minimal risk of hypoglycemia
- can help with weight loss
- oral -
- lowers lipids
risks:
- gi disturbances
- risk for vit b12 defiency with long term
- risk for lactic acidosis
dont give with
- gfr less than 30
- liver disease
- alochol use
- acute hf
- lactic acidosis history
- dcreaed tissue prfusion
drug interactions
- nifedipine - increase metformin
catatonic drugs - eliminated renally
cimetidine caan result in 40% increase in metformin !!!!!!!
sulfonyureas
administration, MOA, indications/ contradictions, side effects, adverse effects
1st gen
- chlorpropamide /
- tolbutamine
- fallen out of favor due to high risk of hypoglycemia and more side effecs than second gen.
second gen
glipizide
- 30 mins before meals
GLYburide
- take with breaskgst
glimepiride
- take with breakfast
- low risk of hypoglycemia
lot of inhibitors and inducers.
TZD’s
administration, MOA, indications/ contradictions, side effects, adverse effects
PIOGLITAZONE
- oral
- periodici monitoring of liver function
ROSIGLITAZONE
- rare used
- questionable increased risk of cv death and MI
GLP1’S S
administration, MOA, indications/ contradictions, side effects, adverse effects
increases insulin, decreases glucagon, increases beta calls, decreases gsastric emptying, increases hunger, and insulin sensivity — we want to increase the glp 1 hormone.
so we either give a glip 1 agonist
or dpp4 - which inhibits breakdown of glp 1
Pros:
- reduce fasting and post prandial BS
- promote weight loss
- low risk for hypoglycemia
- long acting and short acting
- decrease CVD outcomes
- can be monotherapy
- option for second ine therapy with metformin
CONS:
- SQ administration
- cant use with dpp4’s
- risk of hypoglycemia increases if combined with SU or basal insulin
SIDE EFFECTS:
- n/v/d
- acute pancreatisis
- caution with renal impairement
Liraglutide
- weigt loss. SQ
- very expensive
- Decreases CVD risk
dulagulatide
- no renal dose needed
- reduced risk for non fatal MI stroke and CV death
semaglutide
- no renal dosing - oral forms avaiailable
- decreases non fatal stroke outcomes.
exenatide
- short acting
- not reccomended if GFR is less than 30.
BLACK BOX WARNING:
- THYROID C CELL TUMORS AND PANCREATISSI
GLP’1
dpp4
administration, MOA, indications/ contradictions, side effects, adverse effects
inhibit the breakdown of glp -1 by inhibiting the action of dpp4 - an enzyme that breaks down glp - 1
PROS: - reduce both asting and post prandial bs - weight neutral - low risk for hypoglycemia oral administration - option for secon dline therapy
CONS:
- many require renal dose adjustment
- use caution in patients with HF
- should not be used with GLP1 agonist
- URI, HEADACHE, COST
Saxagliptin
linagliptin
alogliptin
vildafliptin
SGLT2’S
administration, MOA, indications/ contradictions, side effects, adverse effects
block reabsorption of glucose in the kidneys promoting renal excretion of glucose
PROS:
- REDUCE a1c up to 1%
- prmote weight loss
- creases CVD outcomes with some formualtion
- low risk of hypoglycemia
- minimal GI side effects
- oral administration
CONS:
- avoid if GFR less than 45.
- decreases effects at kidney function decreases
SIDE EFFECTS
- UTI/ yeast infections
- decreased BMD
- increased risk of amputations
- risk for dehydration and DKA
Canagliflozin
- decreased CV morbidity
- decreased of worsening GFR, esrd and renal related death
Empagliglozin
- significant reduction in CV mortaility
- proven HF benefit and renal benefit
DAPAGLOFLOZIN
- avoid in bladder cancer
- no change in athlerscerotic outcomes but does decrease hospitalizations for HF and other.
- renal benefit
genital area infection
- can happen with these drugs.
INSULIN
START, RISK/ ADVERSE EFFECTS,
consider early therapy with metforms and or glp 1 if aic is more than 1-%
- if therapy is failing and you are ready to add a 2nd or 3rd drug.
- rarely used as monotherapy anymore
- continue metform with inuslin initiation
combo with glp 1 is reccomended
- generally preffered treatment for GDM/DM in pregnancy
downsides are that
- high risk of hypoglycemia, weight gain, BG monitoring
start with basal insulin - controls fasting blood sugars!!
weight based - titrate every 2-3 days.
INSULIN
BASAL VS. PRANDIAL
BASAL
- reduces fasting hyperglycemia
- long duration
- inject morning and or evening
- levenir NPH or lantus
- it is possible to overbasalize - high bedtime glucose minus morning and its more than 50 thats bad. - be aware of hypoglycemia
IF FASTING SUGARS ARE GOOD BUT A1C IS HIGH THEN CHECK POST PRANDIAL SUGARS
Prandial
- reduceds postprandial hyperglycemia
- short acting
- inject at meal times
apidra, humalog, novolog, regular
- RAPID ATING - CAN BE ADDED LATER WITH MEALS
- start with 4 units of 10% of amount of basal insulin - as prandial insulin is adjusted it may make sense to decrease bsal insulin
INSULIN
HOW TO INITIATE
PAT EDUCATION
