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