T2-Diabetes Oral Agents Flashcards
Oral agents are FDA approved for ___ diabetes
Type2
What are the 5 types of oral agents?
Metformin Sulfonylureas TZDs DPP-4 Inhibitors SGLT-2 Inhibitors
What is the cornerstone of T2DM management?
Metformin
When do you start metformin?
Immediately after diagnosis of type 2 diabetes
How does metformin lower blood glucose and improve glucose tolerance?
- Decrease glucose production of the liver
- Decrease glucose absorption of the gut
- Increase sensitivity of insulin receptors
Does metformin stimulate insulin release from the pancreas? What does this mean?
No, it does not “hit” the pancreas to release glucose so it does NOT pose much threat to developing hypogycemia when used alone
What are the 5 most common adverse effects of metformin?
- Diarrhea and flatulence (very common and goes away with time)
- Decreased vitamin b12 (can contribute to peripheral neuropathy)
- Decreased folic acid (deficiency in pregnancy can impair development of CNS of fetus)
- Lactic acidosis (RARE)
- Weight neutral (does not cause weight gain or loss)
What must we teach patients who are taking metformin in regards to lactic acidosis?
Teach them the early signs of it (hyperventilation, myalgia, malaise, and unusual somnolence)
Who is metformin contraindicated in?
Patients with HF
Is it okay to drink alcohol when taking metformin?
No, avoid consuming alcohol in excess, discontinuing would be even safer because alcohol can inhibit the breakdown of LA and therefore, can intensify LA
What is the second most common T2DM?
Sulfonylureas
What is the MOA of sulfonylureas?
“Hits” pancreas over and over to secrete more insulin, so it makes blood sugar go down
If you are taking a sulfonylurea, is there a risk of hypoglycemia?
YES
What are the 3 examples of sulfonylureas?
Glipizide
Glyburide
Glimepiride
What sulfonylurea is the most kidney friendly aka the “least renally excreted”?
Glipizide
What are the 3 adverse effects of the sulfonylureas? (glipizide, glyburide, glimepiride)
- HYPOGLYCEMIA!!!
- Weight gain
- “Burn out”
How much weight gain may be seen with the sulfonylureas?
5-10 lbs
How long can you take a sulfonylureas before “burnout”?
5-10 years
Is it okay to take a sulfonylureas during pregnancy?
No!! ONLY oral drug that is okay in pregnancy is metformin!
Can you take alcohol with sulfonylureas?
NO! There is a disulfiram-like reaction because alcohol POTENTIATES the hypoglycemic effects of this drug!!!
TZDs are normally taking as an add on with what other oral anti-diabetic?
Metformin
What is the MOA of TZDs?
Reduce glucose levels primary by decreasing insulin resistance by activation of the PPAR gamma receptor
Does TZDs work on DNA?
Yes
Since TZDs work on DNA, what does that mean?
It will take 3-4 MONTHS before they start working!
