Glucose Lowering Medications Flashcards
generic name
Glucotrol
Glipizide
class of glipizide
sulfonylureas
indication for glucose lowering medications
diabetes
MOA
sulfonylureas
stimulates insulin release from pancreatic beta cells
contraindications
sulfonylureas
- hypersensitivity
- type 1 diabetes
- diabetic ketoacidosis
common ADRs
sulfonylureas
- hypoglycemia
- dizziness
- weight gain
rare but serious ADRs
sulfonylureas
- hemolytic anemia
- hepatotoxicity
- disulfiram reaction
key counseling points
sulfonylureas
- take first thing in the morning (30 minutes before breakfast or first meal of the day)
- avoid alcohol while taking may cause rare disulfiram reactions
other top 300 medications
sulfonylureas
brand: amaryl
generic: glimepiride
brand name of meglitinides
prandin
generic name of meglitinides
repaglinide
MOA
meglitinides
stimulates insulin release from pancreatic beta cells
contraindications
meglitinides
- diabetic ketoacidosis
- type 1 diabetes
- concurrent use of gemfibrozil
common ADRs
meglitinides
- hypoglycemia
- headache
- nausea/vomiting
- weight gain
rare but serious ADRs
meglitinides
- chest pain
- ischemia
- hypersensitivity (SJS)
key counseling points
meglitinides
- needs to be taken with each meal (15-30 minutes before each meal)
- if patient skips a meal, skip that dose
generic name
biguanides
metformin
brand name
biguanides
glucophage
MOA
biguanides
- primary: decrease output from the liver (hepatic glucose production)
- secondary: increase peripheral muscle glucose sensitivity (glucose uptake and utilization)
contraindications
biguanides
- eGFR < 30 mL/min
- metabolic acidosis
- use with contrast media
black box warning
biguanides
lactic acidosis
common ADRs
biguanides
- GI upset
- diarrhea
- nausea/vomiting
- flatulence
rare but serious ADRs
biguanides
- lactic acidosis
- hemolytic anemia
key counseling points
biguanides
- take with food to reduce GI upset
- avoid use within 48 hours of iodinated contrast media
generic name
Actos
pioglitazone
class of pioglitazone
thiazolidinediones
MOA
thiazolidinediones
- primary: increase peripheral muscle glucose sensitivity (glucose uptake and utilization)
- secondary: decrease glucose output from liver (hepatic glucose output)
contraindications
thiazolidinediones
New York Heart Association Class III/IV heart failure
common ADRs
thiazolidinediones
- edema
- weight gain
rare but serious ADRs
thiazolidinediones
- congestive heart failure
- bladder cancer
- fractures
- hepatotoxicity
key counseling points
thiazolidinediones
- take once daily without regard to meals
- monitor for weight gain and/or swelling of legs
other top 300 meds
thiazolidinediones
brand: avandia
generic: rosiglitazone
generic name
tradjenta
linagliptin
class of linagliptin
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors
MOA
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors
- binds to and inhibits the DPP-4 enzyme, resulting in prolonged incretin hormone levels
- incretin hormones regulate glucose metabolism by increasing insuling secretion and release
contraindications
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors
- type 1 diabetes
- diabetic ketoacidosis
- hypersensitivity
common ADRs
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors
- nasopharyngitis
- hypoglycemia
rare but serious ADRs
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors
- pancreatitis
- heart failure
key counseling points
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors
- take once daily at same time each day
- may be taken with or without food
other top 300 meds
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors
- brand: onglyza, generic: saxagliptin
- brand: januvia, generic: sitagliptin
brand name
dapaglifozin
farxiga
class of farxiga
sodium glucose cotransporter 2 (SGLT2) inhibitors
MOA
sodium glucose cotransporter 2 (SGLT2) inhibitors
- inhibits SGLT2 in the proximal renal tubules which reduces reabsorption of filtered glucose
- reabsorption of filtered glucose = increased urinary excretion of glucose
contraindications
sodium glucose cotransporter 2 (SGLT2) inhibitors
severe renal impairment (ESRD, dialysis)
common ADRs
sodium glucose cotransporter 2 (SGLT2) inhibitors
- dehydration
- hypotension
- UTI
- yeast infection
rare but serious ADRs
sodium glucose cotransporter 2 (SGLT2) inhibitors
- euglycemic diabetic ketoacidosis
- bone fracture
- perineal necrotizing fascitis
- acute kidney injury
key counseling points
sodium glucose cotransporter 2 (SGLT2) inhibitors
- take once daily in the morning
- stay well hydrated while taking
other top 300 meds
sodium glucose cotransporter 2 (SGLT2) inhibitors
- brand: invokana, generic: canagliflozin
- brand: jardiance, generic: empagliflozin (won’t be tested)
generic name
trulicity
dulaglutide
class of trulicity
glucagon-like peptide-1 (GLP-1) receptor agonists
MOA
glucagon-like peptide-1 (GLP-1) receptor agonists
binds to human GLP-1 receptor which augments glucose dependent insulin secretion and slows gastric emptying
contraindications
glucagon-like peptide-1 (GLP-1) receptor agonists
personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasisa syndrome type 2 (MEN2)
black box warning
glucagon-like peptide-1 (GLP-1) receptor agonists
risk of thyroid c-cell tumors
common ADRs
glucagon-like peptide-1 (GLP-1) receptor agonists
- nausea/vomiting
- diarrhea
- GI upset
- weight loss
- decreased appetite
rare but serious ADRs
- pancreatitis
- gallbladder disease
- acute kidney injury
key counseling point
glucagon-like peptide-1 (GLP-1) receptor agonists
- SQ injection, rotate injection site each week
- GI side effects should improve over time
other top 300 meds
glucagon-like peptide-1 (GLP-1) receptor agonists
- brand: victoza & saxenda, generic: liraglutide
- brand: ozempic & wegovy, generic: semaglutide
- brand: byetta &bydureon, generic: exenatide (won’t be tested)
generic name
lantus
insulin glargine
brand name
insulin degludec
tresiba
class of lantus & tresiba
basal (long acting) insulin
MOA
basal (long acting) insulin
insulin promotes cellular uptake of glucose, fatty acids and amino acids and their conversion to glycogen, triglycerides and proteins
contraindications
basal (long acting) insulin
hypersensitivity
common ADRs
basal (long acting) insulin
- hypoglycemia
- weight gain
- injection site reactions
rare ADRs
basal (long acting) insulin
- severe hypoglycemia
- insulin resistance
key counseling points
basal (long acting) insulin
- SQ injection
- rotate injection site
- use new needle each injection
- dosing dial for pens
- draw up dose in syringe for vials
other top 300 meds
basal (long acting) insulin
- brand: Toujeo or Basaglar, generic: insulin glargine
- biosimilar: insulin glargine-aglr (rezvoglar)
- biosimilar: insulin glargine-yfgn (semglee yfgn)
