DM drugs Flashcards
1
Q
Metformin
(Glucophage)
A
- first line for T2DM
- -Dosing: 500mg-2000mg/day
- Max CLINICAL dose: 2000mg/day (1000mg PO BID)
- BBW : Lactic Acidosis
- Common ADE: diarrhea (self-limiting), cramping, nausea, taste disorder
- Take with food
- XR should be used in patients that don’t tolerate IR with BID dosing
- D/C prior to iodinated contrast procedures
- potential B12 deficiency
2
Q
Metformin MOA
A
**suppression of hepatic glucose production
** ↑ insulin-mediated muscle glucose uptake
**↑ intestinal glucose utilization
3
Q
Sulfonylurea (2nd) generation
A
- Glimepiride (Amaryl)
- Glipizide (Glucotrol, Glucotrol XL)
- Glyburide (Diabeta)
4
Q
Sulfonylurea (2nd) generation
A
- -Take 30 min prior to meals
- Test G6PD deficiency for hemolytic anemia
- -Prolong use may result in worsening beta cell function (“beta cell burnout”
- -Not effective in pt with long duration of T2DM
- Glimepiride (Amaryl)- preferred in liver dysfunction
- Glipizide (Glucotrol) – preferred in renal insufficiency (short t1/2)
- -Rapid onset of action/shorter durability vs. metformin
5
Q
Sulfonylurea (2nd) generation MoA
A
** Close 𝐾𝐴𝑇𝑃channels on beta cell plasma membranes
Physiologic action:
**↑ insulin secretion
6
Q
TZD
A
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
7
Q
TZD
A
- -Take with or without food
- -BBW: may cause or worsen heart failure
- -CI in patients with class III/IV HF
- -ADE: fluid retention, peripheral edema, weight gain, risk of bone fracture/atypical fracture
- -Onset: 3 weeks (long onset of action)
- -d/c if signs of hepatitis, AST/ALT > 3x normal
- -Monitor: AST/ALT, visual exam
- -check LFT Q3-6 months
- -Bladder cancer (pioglitazone)
- -↑ LDL cholesterol (rosiglitazone)
8
Q
TZD MoA
A
- activates the nuclear transcription factor PPAR-y (gamma)
- Physiologic action: ↑ insulin sensitivity
9
Q
DDP-4 inhibitors
A
- Sitagliptin (Januvia)
- Saxagliptin (Onglyza)
- Linagliptin (Trajenta)
- Alogliptin (Nesina)
10
Q
DDP-4 inhibitors
A
- Start sitagliptin at 100mg PO daily (25mg and 50mg are renal dose, no need for titration)
- -Not associated with hypoglycemia or weight gain
- -Monotherapy when metformin is CI or in dual/triple tx
- -ADE: nasopharyngitis, pancreatitis, upper respiratory infection, HA, joint pain
- -Saxagliptin, linagliptin-preferred in severe hepatic failure
- -linagliptin- no renal adjustment required
- -DO not combined with GLP-1 receptor inhibitors
11
Q
DDP-4 inhibitors MOA
A
- MOA: inhibit DDP-4 activities
- Physiologic action:
- ↑ postprandial incretin (GLIP-1) concentration
- ↑ insulin secretion and ↓ glucagon secretion (glucose dependent)
12
Q
GLP-1 receptor agonist
A
- Long acting
- Exenatide extended release (Bydureon), Liraglutide(Victoza), Dulaglutide (Trulicity)
- Semaglutide (Ozempic)
- Short acting
- Exenatide (Byetta)
- Lixisenatide (Adlyxin)
13
Q
GLP-1 receptor agonist
A
- – Take within 60 minutes prior to a meal
- –ADE: Nausea (40-44%) diarrhea, vomiting, constipation (slow gastric emptying)
- -Not recommended in combination with SGLT-2 or bonus insulin
- –GLP-1 decrease FBG, PPBG, weight, and insulin requirement when combined with basal insulin or bonus insulin (not FDA approved, but clinically safe and effective- 2016 ACCP GLP-1 addon to bolus insulin)
- –BBW: thyroid C-cell tumors
- –Precaution: risk of acute pancreatitis
14
Q
GLP-1 receptor agonist MOA
A
- Activated GLP-1 receptor
- Physiologic action:
- ↑ insulin secretin (glucose dependent)
- ↓ glucagon secretion (glucose dependent)
- slow gastric emptying
- ↑ satiety
15
Q
SGLT-2 inhibitors
A
- Canagliflozin (Invokana)
- Dapagliflozin (Farxiga)
- Empagliflozin (Jardiance)
