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860-diabetes > drug table > Flashcards

drug table Flashcards

1
Q

Metformin

effect

A
  • Lowers A1C 1-2%

* Lowers fasting glucose primarily

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2
Q

metformin

AE

A
  • Malabsorption of B12
  • GI distress: Diarrhea, abdominal cramping (ER formulation better tolerated)
  • Lactic acidosis [Boxed warning]
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3
Q

metformin contradiction

A
  • eGFR <30
  • eGFR 30-45 no new starts, use half maximal dose
  • severe hepatic, pulmonary, cardiac disease (avoid in unstable or hospitalized HF)
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4
Q

metformin comments

A
  • Improved CV outcomes (UKPDS)
  • No hypoglycemia
  • Weight neutral
  • Max:2550mg/day
  • Unlabeled use: PCOS
  • May be used to reduce insulin requirements in Type 1
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5
Q

Sulfonylurea

A

1st gen-
tolbutamide, acetohexamide, chlorpropamide,
2nd gen-
glyburide, glipizide, glimepiride

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6
Q

Sulfonylurea

effects

A
  • Lowers A1C 1-2%

* Lowers both fasting and postprandial glucose

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7
Q

Sulfonylurea

AE

A
  • Hypoglycemia

* Weight gain

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8
Q

Sulfonylurea

contradiction

A
  • Lactating women
  • Type 1 DM
  • Hypoglycemic unawareness
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9
Q

Sulfonylurea

comments

A
  • Glyburide- active metabolite secreted renally (avoid in renal dysfxn)
  • Associated with high treatment failure (beta cell destruction)
  • Reduces microvascular complications (UKPDS)
  • Avoid in basal/bolus insulin therapy
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10
Q

Thiazolidinediones

A
  • Rosiglitazone

* Pioglitazone

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11
Q

Thiazolidinediones

effects

A
  • Lowers A1C 0.8-1.5%

* Primarily lowers fasting blood glucose

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12
Q

Thiazolidinediones

AE

A
  • Does not cause hypoglycemia- generally well tolerated
  • Wt gain
  • CHF exacerbation
  • Hepatotoxicity
  • Fractures
  • ? MI (rosiglitazone)
  • ? bladder cancer (pioglitazone)
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13
Q

Thiazolidinediones

contradiction

A
  • CV- ? MI in predisposed individuals (duration of exposure related, rosiglitazone
  • Do not use in CHF III, IV
  • ALT >2.5x ULN
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14
Q

Thiazolidinediones

comment

A
  • Long lag before max effect (8-12 weeks)
  • Bladder cancer risk increases in males, tobacco users and PMH/FH of bladder cancer
  • Increase in HDL and decrease in TRG (pioglitazone) (IMPORTANT)
  • Can induce ovulation in PCOS
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15
Q

Alpha-glucosidase inhibitors

A
  • Acarbose

* Miglitol

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16
Q

Alpha-glucosidase inhibitors

Effect

A
  • Lowers A1C 0.5-1%

* Lowers postprandial glucose levels

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17
Q

Alpha-glucosidase inhibitors

AE

A
  • GI: flatulence, diarrhea
  • Weight neutral
  • No hypoglycemia
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18
Q

Alpha-glucosidase inhibitors

contradiction

A

• Do not use in IBD, intestinal obstruction, cirrhosis, sCr >2mg/dl, CrCl <25 ml/min

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19
Q

Alpha-glucosidase inhibitors

comments

A
  • physical drug-drug interactions
  • Nonsystemic
  • ? reduction in CVD events (STOP-NIDDM)
20
Q

Metformin MOA

A

Decreased liver gluconeogenesis and increased insulin sensitivity in muscle tissues

21
Q

sulfonylurea MOA

A

Close the ATP dependent K+ channel to cause the depolarization of the beta cell and release of insulin in a glucose independent manner

22
Q

Thiazolidinediones MOA

A

Increase target tissue sensitivity to insulin by activating genes (PPAR-gamma) involved in carb and lipid metabolism, increased glucose uptake in muscle, and reduced liver gluconeogenesis

23
Q

alpha-glucosidase inhibitors MOA

A

Inhibits a-glucosidase enzyme in the GI tract that hydrolyzes complex carbs into glucose, thus reducing circulating postprandial glucose levels

24
Q

DPP-IV inhibitors

A
  • • sitagliptin
  • vildagliptin
  • saxagliptin
  • linagliptin
  • Alogliptan
25
Q

DPP-IV inhibitors MOA

A
  • Reversible inhibition of DPP-IV protease activity
  • Glucose dependent; affects post-prandial levels
  • Increase insulin secretion and lowers glucagon secretion
26
Q

DPP-IV inhibitors effects

A
  • Lowers A1C 0.6-0.8%

* Lowers postprandial sugars

27
Q

DPP-IV inhibitors AE

A
  • URI, HA, UTI

* Generally well tolerated

28
Q

DPP-IV inhibitors

contradiction

A
  • Hx of pancreatitis
  • DKA
  • DM type 1
29
Q

DPP-IV inhibitors

comments

A
  • Avoid in basal/bolus insulin therapy

* Dose adjustments with impaired renal function (all except linagliptin)

30
Q

SGLT 2

A
  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
  • Ertugliflozin
31
Q

SGLT 2 MOA

A
  • lowers renal threshold for glucose

* increases urinary glucose excretion

32
Q

SGLT 2 effect

A
  • lowers A1C by 1 %

* Mixed effect

33
Q

SGLT 2 AE

A
  • polyuria
  • UTI
  • Mycotic infection
  • No hypoglycemia
  • Decreased weight and blood pressure
34
Q

SGLT 2 contradiction

A
  • Recurrent UTI and mycotic infections
  • Fournier’s Gangrene (necrotizing fasciitis of the perineum) serious but rare
  • BOXED WARNING: Increased risk of foot/toe amputations (Canagliflozin)
  • Risk of DKA while euglycemic or only slightly elevated DKA
35
Q

SGLT 2 comments

A
  • No hypoglycemia
  • Effective at all stages of Type 2
  • Can increase LDL levels
  • Adjust dose if crcl <60 ml/min (see table below)
  • Empagliflozin, dapagliflozin, canagliflozin have demonstrated benefit (reduce HF, CKD)***IMPORTANT
36
Q

GLP-mimetic injectable

A
  • Exenatide
  • Liraglutide
  • Dulaglutide
  • Semaglutide (Ozempic Subcut, NEW Rybelsus Only current Oral GLP)
37
Q

GLP-mimetic injectable MOA

A
  • Glucagon like peptide-1 (GLP-1) mimetic reduces food intake and results in weight loss
  • Increase endogenous incretin levels and decrease glucagon secretion (glucose dependent)
  • Increases satiety through delayed gastric emptying
38
Q

GLP-mimetic injectable

Effect

A
  • Lowers A1C 0.6-1.0%
  • Lowers postprandial (exenatide)
  • Lowers more fasting glucose (liraglutide)
  • Mixed Effect: exanetide ER (Bydureon) and semaglutide
39
Q

GLP-mimetic injectable

AE

A
  • N/V, diarrhea, dizziness, HA, dyspepsia

* Weight loss

40
Q

GLP-mimetic injectable

contradiction

A
  • Avoid in CrCl <30ml/min (exenatide)
  • Gastroparesis
  • Pancreatitis
  • Thyroid carcinoma
41
Q

GLP-mimetic injectable

comments

A

• Injectable
• Thyroid tumors in animal studies
• Reduce insulin dose by up to 20% when starting this drug class, in most cases will reduce insulin burden
• Exenatide 1 hour before meals, titrate monthly
• Liraglutide: w/o regard to meals, titrate weekly
• Liraglutide>
semaglutide>
exenatide er CV benefits

42
Q

insulin

rapid acting

A

• Rapid acting-

Lispro, aspart, glulisine

43
Q

insulin

short acting

A

Human regular

44
Q

insulin intermediate acting

A

NPH

45
Q

insulin long acting

A

detemir, glargine, degludec

860-diabetes (2 decks)

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