L30- Antidiabetic Drugs II (drug guidelines) Flashcards
_____ is the initial drug 1st line therapy for type II DM
Metformin (inhibits gluconeogenesis, inc liver/muscle glucose utilization)
Monotherapy with non-insulin antidiabetic can by itself reduce HbA1c by (1)
Dual therapy in newly diagnosed type II DM patients is considered if (2)
1- ~1%
2- HbA1c is >1.5% above glycemic target
Monotherapy, = (1), is advanced to dual combination therapy if (2) is not achieved. (3) or (4) are the additional 2nd drug.
1- metformin
2- HbA1c goal is reached in ~3 mos
3- GLP-1 agonist (incretiin analog: exentide)
4- basal insulin
Dual therapy, = (1), is advanced to triple therapy if (2) persists, then (3) will be added.
1- metformin, GLP-1 agonist (exentide)
2- HbA1c >8.5%
3- insulin (basal, then mealtime)
describe why GLP-1 receptor agonist or insulin therapy is preferred
*GLP-1 receptor agonist (incretin analog: exentide)
Pros: (to minimize hypoglycemia or weight gain)
- similar efficacy
- lower hypoglycemic risk
- dec weight
Cons:
- greater GI side-effects, lower tolerability
- high cost
Insulin is indicated as initial diabetic therapy if……
(for DM II)
- ongoing catabolism (weight loss)
- significant hyperglycemic Sxs
- ketonuria
- HbA1c >10%
- random glucose >300
describe the management of diabetes in pregnancy
(pre-existing DM I or II, and gestational DM)
insulin (doesn’t cross placenta)
DM managment in pregnancy:
- (1) is typical insulin regimen choice
- (2) is then usually added if needed
1- NPH (intemediate acting), single dose at bedtime
2- postprandial control: lispro, aspart (rapid-acting)
list the main diabetic complications
CVS: HTN, dyslipidemia, anti-platelet therapy
Nephropathy
Neuropathy: neuropathic pain, gastroparesis, ED
________ is the major cause of death in diabetics
cardiovascular disease
list the drugs of choice for HTN in DM
1) ACEI / ARB (especially to reduce albuminuria if present –> dec risk of CRF)
2) thiazide
3) dihydropyridine CCB
describe management of dyslipidemia in DM
Statins regardless of lipid levels for patients with:
- overt CVD
- <40 y/o w/ CVD risk factors
- > 40 y/o w/ or w/o CVD risk factors
_____ therapy (OTC) is considered as a primary prevention strategy in patients with DM I or II
ASA- anti-platelet agent
(T/F) neuropathic pain is simply treated with traditional pain therapies (NSAIDs, opiods, etc)
F- does not respond well to traditional pain therapies
(1) and (2) are common ANS neuropathic symptoms, include Tx
1- Gastroparesis (delayed gastric emptying Sxs) –> Prokinetic Agents: metoclopramide, erythromycin
2- ED –> phosphodiesterase type 5 inibitors (sidenafil)