Misc Flashcards
Which DM meds may cause weight gain?
Insulin
SU
TZD
Which DM meds may cause low blood glucose?
Sulfonylureas
Insulin
Which DM meds usually don’t cause low blood glucose?
Biguanides DPP-4 inhibitors GLP-1 receptors SGLT inhibitors Alpha glucosidase inhibitors Thiazolidinediones
Which medications may cause hyperglycemia?
Corticosteroids, hormones, protease inhibitor, diuretics, beta blockers, statins, transplant immunosuppressants, niacin, atypical antipsychotics (clozapine, risperidone,olanzapine, quetiapine)
How does biguanide (Metformin) work?
Decreases hepatic glucose production, increases insulin sensitivity
*may improve lipid profile
How much A1c reduction can be expected with biguanide (metformin)?
1-2%
What are the contraindications for biguanide (metformin)?
Serum creatinine >1.5 (male) or >1.4 (female), acidosis (acute or chronic), hepatic dysfunction, excessive ETOH, DM1, DKA
Do not initiate if GFR is between 30-45, reduce to 1000 mg if taking
Contraindication of GFR < 30
Side effects of biguanide (metformin)?
Wt loss, N/V, epigastric pain, bloating, gas
XL can minimize side effects
Taking with food will help limit GI side effects
What is the max daily dose of metformin?
2550 mg/day (liquid or pill form)
How should metformin be initiated?
250 (children) -500 (adults) mg daily, titrate up every 1-2 weeks
Prescribed once or twice a day, should be taken with first bite of meal
What medications are SU, and how should they be taken?
Glyburide
Glipizide
Glimepiride
- all renally cleared, caution w/ irregular eating pattern
- taken once of twice daily with or just before meals
- pill only
How do SUs work?
Increase release of insulin from the pancreas
How much A1c reduction can be expected from SU?
1-2%
What are the contraindications for SU?
Type 1 DM, DKA
What are the side effects of SUs?
Hypoglycemia, weight gain
What medications are Dipeptidyl Peptidase-4 Inhibitors (DPP 4 inhibitors)
Sitagliptin, Saxagliptin, Linagliptin
How do Dipeptidyl Peptidase-4 Inhibitors (DPP 4 inhibitors) work?
Inhibits breakdown of incretin and glucagon like peptide 1 (GLP-1). This reduces glucagon secretion, slows gastric emptying time and promotes satiety
What are the side effects associated with Dipeptidyl Peptidase-4 Inhibitors (DPP 4 inhibitors)?
pancreatitis, pulmonary infections
When are SLGT-2 inhibitors typically used in a pt’s treatment regimen?
2nd or 3rd line options after metformin, diet, and exercise (as an oral option)
Which medications are Sodium Glucose Co Transporter 2 Inhibitors (SGLT2 inhibitors) and how are they taken?
Canagliflozin, dapagliflozin, ertugliflozin, empaglifozin
*All day medication. Taken with or without food. Rec to take first thing in AM bc they cause urinary frequency
How do Sodium Glucose Co Transporter 2 Inhibitors (SGLT2 inhibitors) work?
Reduces reabsorption of glucose in the kidney, lowers renal threshold for glucose excretion
Which conditions are contraindicated with Sodium Glucose Co Transporter 2 Inhibitors (SGLT2 inhibitors)?
Severe renal impairment, dialysis, DM1, DKA, UTIs, genital infections
Which medication are GLP-1 agonists and how are they given?
Exenatide, liraglutide, dulaglutide
*Only used in DM2. Available in injection pen form. Should be discarded 30 days after use. Daily or weekly injections available
How do GLP-1 agonists work?
Increases glucose dependent insulin secretion, reduces glucagon secretion, slows gastric emptying time, promotes satiety
