Thiazolidinediones (TZD) Flashcards
1
Q
Thiazolidinediones (TZD): MOA
A
- Primary MOA: INCREASE peripheral muscle glucose sensitivity (glucose uptake and utilization)
- Secondary MOA: DECREASE glucose output from the liver (hepatic glucose output)
Opposite of metformin
2
Q
Thiazolidinediones (TZD): Site of Action
A
- MUSCLE and ADIPOSE TISSUE
3
Q
Thiazolidinediones (TZD) Drugs
A
- Rosiglitazone (Avandia)
- Pioglitazone (Actos)
4
Q
Rosiglitazone (Avandia): Dosing
A
- 4-8 mg PO daily; MDD = 8mg/day
5
Q
Pioglitazone (Actos): Dosing
A
- Initial: 15-30 mg PO daily; MDD = 45mg/day
6
Q
Thiazolidinediones: Side effects
A
- Edema (precursor to heart failure): may worsen CHF
- Fracture (do benefit risk test)
7
Q
Rosiglitazone: Drug interactions
A
- Insulin
- Nitrates
8
Q
Pioglitazone: Drug interactions
A
- Oral contraceptives (makes it less effective, increase pregnancy)
- Progestins
- Pazopanib
9
Q
Thiazolidinediones: Contraindications
A
- Hypersensitivity/T1DM/DKA
- ALT>2.5xULN
- NYHA Class III-IV
- CHF (symptomatic)
- ACS
- Active bladder cancer
10
Q
Thiazolidinediones: Precaution
A
- CHF NYHA Class I-II
- Edema
- Myocardial Infarction
- Impaired liver function
- Insulin/SU use
- Bladder cancer history
- Females (induce ovulation)
- Fracture risk
11
Q
Thiazolidinediones: Black Box Warning
A
Congestive Heart Failure (both)*****
- Can exacerbate CHF
- Monitor for symptoms (rapid weight gain, dyspnea, edema)
Myocardial Infarction (rosiglitazone only)*****
12
Q
Thiazolidinediones: Counseling points
A
- Take once a day; same time each day
- Do not use in NYHA Class III-IV CHF
- Report weight gain and/or swelling of legs immediately
- Avoid alcohol use
ASK ABOUT: edema and weight gain
13
Q
Thiazolidinediones: Monitoring
A
- LFT’s
- Edema
- Weight gain
- Cholesterol panel
- FBG/PPG
- A1c
Time to peak effect: 6-8 weeks
