T2D Drugs Flashcards
What are the drug interactions of metformin
Cimetidine
Dolutegravir
Alcohol
What are the AE of metformin?
Diarrhea
GI
What are the Less common effects of metformin?
Metal taste,
B12 deficiency
What are the precautions and CI of metformin?
Lactic Acidosis
Decrease dose if ClCr <60ml/min
1500mg/d 45-59
1000mg/d 30-44
What is the MOA of SUs
Enhance the secretion of insulin by binding to SU receptor on beta cells of the pancreas
Stimulate basal and meal stimulated insulin release
What are the three SUs
Glyburide, Glicalizide, glimepiride
What is the usual dosage of Glyburide?
5m-20mg/d
What is the usual dosage of glicalizide
80mg-160mg
What is the usual dosage of Glimepiride
1mg-8mg
Which eGFR is glyburide CI in?
<60ml/min
Which eGFR is gliclazide and glimepiride in?
<30ml/min
Which SU does not cross the placenta?
Glyburide
What is the MOA of repaglinide? (Meglitinides)
Binds to a site adjacent to the SU receptor, resulting in stimulation of the secretion of insulin from the pancreas
What is the dosing of Repaglinide?
◼A1C <8%: initiate at 0.5mg before each meal + titrate up
◼A1C >8%. Initiate at 1-2mg before each meal + titrate up
Max dose: 4mg before each meal (max dose 16mg/d)
What is a possible DI or CI with repaglinide?
Grapefruit juice,
What are the two Thiazolidinediones
Rosiglitazone, Pioglitazone
What is the MOA of Rosiglitazone, Pioglitazone?
Bind to PPAR-γ receptors which are primarily found in adipose tissue. Activation alters genes that influence glucose and lipid metabolism
What was controversial due to Thiazolidinediones?
Cardiovascular safety and how they both can promote fluid retention and edema and increase risk of HF
What are the GLP-1 receptor agonists (glucagon-like peptide) drugs?
Exenatide (Byetta®)
* Liraglutide (Victoza®) ®
* Dulaglutide (Trulicity®)
* Exenatide weekly (Bydureon®)
* Lixisenatide (Adlyxine®)
* Semaglutide (Ozempic® SC, Rybelsus® oral)
-tide is the suffice GLP-1Tide
DPP-4 (dipeptidyl peptidase) Inhibitors
- Linagliptin (Trajenta®)
- Sitagliptin (Januvia®)
- Saxagliptin (Onglyza®)
- Alogliptin (Nesina®)
DPP4-iptin
Activation of the GLP-1 receptor results in:
- Potent inhibition of gastric emptying
- Potent inhibition of glucagon secretion
- Reduction of food intake and body weight
Adverse effects and precautions due to DPP4i?
headache, nasopharyngitis, URTI
What are the short acting GLP1RAs?
Exenatide, Lixisenatide
Must be taken before meals
What are the long acting GLP1RAs?
Liraglutide
Exenatide
Dulugatide
Semaglutide
What is the effect on weight with GLP1RA?
Weight loss
What renal levels are SGLT2i no longer effective?
<45
What are the common AE of SGLT2i?
Urination and thirst
What are the CI of SGLT2i?
Elderly, on other diuretics
DKA risk
Are SGLT2i renal protective?
Yes
What is the desired dosing of metformin?
850-1000mg BID
What happens when you have Climetidine and metformin DI?
Competes for renal tubular secreiton and increases metofrmins levels by 60%
What does Dolutegravir do?
Increases metformin concentration
What is the tyipical dosing of repaglinide if the A1C is below 8%?
0.5mg before meal
What is the typical dosing of repaglinide if the A1C is above 8%
1-2mg before meal and titrate up to 4mg before mealk
What is the typical dosage of acarbose?
25- 50mg OD and go up to 100mg TID is the goal
What do TZDs do?
Enhance insulin sensitivity
Decreast hepatic glucose production
Convert LDL to fluffy LDLs
What is the dosage of rosiglitazone (Rosi)(
2-4mg OD and may increase to 4mg BID
What is the typical dosage of pioglitazone?
15mg OD and 30-45mg OD
What is the only DPP4 inhibitor that does not require dose adjustment due to renal dosing”
Linaglipitin
What drugs should be avoided when takling DPP4 inhibitors?
GLP1RA
What are the dosages of EL short acting GLP1RAs?
5ug BID (Exenatide)
Lixisenatide (10ug to 20ug OD)
What is the dosage of Dapa?
5-10mg
What is the dosage of Cana? -flozin
100-300mg OD
What is the dosage of Empaglifozin?
10-25mg
