Type2 Flashcards
Biguanides
Metformin
Alpha-glucosidase inhibitors
acarbose (precose), miglitol (glyset)
Meglitinide agonists
Repaglinide (Prandin)
D-Phenylalanine derivative
Nateglinide (Starlix)
Sulfonylureas
Glimepride (amaryl), glyburide (diabeta, micronase, glynase), glipizide (glucotrol, gluctrol XL)
Thiazolidinediones
Pilgitazone (actos), Rosiglitazone (avandia)
GLP-1 receptor agonists (injectable)
exenatide (Byetta), liraglutide (victoza)
DPP-4 inhibitors
Sitagliptin (Januvia), Saxagliptin (onglyza), linagliptin (tradjecta)
Metformin C/I
GFR less than 30, less than 80 yrs
Metformin mechanism
improves insulin action at LIVER
MUSCLE glucose uptake
Metformin S/E
GI upset; metallic taste (usually transient)
Lactic acidosis = RARE
Metformin renal dosing
GFR less than 30 – do NOT use
30-45 – if on metformin, decrease dose
30-45 – not on metformin, dont start
Metformin drug interaction
cimetidine
Metformin advantages
No hypoglycemia
Decreases microvascular and CVD events
Lack of weight gain – potential weight reduction
Improves lipid profile (decreases TG and LDL)
Sulfonylureas (second generation preferred) MOA
stimulates beta cell secretion of insulin
Sulfonylureas disadvantages
Higher risk of hypoglycemia; weight gain
Avoid in early stages of typical DM2
sulfonylureas
risk for lactic acidosis
metformin
TZD MOA
more focus on glucose uptake in muscle and adipose tissue
Slow onset (2-3 months)
TZD
Advantage of Pioglitazone (actos)
favorable response in lipid
Disadvantage of TZD
weight gain
Edema due to increased plasma volume
AVOID in CHF patients
avoid in liver dysfunction
Moderate bone loss
TZD
Alternative to metformin
TZD
Usually used in combo except very early in diagnosis of DM2
TZD
DPP-IV Inhibitors MOA
prevents breakdown of GLP-1
Mainly lowers post-prandials
DPP-4 Inhibitors
DPP-4 Inhibitors increased risk of heart failure
Saxaglipton
Alogliptin
No increased risk of MACE (DPP-4)
Sitagliptin, Linagliptin
GLP-1 Agonists MOA
mimics GLP-1 (increases insulin release, decreases glucagon release)
does NOT impair normal glucagon response to hypoglycemia
GLP-1 Agonists S/E
Slows gastric emptying (GI effects)
Increases HR
Small risk – acute pancreatitis
GLP-1 Agonists CI
Gastroporesis
severe renal impairment (Byetta, Bydureon)
Daily (short acting) GLP-1 Agonists
exenatide
liraglutide
Weekly (long acting)
albiglutide
dulaglutide
exenatide
GLP-1 primarily targeting PPG (usually BOTH FBG and PPG)
exenatide (byetta)
albiglutide (tanzeum)
GLP-1 advantages
no hypoglycemia
weight loss
decreases some CV risk factors
decreases postprandial glucose excursions
SGLT-2 Inhibitors MOA
upregulates SGLT-2 –> renal threshold for glucose reabsorption increased
SGLT-2 (FBG or PPG?)
targets FBG primarily
SGLT-2 Advantages
no hypoglycemia
weight loss
decreases BP slightly
SGLT-2 Disadvantages
GU infections – UTI most common
increases LDL
volume depletion/dizziness
BONE LOSS potential