Non-insulin agents Flashcards
metformin class
biguanide
metformin MOA
decrease hepatic glucose production, improve insulin sensitivity, decrease intestinal absorption of glucose
name the sulfonylureas
glipizide, glyburide, glimepiride
sulfonylurea MOA
stimulate pancreatic beta cells to secrete insulin
name the meglitinides
repaglinide, nateglinide
meglitinide MOA
stimulates pancreatic beta cells to secrete insulin
name the thiazolidinediones (TZDs)
pioglitazone, rosiglitazone
TZD MOA
insulin sensitizers: improve glucose uptake in muscle and fat, selective agonist for PPAR gamma, decrease hepatic glucose output, inhibit lipolysis, preserve beta cell function
name the GLP-1s
semaglutide, dulaglutide, exenatide, liraglutide, lixisenatide
GLP-1 MOA
increases glucose dependent insulin secretion, slows gastric emptying, promotes satiety, decreases glucagon secretion
name the DPP-4i
sitagliptin, saxagliptin, linagliptin, alogliptin
DPP-4i MOA
enhances levels of GLP-1 and other incretin hormones, stimulates glucose-dependent insulin synthesis and secretion and suppresses glucagon
name the SGLT-2is
canagliflozin, empagliflozin, dapagliflozin, ertigliflozin
SGLT-2i MOA
reduces urinary glucose reabsorption and increases urinary glucose excretion
name the alpha glucosidase inhibitors
acarbose, miglitol
alpha glucosidase inhibitor MOA
inhibits maltase, isomaltase, sucrase, and glucoamylase in the small intestine, delaying breakdown of starches and certain sugars, decreases post-prandial glucose peak
name the bile acid sequestrant
colesevelam
bile acid sequestrant MOA
binds bile acids in the intestines, MOA regarding glucose control not known
name the dopamine agonist
bromocriptine mesylate
dopamine agonist MOA
affects circadian rhythm and leads to increased insulin sensitivity and glucose disposal
name the amylin mimetic
pramlintide
amylin mimetic MOA
slows gastric emptying, suppresses glucagon, promotes satiety
metformin side effects
GI– diarrhea, abdominal discomfort, stomach upset
metallic taste
vitamin b12 deficiency
lactic acidosis
sulfonylurea side effects
hypoglycemia, weight gain
meglitinides side effects
hypoglycemia, weight gain
TZD side effects
weight gain (water weight), edema, new onset/worsening HF, increased fracture risk in upper/lower limbs of postmenopausal women, increased risk bladder cancer and macular edema
GLP-1 side effects
n/v/d
decreased appetite
risk of thyroid c cell tumors
assoc with cases of acute pancreatitis
case reports of AKI or worsening renal function
DPP-4 side effects
generally well tolerated, assoc. with cases of acute pancreatitis, increased hospitalization for heart failure, bullous pemphigoid requiring hospitalization, arthralgias
SGLT-2i side effects
genital mycotic infections, UTIs, increased urination, increased risk of necrotizing fasciitis of the perineum (fournier’s gangrene), hypotension, dehydration (increased risk AKI, syncopem, falls), euglycemic DKA
canagliflozin– increased risk of bone fracture
alpha glucosidase inhibitor side effects
flatulence, diarrhea, abdominal pain, bloating
bile acid sequestrant side effects
constipation, dyspepsia, nausea
dopamine agonist side effects
nausea, fatigue, headache, vomiting, hallucinations, somnolence (think CNS effects)
amylin mimetic side effects
nausea, anorexia, vomiting, fatigue, abdominal pain, dizziness
metformin counseling points
take with first bite of meal to prevent GI side effects, titration
metformin dosing
IR 500-1000 mg BID titrate slowly to 1000 mg BID
XR 500-2000 mg once or twice daily
metformin renal considerations
contraindicated when eGFR<30
do not start with eGFR 30-45
reduce dose if eGFR<45
metformin advantages
minimal hypoglycemia risk, does not cause weight gain, may cause modest weight loss, decreases triglycerides & LDL, increases HDL, A1c reduction 1-2%
the hypoglycemic action of sulfonylureas can be potentiated by what drugs
NSAIDs, clarithromycin, salicylates, sulfonamides, chloramphenicol, coumarins, probenecid, MAOi, beta blockers
avoid what class/use with caution in older adults
sulfonylureas
meglitinides counseling
take it when you are eating! if not eating, don’t take it
meglitinides renal considerations
can be used in renal insufficiency
coadministration of what drugs with meglitinides increases risk of hypoglycemia
clopidogrel, cyclosporine, gemfibrozil, ketoconazole
TZD contraindications
NYHA Class III-IV HF
do not use GLP-1 agonists with what class
DPP-4
when to avoid GLP-1
family history of medullary thyroid carcinoma, gastroparesis, people on DPP-4
counseling for SGLT-2
drink plenty of water, use good hygiene, stop 72 hours before surgery
when to avoid alpha glucosidase inhibitors
SCr>2
CrCL<25
counseling point for alpha glucosidase inhibitors
use glucose tabs or milk to treat hypoglycemia (sucrose not effective)
skip the dose if not eating
when are alpha glucosidase inhibitors contraindicated
any type of bowel disease
acarbose may increase ____ levels, which is dose related
liver transaminase
who should not receive bile acid sequestrants
patients with history of bowel obstruction, serum triglyceride >500, history of pancreatitis
counseling points for bile acid sequestrants
may decrease absorption of fat soluble vitamins and other drugs, administer other drugs at least 4 hours prior
dopamine agonist counseling points
take within 2 hours after waking in the morning, with food
do not use dopamine agonists in _____
patients with severe psychotic disorders
dopamine agonist drug interactions
CYP3A4 inhibitors
amylin mimetic should only be used in ____
patients using mealtime insulin
avoid amylin mimetics in ____
people with hypoglycemic unawareness, gastroparesis
amylin mimetics cause weight ____
gain
