Diabetes Flashcards
Lantus generic
Insulin glargine
Indications for Lantus
Type I and Type II diabetes mellitus
Lantus AEs
Hypoglycemia, injection site reactions, weight gain, hypokalemia, lipodystrophy, retinopathy, and insulin shock
Lantus metabolism
hepatic and metabolic
Lantus interactions:
Alcohol, corticosteroids, thiazides, loop diuretics, oral contraceptives, beta blockers, ace inhibitors, ARBs
Lantus contraindications
hypoglycemic episodes
Lanuts Monitoring parameters
blood glucose, and A1C
How does Lantus interact with alcohol
Increases the risk of hypoglycemia mainly in fasting patients
How does Lantus interact with corticosteroids?
decreases hypoglycemic effects of Lantus
How does Lantus interact with thiazides and loop diuretics?
decreases hypoglycemic effects of Lantus
How does Lantus interact with oral contraceptives?
decreases hypoglycemic effects of Lantus
How does Lantus interact with Beta blockers?
Increases the duration of hypoglycemic episodes and inhibits the symptoms
How does Lantus interact with ACE inhibitors/ARBs?
increases hypoglycemic effects of insulin by improving insulin sensitivity
Brand names of Insulin Aspart?
Novolog and humalog
Indications of insulin aspart?
type I or type II diabetes mellitus
AEs of insulin aspart
Hypoglycemia, injection site reaction, weight gain, hypokalemia, lipodystrophy, retinopathy, and insulin shock
metabolism of insulin aspart
hepatic and renal
interactions with insulin aspart
alcohol, corticosteroids, thiazides, loop diuretics, oral contraceptives, beta blockers,
insulin aspart interaction with alcohol
increased risk of hypoglycemia especially in fasting patients
insulin aspart interaction with corticosteroids
decrease hypoglycemic effects of insulin
insulin aspart interaction with thiazide and loop diuretics
decrease hypoglycemic effects of insulin
insulin aspart interaction with oral contraceptives
decrease hypoglycemic effects of insulin
insulin aspart interaction with beta blockers
increase the duration of hypoglycemic episodes and inhibit the symptoms
contraindications for insulin aspart
hypoglycemia
monitoring of insulin aspart
blood glucose and A1C
Brand name of sitagliptin
Januvia
Januvia class
Dipeptidyl-peptidase IV (DPP-IV) inhibitor
Indications of Januvia
Type II diabetes mellitus
Dosage of Januvia
50 mg to 100 mg
AEs of Januvia
naso-pharyngitis, upper respiratory infection, peripheral edema, hypoglycemia renal failure
metabolism of Januvia
Renal (major) and hepatic
Interactions of Januvia
beta blockers, ACE inhibitors/ARBs, Thiazides, loop diuretics, cyclosporine, digoxin,
Januvia interaction with beta blockers
increase the duration of hypoglycemic episodes and inhibit the symptoms
Januvia interaction with ACE inhibitors / ARBs
increase the hypoglycemic effects of sitagliptin
Januvia interaction with Thiazides/loop diuretics
decrease the hypoglycemic effects of sitagliptin
Januvia interaction with cyclosporine
decrease the hypoglycemic effects of sitagliptin
Januvia interaction with digoxin
increase the AUC and Cmax of digoxin levels
contraindications of Januvia
angiodema
Monitoring for Januvia
blood glucose, A1C, serum creatinine/BUN, serum electrolytes, and serum lipase
Brand name of pioglitazone
Actos
Class of Actos
antidiabetic - thiazolidinediones
indications of Actos
type II diabetes mellitus
dosage range of Actos
15-45 mg orally daily
AEs of Actos
hypoglycemia, macular edema with visual impairment, weight gain and edema
metabolism of Actos
Hepatic (CYP 3A4, CYP 2C8)
Interactions with Actos:
oral contraceptives, CYP 3A4 inhibitors, Cyclosporine, tacrolimus, CYP 3A4 inducers
Cyp 3A4 inhibitors
erythromycin, itraconazole, verapamil, grapefruit juice, nefazodone, protease inhibitors)
CYP 3A4 inducers
phenytoin, st John’s Wort oxcarbazepine
interaction of actos with oral contraceptives
decrease blood levels of the oral contraceptives
interaction of actos with cyp 3a4 inhibitors
increase blood levels of actos
interaction of actos with cyclosporine
increase hyperglycemia
interaction of actos with tacrolimus
increase hyperglycemia
interaction of actos with cyp 3A4 inducers
decrease blood levels of actos
contraindications of actos
acute heart failure or heart failure
monitoring parameters of Actos
blood glucose and LFTs
Brand name of insulin detemit
Levemir
Levemir indication
type 1 and 2 diabetes mellitus
AEs of Levemir
hypoglycemia, weight gain, hypokalemia, lipohypertrophy, insulin resistance, peripheral edema, and abdominal pain
metabolism of levemir
hepatic and renal
interactions with levemir
alcohol, corticosteroids, thiazides, loop diuretics, oral contraceptives, beta blockers, ace inhibitors, ARBs,
contraindications of levemir
hypoglemic episodes
monitoring parameters of levemir
blood glucose and A1c
Levemir interaction with alcohol
increase risk of hypoglycemia especially in fasting patients
levemir interaction with corticosteroids
decrease hypoglycemic effects of insulin detemir
levemir interaction with thiazides and loop diuretics
decrease hypoglycemic effects of insulin detemir
levemir interaction with oral contraceptives
decrease hypoglycemic effects of insulin detemir
levemir interactions with beta blockers
increase of the duration of hypoglycemic episodes and inhibit the symptoms
levemir interactions with ace inhibitors/ARBs
increase hypoglycemic effects of insulin by improving insulin sensitivity
brand names of exenatide
byetta, bydureon
exenatide class
insulin mimetics
indications of exenatide
type II diabetes mellitus
dosage range of exenatide
5-10 mcg subcutaneously twice a day, 2 mg subQ one weekly, within 60 minutes of a meal
AEs of exenatide
hypoglycemia, nausea/vomiting. hyperhidrosis, headache, injection site reaction, antibody formation
metabolism of exenatide
renal
interactions of exenatide
estrogens/progesterones, thiazides, triamterene, ACE inhibitors, ARBs
contraindications of exenatide
medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2 (MEN 2), thyroid cancer
monitoring of exenatide
blood glucose, A1C, serum creatinine and urinalysis
interaction of exenatide with estrogens/progesterones
decrease hypoglycemic effect of exenatide
interaction of exenatide with thiazides
decrease hypoglycemic effect of exenatide
interaction of exenatide with triamterene
decrease hypoglycemic effect of exenatide
interaction of exenatide with ACE inhibitors/ARBs
increase hypoglycemic effect of exenatide
Brand name of metformin
glucophage
metformin drug class
biguanide antidiabetic
indication of metformin
type II diabetes mellitus
Dosage range of metformin
500 mg oral twice daily or 850 mg orally once daily. doses > 2000 mg should be divided doses
AEs of metformin
GI effects, vitamin B 12 deficiency, weight loss, lactic acidosis, and hypoglycemia (less likely)
metabolism of metformin
renal
interactions of metformin
furosemide, thiazide diuretics, triameterene, digoxin, amiloride, cimetidine, adefovir, trimethoprim, oral contraceptives
contraindications to metformin
diabetic ketoacidosis, metabolic acidosis, radiographic contrast administration, renal failure
monitoring of metformin
blood glucose, A1c, CBC, serum creatinine/BUN
metformin interaction with furosemide
increase metformin plasma levels, hyperglycemia and glycosuria
metformin interaction with thiazides
decrease hypoglycemia effects of metformin
metformin interaction with digoxin
increase serum digoxin concentration
metformin interaction with amiloride
increase risk of lactic acidosis
metformin interaction with cimetidine
increase risk of lactic acidosis
metformin interaction with adefovir
increase risk of lactic acidosis
metformin interaction with trimethoprim
increase risk of lactic acidosis
metformin interaction with oral contraceptives
decrease hypoglycemic effects of metformin
metformin interaction with triameterene
decrease hypoglycemia effects of metformin
Brand name of repaglinide
Prandin
Prandin drug class
anti-diabetic Meglitinide derivative
Prandin indications
type II diabetes mellitus
Prandin initially dosing
nieve pts/ A1C > 8 : 0.5 mg before each meal
treated pts/ a1c < 8: 1-2mg before each meal
Prandin dosing range
0.5-4 mg before meals. 2-4 times per day
Contraindications to prandin
diabetic ketoacidosis, type I diabetes, concurrent gemfibrozil therapy
Pregnancy category of prandin
C
AEs of prandin
Headache, hypoglycemia, upper respiratory tract infection,
Metabolism of prandin
hepatic: CYP2C8, CYP 3A4, SLCO1B1
Monitoring of prandin
blood glucose, A1C,
MOA of prandin
blocks ATP dependent calcium channels to calcium entry stimulating release of insulin from beta cells (glucose dependent relesse)
Prandin drug interactions
Androgens, Atazanavir, Bosentan, Corticosteroids, cyclosporine, CYP 2C8 inducers/inhibitors, CYP 3A4 inducers/inhibitors, gemfibrozil, loop diuretics/thiazides, MAOIs, Macrolides, Rifampin, SSRIs, ST John’s Wort, Trimethoprim