Drugs for Diabetes Flashcards
What are the 10 classes
1) Alpha-glucosidase inhibitors
2) Biguanides
3) sulfonylureas
4) meglitinides
5) Thiazolidinediones
6) Dipeptidyl peptidase-4 (DPP-4)
7) Glucagon-like peptide-1 GLP-1 receptor agonists
8) SGLT2 inhibitors
9) weight loss agents
10) Insulins
What is the A1C target for adults with T2D to reduce the risk of CDK and retinopathy if at low risk of hypoglycemia
<=6.5
What is the A1C target for most adults with T1D or T2D
<=7.0
What is the A1C target for the end of life
7.1-8.5
What pharmacotherapy do you give if A1C 1.5% over target
Initiate healhty behavior interventions and start metformin if not a target in 3 months or start metformin with helahty behavior interventions
What pharmacotherapy do you give if A1C >=1.5% over target
start metformin with healthy behaviour interventions and consider a second concurrent agent
I patient presents as symptomatic hyperglycemia ad or metabolic decompensation Polyuria polydipsia weight loss volume depletion
Start insulin plus or minus metformin
What are good drugs for Chronic kidney disease and Diabetes
SGLT2i and GLP1-RA
What is a good drug for Heart failure and Diabetes
SGLT2I
What is a good drug for
Atherosclerotic cardiovascular disease and Diabetes
SGT2I
What is the mechanism of action of Biguanide?
Acts on liver and decrease hepatic glucose output an decreases insulin resistance , increase glucose metabolism
decrease gluconeogenisi. drecreased glyconolysis
decreased FA oxidation
decreased insulin mediated glucose uptake
decrease NADH oxidation, ampk signalling TCA cycle flux ATP synthesis GNG
What type of drug is metformin
Beguanide
Metformin advantages
effective gluvose lowering (1.5-2.0%)
no significant hypoglycemia (rare)
durable effect
not associated with weight gain or CV sdie effects (possible benefit
Metformin disadvantages
GI side-effects nausea diarrhea metallic taste
rare lactic acidosis
What are the two types of Secretagogues
Long acting sulfonylureas
GLyburide
glicalzide
glimepiride
Short-acting secretogogues
Repaglinide
Nateglinide
What are the long-acting sulfonylureas
GLyburide
glicalzide
glimepiride
What are the short-acting sulfonylureas
Repaglinide
Nateglinide