Non- Insulin medications Flashcards
Mechanism of action of Metformin
- Improves insulin sensitivity
- Increases tissue uptake and utilization of glucose by muscle
- Decreases hepatic production of glucose
Clinical applications of Metformin
- T2DM adject therapy
- Use for all type 2 DM patients if tolerated and not contraindicated
First line therapy for adjuctive therapy for type 2 DM
Metformin
A1C change in Metformin
Decrease by 1.5-2%
usually seen within the first 3 months of treatment
Does Metformin target the FBG or PPG? What is the change?
FBG: decrease 60-80mg/dL
How is Metformin eliminated in the body?
Excreted unchanged in the urine
Advantages of Metformin (8)
Less risk of hypoglycemia due to no insulin release
Benefit on lipids: ↓ TG and LDL by 8-15%
No weight gain or even weight loss (2-3 kg)
Cost-effective
↑ fibrinolysis = CV protection
Has been shown to ↓ macrovascular complications and the risk of total mortality in clinical trials
↓ risk of stroke and all-cause mortality when compared to insulin and sulfonylureas
↓ diabetes-related death and myocardial infarctions vs. conventional treatment in UKPDS trial
Metformin Disadvantages
May cause lactic acidosis (LA)–> Rare
Current studies point to a weak causal relationship between metformin and lactic acidosis
Contraindications of Metformin
Contraindicated in HF pts that are class III and IV: Patients that are class I or II HF can use metformin
Alcoholics and Metformin
Watch excessive intake and avoid use with heavy intake
Increased risk of LA in these patients
Lactic Acidosis and Metformin Use
Avoid use in these pts:
- post MI
- COPD exacerbation
- Hepatic Failure
- Shock
- Surgery
- Stop metformin when patients are admitted to the hospital
Side effects of Metformin
GI effects- diahrrea, fatulence, nausea, and vomitting
- Take with a large meal to help
start with a low dose and titrate up
Vitamin B12 malabsorbtion or deficency
Dosing Metformin
Initial dose- 500mg BID (can start at pod) with meals
Titrate dose weekly and increase by 250-500mg
Max dose 2gm/d
Dosing Metformin in Renal Deficiency
>60- monitor SCr 60-45- Continue use but monitor SCr 3-6 months 45-30- Do not start Metformin If already on, reduce dose by 50% <30- DO NOT USE
Name the GLP-1 agonists
Liraglutide (Victoza) Dulaglutide (Trulicity) Semaglutide (Ozempic) Exenatide (Byetta, Bydureon) Lixisenatide (Adylyxin)
Mechanism of Action of GLP-1 agonists
-Stimulating Beta-cell growth and differentiation and insulin gene expression
-Will only increase insulin release when elevated glucose levels present
-Has been shown to inhibit Beta-cell death
Inhibits glucagon secretion, delays gastric emptying, and decreases appetite
o Decrease glucose production by the liver
o Not absorbing the glucose as quickly
o Increases satiety
- GLP-1 agonist medications are resistant to DPP-IV
- Increases in both first and second-phase insulin secretion after meals occur
A1C changes with GPL-1 agonists
Decrease in A1C by 0.7-1.6%
Do GLP-1 agonists target FBG, PPG, or both? What is the change?
Long acting GLPs- target FBG
Short acting GLPs- target PPG
Weight changes with GLP-1s
Weight loss!!
1.5-3kg (10lb after 2 years)
Adverse Effects
Nauses and Vomiting- very problematic titrate dose up
Symptoms decrease in 4-8 weeks
Hypoglycemia when used in combination with other products
Acute Pancreatitis (do not use if pt has history of pancratitis_
Black box warning for Thyroid cancer (mostly for pts with hx or FH)
Dosing of Trulicity (Dulaglutide)
0.75mg SQ once weekly
Dosing of Ozempic (Semaglutide)
- 25mg SQ x4 weeks
0. 5mg SQ once weekly (can titrate to 1g if needed)
Dosing of Victoza (Liraglutide)
0.6mg SQ x 7 days then 1.2-1.8 mg SQ daily
Dosing of Byetta (Exenatide)
5mcg SQ BID x 1 month then titrate to
10mcg SQ BID
