Pharmacotherapy of Oral Diabetes and Non-Insulin Injectable Medications Flashcards
What are the hallmark symptoms of hyperglycemia?
Polydipsia, Polyuria, and Polyphagia
What are the reasons for an alternate goal?
High risk for hypoglycemia, high risk for complication of hypoglycemia occurs, barriers to drug therapy required for optimal control, lower risk for chronic complications, and elderly
What is the A1c goal of healthy patient with few coexisting chronic illnesses and intact cognitive function?
<7-7.5%
What is the A1c goal for a complex patient with multiple coexisting chronic illnesses with mild cognitive impairment?
<8%
What is the A1c goal of a very complex end stage chronic illness with mod/severe cognitive impairment?
Avoid reliance on A1c
What is the primary action of Metformin?
Decreases hepatic glucose production
What is the use of Metformin?
Should always be considered in type 2 DM unless there is a CI
What is the dose adjustment of Metformin for eGFR >45?
No adjustment
What is the dose adjustment of Metformin for eGFR 30-45?
Can initiate at 500 mg QD and titrate to 500 mg BID for new therapy
Continuation of therapy = 50% REDUCTION
What is the max dose of Metformin in eGFR 30-45?
1 g/day
What is the dose adjustment of Metformin for eGFR <30?
CI due to increased risk of lactic acidosis
What are the A/Es of Metformin?
Diarrhea and Decreased B12
What are the warnings/DIs of Metformin?
Lactic Acidosis or Age >80 due to decreased renal clearance
What do you monitor for Metformin?
Renal Function and B12
What is the place in therapy for Metformin?
First Line
A1c Lowering 1.5-2%
Highest lowering effect
What are the pearls of Metformin?
Improve HDL and LDL, Max Dose = 2000mg, Weight Neutral
What is the primary action of Sulfonylureas?
Increases insulin secretion = glucose INDEPENDENT
What is the brand name of Glimepiride?
Amaryl
When do you avoid Amaryl?
Avoid eGFR <15 other than that no renal dosing
What is the brand name of Glipizide?
Glucotrol
Do you renally dose adjust in Glucotrol?
No
What is the brand name of Glyburide?
Glynase
When is Glynase not recommended?
eGFR <60
What are the A/Es of Sulfonylureas?
Hypoglycemia and Weight Gain
What do you monitor in Sulfonylureas?
Hypoglycemia and Renal Function
What is the place of therapy for Sulfonylureas?
2nd or 3rd line
A1c lowering 1-2% (better as mono therapy and not adjunct)
What 2 Sulfonylurea’s are on the BEER’s List?
Glyburide and Glimepiride
What is the primary action of Meglitinides?
Increases insulin secretion, glucose DEPENDENT
What is the brand name of Repaglinide?
Prandin
What is the brand name of Nateglinide?
Starlix
What are the A/E of Meglitinides?
Hypoglycemia and Weight Gain
What is the warning associated with Meglitinides?
Not recommended to use together with SU
What is the place in therapy of Meglitinides?
2nd or 3rd line
A1c lowering 0.8-1%
What are the pearls of Meglitinides?
Skip is the patient skips a meal, however useful for patients with inconsistent eating patterns
What is the primary action of Thiazolidinediones?
Increased insulin sensitivity, takes 6-12 wks for MAX effect
What is the brand name of Pioglitazone?
Actos
What is the brand name of Rosiglitazone?
Avandia
When do you DC TZD therapy?
When LFTs are elevated
What are the A/Es of TZDs?
Peripheral edema/fluid retention, elevated LFTs, and weight gain
What is a CI of TZDs?
NYHA III or IV Heart Failure
What is a warning of TZDs?
Can exacerbate HF at any stage with fluid retention (black box) and hepatotoxicity
What do you monitor with TZDs?
LFT, Alkaline phosphatase, and total bilirubin at baseline
What is the place of therapy for TZDs?
3rd line
A1c Lowering 1-1.5%
Why is Rosiglitazone NOT so Rosy?
Can increase risk of MI
What is the primary action of GLP-1 Agonists?
Increase insulin secretion, decrease glucagon secretion (glucose DEPENDENT), slow gastric emptying, and increase satiety
What is the brand name of Exenatide IR and ER?
IR: Byetta
ER: Bydureon
What is the dosing for Byetta/Bydureon
Byetta: BID
Bydureon: once weekly
What is the renal dosing for Byetta/Bydureon?
CrCl < 30 = DC
What is the brand name of Liraglutide?
Victoza