Non-insulin meds Flashcards
What is the DOC for newly diagnosed DM2 pt’s?
Metformin (which is a biguanide)
What is are ADR’s of Metformin?
GI - d/n/v/f
can lead to vitamin B12 deficiency long term
When should you d/c Metformin in clinical situations?
5 conditions
- cardiovascular collapse
- respirator failure
- acute MI
- acute CHF
- septicemia
(want to d/c in situations predisposing pt’s to hypoxia)
At what GFR is Metformin not recommended?
GFR of 30-45mL/min
What are contraindications for Metformin?
- severe renal dysfunction (GFR<35ml/min)
- acute or chronic metabolic acidosis
(use caution in pt’s with heart failure, hepatic impairment, renal impairement, elderly (avoid in pt’s >80))
In which situation should Metformin be discontinued for diagnostic testing?
when pt is undergoing testing that needs IV radiographic contrast agents
What are the drugs in the Thiazolidinediones class?
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
What is the MOA of sulfonylrureas?
Stimulate insulin secretion by blocking the ATP-sensitive K+ channels
What are ADRs for thiazolidinediones?
- edema
- heart failure
- URI
- anemia
What is the BBW for Thiazolidinediones?
Heart failure risk
What should you do before prescribing Thiazolidinediones?
baseline liver enzymes (due to risk of liver failure)
What are ADRs of α-Glucosidase Inhibitors?
farting, diarrhea, bloating, cramping
What drugs are in the class Dipeptidyl Peptidase-4 (DPP-4) Inhibitors? (four drugs)
Alogliptin (Nesina)
Linagliptin (Tradjenta)
Saxagliptin (Onglyza)
Sitagliptin (Januvia)
Which of the DPP-4 inhibitors does not need dose adjustments for renal/hepatic failure?
Linagliptin
What drugs are in the class SGLT2 Inhibitors?
Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
What is the MOA of SGLT2 Inhibitors?
will inhibit the SGLT2 transporter in proximal renal tubules to reduce the reabsorption of glucose. (they can also help weight loss and BP)
What are the ADRs for SGLT2 Inhibitors?
- vaginal yeast infections*
- UTIs*
- Hyperkalemia
- Increased LDL
What are the CI’s for SGLT2 Inhibitors?
Severe renal impairment, ESRD, dialysis
What should you be careful about when prescribing SGLT2 Inhibitors in terms of DDIs?
- be careful with other drugs that work for the kidneys like ACEIs, ARBs, duiretics
Which of the SGLT2 Inhibitors has a BBW for leg and foot amputations?
Canagliflozin
Which SGLT2 Inhibitors showed trends for reduced CV?
Empagliflozin (jardiance)
Which pt population should you be cautious with when prescribing Sulfonylureas?
elderly pt’s due to risk of hypoglycemia/falls
Which drugs are in the class Meglitinides?
Nateglinide (Starlix)
Repaglinide (Prandin)
which two classes of non-insulin drugs should not be prescribed together?
Meglitinides and Sulfonylureas
Which drug is a synthetic amylin Analog?
Pramlintide (Symlin, Symlinpen)
What are the ADR’s of APramlintide (Symlin, Symlinpen) and what cautions should you take when prescribing it?
ADRs: hypoglycemia, GI upset, n/v/anorexia
Warning: avoid use in pt’s w/ diabetic gastroparesis or / hypoglycemic unawareness
What are some injectable GLP-1 agonists? (5)
Exenatide (Byetta, Bydureon) Liraglutide (Victoza) Albiglutide (Tanzeum) Dulaglutide (Trulicity) Lixisenatide (Adlyxin)
What are the ADRs of GLP-1 agonists?
GI issues: n/v/d/c
What is the BBW for GLP-1 agonists?
thyroid tumors in animal studies, pancreatitis risk (so avoid in pt’s w/ thyroid disease), severe GI disease or gastroparesis, avoid in pt’s w/ gallbladder disease and hypersensitivity
Which of the GLP-1 receptor agonists can have anti-drug antibodies formed against them?
Exenatide
liraglutide
lixisenatide
Which GLP-1 agonist causes tachycardia, PR interval prolongation, AV block?
Dulaglutide
Which of the GLP-1 receptor agonists increases resting heart rate?
Liraglutide
Which GLP-1 receptor agonist has a new indication to reduce the risk of major adverse CV events in adults w/ type II DM ?
Liraglutide
Note: the brand Saxenda of liraglutide is indicated for weight loss
