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PHARM 343 > Type 2 Diabetes Initial Oral Therapy > Flashcards

Type 2 Diabetes Initial Oral Therapy Flashcards

1
Q

Metformin

A

Slight risk reduction
- Pretty safe

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2
Q

Acarbose

A

Slight risk reduction
- Causes serious GI side effects

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3
Q

Pioglitazone

A

Strongest risk reduction
- Causes heart failrues

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4
Q

Rosiglitazone

A

Strong risk reduction
- Causes CV side effects (No longer on market)

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5
Q

Ramipril

A

No significant difference

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6
Q

Muscle and Liver
- Diabetes Pathophysiology
- Drugs

A

Insulin Resistance

Decrease Insulin Resistance
- Thiazolidinediones

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7
Q

Pancreatic Beta Cells
- Diabetes Pathophysiology
- Drugs

A

Decreases Insulin Secretion

Increases Insulin Secretion
- Thiazolidinediones
- GLP1ra
- DPP4i
- Sulfonylureas
- Non-sulfonylurea Secretagogues
- Insulin

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8
Q

Liver
- Diabetes Pathophysiology
- Drugs

A

Increase Hepatic Glucose Production

Decreases Hepatic Glucose Production
- Metformin
- Thiazolidinediones
- GLP1ra
- DPP4i

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9
Q

Small Intestine
- Diabetes Pathophysiology
- Drugs

A

Decreases Incretin Hormone Secretion

Increases Incretin Hormone Secretion
- GLP1ra
- DPP4i

Alpha-glucosidase Inhibitors (Acarbose)
- Inhibits breakdown of complex carbohydrates

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10
Q

Adipose Tissue
- Diabetes Pathophysiology
- Drugs

A

Increases Release of Free Fatty Acids

Prevents release of free fatty acids
- Thiazolidinediones

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11
Q

Pancreatic alpha cell

A

Increases Glucagon Secretion
- GLP1ra
- DPP4i

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12
Q

Kidney

A

Increases Glucose Reabsorption by Sodium/Glucose Co-Transporter 2

Inhibits SGLT2
- SGLT2i

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13
Q

Brain

A

Neurotransmitter Dysfunction
- GLP1ra

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14
Q

What Type 2 Diabetes Drugs have been removed from practice

A

Thiazolidinediones (Heart Attack/Failure)

Alpha-glucosidase Inhibitors (Nasty GI AE)
- Acarbose

Sulfonylurea (High Hypoglycemia Risk)
Non-Sulfonylurea Secretagogues

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15
Q

Goals of Therapy
- Type 2 Diabetes

A

Treat Normally:
- Maintain Targets (A1c/FPG/2-Hour Post-Prandial Blood Glucose)

Treat Agressively
- Reduce Microvascular and Macrovascular complications
- Minimize risk of hypoglycemia
- Maintain targets for CV risk factors

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16
Q

Type 2 Diabetes Guidelines

A
  1. Initial Therapy
    - Healthy Behaviour Interventions
    - Can add Metformin if needed
    - Can add drugs for CV and Kidney
  2. Add Antihyperglycemic Therapy if targets not reached within 3 months
    - Add Metformin before other therapies
  3. A1c is above 1.5% target
    - Combine Metformin with a second antihyperglycemic agent
  4. If patient has metabolic decompensation
    - Start Insulin with or without Metformin
17
Q

How long to reach target for Type 2 Diabetes

A

3-6 months

18
Q

How much can Metformin shift A1c

A

By 1.5%

19
Q

Metabolic Decompensation
- Symptoms

A

Marked Hyperglycemia

Ketosis

Unintentional Weight Loss

20
Q

Initial Choice of Therapy
- A1c is less than 1.5% over target

A

Initiate healthy behaviour interventions and start Metformin if not at target in 3 months
OR
Start Metformin with Initiate healthy behaviour interventions

21
Q

Initial Choice of Therapy
- A1c is greater than 1.5% over target

A

Start metformin with Healthy Behaviour Interventions AND Consider second concurrent agent

22
Q

Initial Choice of Therapy
- When to start Insulin

A

Signs of Hyperglycemia and/or Metabolic Decompensation:
- Polyuria
- Polydipsia
- Weight Loss
- Volume Depletion

Start Insulin +/- Metformin

23
Q

Why is Metformin the Initial Agent

A
  1. Efficacy in Lowering A1c
  2. Favourable Side Effect Profile
    - Low Risk of Hypoglycemia
    - Weight Gain is minimal/neutral
  3. Cost Effective
24
Q

Metformin
- Clinical Evidence

A

Only lowers blood sugars
- Does not reduce CV events or reduce progression of diabetes

Trials that do show CV benefits did not have many participants

25
Q

Intolerances of Metformin

A

GI Side Effects (Nausea, Vomiting, Flatulence, Abdominal discomfort)
- Should go away after 2 weeks
Metallic Taste
- Does not go away
Renal Impairment
- Can not use if eGFR is less than 30

26
Q

Alternatives to Metformin

A

SGLT2i
DPP4i
GLP1ra
- Oral agents are expensive
- Injectables are an option

Sulfonylureas are not used anymore

27
Q

Dosing of Antihyperglycemic Agents

A

Better to use combinations with submaximal doses rather than max dose of monotherapy
- Will produce more rapid and improved glycemic control
- Will cause less side effects

PHARM 343 (35 decks)

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