DM Drugs Flashcards
Metformin
Glycemia? Weight? Other effects?
Euglycemic, weight loss, decreases macrovascular events (stroke, #1 DM killer), decreases TG.
Metformin S/E
Common: GI (diarrhea)
Serious: Lactic acidosis (esp in ESRD, also in hepatic dz, alcoholism, diseases that predispose to hypoxia: CHF, COPD, being super sick in the hospital, etc). Take pts off 2 days before contrast and when in hospital sick.
Metformin–does it have a black box?
Yes, Lactic acidosis
Metformin–when to take off
2 days before getting contrast
If sick in the hospital
If kidneys are failing
If pt can’t tolerate the diarrhea
Which drugs are second line after Metformin?
Incretins:
incretin mimetics {“-tide”, exenatide (Byetta), Liraglutide (Victoza), Dulaglutide (Trulicity)}
DPP-IV inhibitors {“-gliptin”, sitagliptin (Januvia), saxagliptin (Ongyliza), Linagliptin (Tradjenta), Alogliptin (Nesina)}
How is Metformin given?
Orally–
850-1000mg PO bid, start low and move up. Give w meals, stop for contrast
Extended release: 1000-2000 PO qpm
Metformin MOA
Increases insulin sensitivity–> increased glucose uptake.
Decreases hepatic glucose production (gluconeogenesis)
decreases GI glucose absorption
Decreases glucagon production
MOA incretin mimetics
Activate glucagon-like-peptide-1 (GLP1) receptor–> increase insulin secretion, decrease glucagon secretion, delay gastric emptying
MOA DPP-IV inhibitors
Blocks DPP-IV, which degrades incretins, thereby potentiality incretin effects. (Up insulin, dn glucagon, dn gastric emptying)
Name the incretin mimetics
Exenatide (Byetta)
Liraglutide (Victoza)
Dulaglutide (Trulicity)
Name the DPP-IV inhibitors
Sitagliptin (Januvia)
Saxagliptin (Ongyliza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
How are incretin mimetics administered?
S.C…..either 60 min before 2 main meals, or once a week
How are DPP-IV inhibitors administered?
Orally…once a day (Januvia 100mg)
Adverse effects of Incretin mimetics
Common: GI disturbance. Slows GI emptying, so careful w pts w slow GI dz. careful w renal impairment.
Bad: pancreatitis, pancreatic CA.
Adverse effects of DPP-IV inhibitors
Common: Less than incretin mimetics. Slow GI probs
Bad: pancreatitis, pancreatic CA (less than incretins)
Main difference between incretin mimetics and DPP-IV inhibitors
Incretin mimetics cause weight loss, DPP-IV I are weight neutral.
Do incretin mimetics have a black box?
Yes—Liraglutide (Victoza), for Thyroid CA. Contraindicated in pts w medullary thyroid carcinoma hx or FHx, and in pts w MEN-2