Diabetes Oral Meds Flashcards
Sulfonylureas
First generation
How/When to take
Metabolized & excreted where?
chlorpropamide (Diabinese)
tolazamide (generic)
Insulin Stimulators: increase insulin release from beta cells and increase number of insulin receptors
Give with meals. Don’t give after last meal of the day. Tablets may be crushed and taken with fluids for those with swallowing difficulty.
Metabolized in liver an excreted in urine and bile.
Sulfonylureas
2nd generation
How/When to take
Metabolized & excreted where?
glimepiride (Amaryl)
glipizide (Glucotrol)
glyburide (DiaBeta, Micronase)
Insulin Stimulators: increase insulin release from beta cells and increase number of insulin receptors
Give with meals. Don’t give after last meal of the day. Tablets may be crushed and taken with fluids for those with swallowing difficulty.
Avoid alcohol! Antabuse effect
Avoid NSAIDs
Metabolized in liver and excreted in urine and bile.
Meglitinide analogs
repaglinide (Prandin)
nateglinide (Starlix)
Insulin Stimulators: increase insulin release from beta cells and increase number of insulin receptors
Give up to 30 mins before meals.
Limit grapefruit juice to <1L
Can combo with Metformin (PrandiMet)
Thiazolidinediones “glitazones”
When to take
Insulin Sensitizers
Decrease liver glucose production
Increase insulin sensitivity
Used in combo with insulin, metformin or sulfonylureas
pioglitazone (Actos)
rosiglitazone (Avandia) -stroke, angioedema
Can be given with or without meals
BLACK BOX WARNING
HF, bone fracture, macular edema, heart-related deaths, RENAL impairment
Notify HCP if liver dysfunction such as jaundice, N/V, abdominal pain, fatigue, dark urine occur, or HF symptoms occur.
Actos strongly linked to bladder cancer and liver failure if used 1+ year
Alpha-Glucosidase Inhibitors
When to take
acarbose (Precose)
miglitol (Glyset)
Decrease starch digestion and glucose absorption in INTESTINES.
Used in combo with sulfonylureas, metformin, insulin
Take with FOOD and eat more iron to avoid iron deficiency anemia.
Biguanides
SE:
metformin (Glucophage)
Decrease intestinal absorption of glucose and decrease liver glucose production. Increase insulin sensitivity
SE: can cause Lactic Acidosis. Avoid pts with renal impairment
To prevent L.A. and AKI, hold metformin 24 hrs before and 48 hrs after using contrast medium.
Dipeptidyl peptidase-4 (DPP-4) inhibitors
SE:
Teaching:
alogliptin (Nesina) -HF
linagliptin (Tradjenta)
saxagliptin (Onglyza)
sitagliptin (Januvia)
Slows breakdown of GLP-1, leads to increased insulin release
SE: Risk for pancreatitis, HA, V, HF
Report any jaundice, intense radiating abd pain, or blue-gray discoloration of abdomen/periumbilical area
Sodium-Glucose Cotransport Inhibitors
SE:
Teaching:
canagliflozin (Invokana) -Lower limb amputations risk
dapagliflozin (Farxiga)
empagliflozin (Jardiance) -AKI risk
ertugliflozin (Steglatro)
Prevent kidney reabsorption of glucose and sodium
Jardiance reduces MI, stroke, and CHF
Teaching: s/s of hypoglycemia, dehydration, hyponatremia, UTIs, yeast infections, Fournier gangrene, perineal fasciitis
Human Amylin/amylin analogs
Teaching:
When to take
pramlintide acetate (Symlin)
Delays gastric emptying; Lowers after-meal glucose levels; triggers satiety
Teaching: Can’t mix with insulin syringe! pH not compatible
CAN give to both DM Types 1 & 2
Given BEFORE major meals
Peaks in 20 mins
