Diabetes Flashcards
Drugs used to treat diabetes
○ Biguanides/Metformin
○ Sulfonylureas
○ Thiazolidinediones (TZDs)
○ Dipeptidyl peptidase-4 (DDP-4) inhibitors
○ Glucagon-like peptide-1 (GLP-1) agonist
○ Sodium-glucose cotransporter-2 (SLGT-2) inhibitors
○ Insulin
Biguanides example
Agents: Metformin (Glucophage™)
○ Immediate Release Formulation
○ Extended Release Formulation
Biguanides MOA
Decreases hepatic glucose production, decreased intestinal
glucose absorption, and increases insulin sensitivity and peripheral glucose uptake and
utilization
Biguanides preferred
Preferred initial agent for type 2 diabetes
Biguanides efficacy
Efficacy: Decreases A1C approximately 1-1.5%
Biguanides SE
○ GI Upset (diarrhea, nausea, upset stomach, flatulence)
○ B12 and other vitamin deficiencies
Biguanides do what to avoid SE
take with food
Biguanides Serious side effects
○ Lactic Acidosis
Biguanides Monitoring
○ Side effects (mainly GI)
○ Renal Function
○ Lactic Acidosis
○ A1C, Fasting and 2-hour PP Blood glucose
Biguanides Contraindications
○ eGFR <30mL/min
Sulfonylureas - agents
glipizide (Glucotrol™), glimepiride (Amaryl™), and glyburide (Glynase™)
Sulfonylureas - MOA
: Stimulates insulin secretion from functioning beta cells in the
pancreas, especially in response to a meal; may also increase insulin sensitivity and lower
hepatic glucose production
Sulfonylureas - Efficacy
○ Hypoglycemia
○ Weight gain
Sulfonylureas - Common side effects
○ Hypoglycemia - Avoid in elderly patients for fall risk
Sulfonylureas - Serious side effects
○ Hypoglycemia!
○ A1C, blood glucose
Sulfonylureas monitoring
○ Avoid in patients with G6PD deficiency
○ Glimepiride - Avoid in the elderly