Module 10 - Non Insulin DM Drugs

Question 1

Metformin Mechanism of Action *

Answer 1

• Biguanide: Glucophage (Metformin)

MOA:
- decreases hepatic glucose production
- decreases intestinal absorption of glucose
- improves insulin sensitivity by increasing peripheral glucose uptake + utilization

Question 2

Metformin Important Points *

Answer 2

• weight neutral
• may reduce CV risk
• safe in HF + moderate renal impairment
• first line after diet and exercise
• not considered a hypoglycemic bc their major pharm action does not increase insulin secretion
• biggest s/e is diarrhea (decrease by increasing slowly)
• max dose 1000mg BID
• contraindicated in GFR < 30

Question 3

A/E of Sulfonylureas *

Answer 3

(glipizide, glimepiride, glyburide)

1. hyperinsulinemia + hypoglycemia
   - more so in elderly, hepatic, renal dx
2. weight gain 2/2 increased appetite
   - more w/ glyburide, less w/glim, glip
3. GIT upset: N/V/D
4. PHOTOSENSITIVITY

Question 4

Sulfonylureas Contraindications *

Answer 4

• hepatic or renal insufficiency
• preggo or lactation
• TYPE 1 DM
• Sulfa Allergy

Question 5

SGLT2 Benefits *

Answer 5

• intermediate A1C reducation
• low risk of hypoglycemia
• BP lowering effect
• weight loss
• CV benefit in those WITH ASCVD
  (emp + cana)
• HF benefit
  (emp + cana + dapa + ertu)
• renal benefit
  (emp + cana + dapa)

Question 6

SGLT2 Disadvantages *

Answer 6

GU PROBLEMS !!!!
* urinary frequency
* UTI
* genital mycotic infection

• hypotension
• fractures (cana)
• amputations
• increased bladder ca
• increased LDL
• hyperkalemia

Question 7

GLP1 Benefits *

Answer 7

• weight loss
• decreased risk of hypoglycemia
• CV benefit in those with ESTABLISHED ASCVD
  (lira, sema, dula)
• weekly injectables
• daily injectables
• combinations in injectables

Question 8

GLP1 Disadvantages *

Answer 8

• injections (sema has PO option)
• A/E: headache, nausea, diarrhea
• contraindicated in severe renal dx
• associated with thyroid cancer
• may be associated with gallbladder dx

Question 9

With or Without Diagnosis of ASCVD

Answer 9

DULAGLUTIDE: only med approved for CV benefit for those with or without established CV disease

Others reduce ASCVD risk if those DIAGNOSED with ASCVD
(lira + sema)

Question 10

CKD *

Answer 10

SGLT2
- emp, cana, dapa

Question 11

Weight *

Answer 11

Weight loss: SGLT2 or GLP1

Neutral: Metformin

Weight gain: SUL, insulin, TZD

Question 12

ASCVD *

Answer 12

GLP1: lira, sema, dula
or
SGLT2: emp + cana

Question 13

HF *

Answer 13

SGLT2: emp, cana, dapa, ertu

Question 14

Avoid Hypoglycemia *

Answer 14

Metformin
SGLT2
GLP1

DPP
TZD

Question 15

Low Cost *

Answer 15

Metformin
SUL
Human Insulin
TZD