non-insulin treatments pg 1-17 Flashcards
kania pt 3 (46 cards)
what is the brand name(s) of metformin?
glucophage
fortamet
glumetza
metformin MOA
decrease hepatic production of glucose
increase intestinal glucose utilization –> decrease glucose uptake into circulation
can increase GLP-1 secretion
modest effect on increasing tissue uptake and utilization of glucose by muslces
why is metformin recommended by the ADA in all T2DM pts if tolerated?
shown to reduce risk of mortality and CV death
extensive experience
efficacious with minimal hypoglycemia
positive and/or neutral effects on weight
widely available and inexpensive
what are some off-label uses of metformin?
T1DM management in pts who are overweight and low risk of ketoacidosis
PCOS – increases ovulation, lowers androgen
what is the efficacy profile of metformin?
A1c –> decrease by 1.5-2%
FBG –> decrease by 60-80 mg/dL
TG/LDL –> decrease by 8-15%
Weight –> decrease by 2-3 or neutral
why is metformin d/c while in hospital?
may cause lactic acidosis in combination with medications
when should metformin use be cautioned?
in pts with renal dysfunction (needs adjustment)
acute decompensated hospitalized HF pts, unstable HF pts, or HF with severe renal/hepatic disease (AVOID)
alcoholics
what are some disadvantages of metformin?
lactic acidosis
GI effects (NVD flatulence)
vit B12 deficiency
controversial study of dementia risk
what is the normal dosing for metformin?
start at 500 mg BID wm
titrate weekly or bi-weekly by 250-500mg/day to avoid SE
max of 2gm/day
what is the dosing for metformin in renal insufficiency?
above 60 –> no change
45-60 –> safe to start and continue but monitor 3-6months
30-45 –> do not start, reduce 50% if taking already, monitor 3 months
<30 –> do not start, d/c if taking
what is the brand name(s) of canagliflozin?
invokana
what is the brand name(s) of of dapagliflozin?
farxiga
what is the brand name(s) of empagliflozin?
jardiance
what is the MOA of SGLT2 inhibitors?
inhibition of SGLT2 (transports renal glucose to increase glucose reabsorption) –> leads to renal glucose excretion
when is SGLT2 inhibitors recommended as initial therapy?
with T2DM patients that have
- ASCVD
- high risk for atherosclerotic CV disease (over 55y with at least 2: HTN, HLD, obesity, smoking, or albuminuria)
- HF
- CKD
what is the efficacy profile of SGLT2 inhibitors?
A1c –> decrease by 0.5-1.0%
FBG –> decrease by 25-35 mg/dL
PPG –> decrease by 40-60 mg/dL
Weight –> decrease by 1-5kg
BP –> decrease by 3-6mmHg (SBP) and 2-3 mmHg (DBP)
what are common SE of SGLT2 inhibitors?
UTIs
female/male genital mycotic infections
increased urination
hypotension
hyperkalemia
increased cholesterol
if a pt is UTI free for the past year, are they ok to start SGLT2 inhibitors?
yes
can SGLT2 inhibitors be considered for pts with h/o of GMIs?
yes if uncomplicated or rectified complicated
counsel on s/s
counsel on good perineal hygiene
d/c if infections
what are the FDA warnings for SGLT2 inhibitors?
DKA
bone fractures and decreased BMD in patients (specifically canagliflozin)
AKI (specifically in canagliflozin and dapagliflozin)
increased risk of leg and foot amputations (specifically canagliflozin but removed in 2020)
what is the recommendation for SGLT2 inhibitors near surgery?
hold three days before (4 if ertugliflozin)
restart once back to baseline due to increased risk of DKA
what is the dosing for canagliflozin?
if eGFR > 60 –> 100 mg, max of 300mg qd
if eGFR 30-60 –> 100 mg if no albuminuria
if eGFR < 30 –> do not start, if already taking may use 100 mg daily if albuminuria > 300 mg/d
what is the dosing for dapagliflozin?
if eGFR > 45 –> 5mg, max of 10 mg qd
if eGFR < 25 –> do not start, if on monitor
what is the dosing for empagliflozin?
if eGFR > 30 –> 10mg, max of 25
if eGFR < 30 –> do not start, monitor if on
