week 8 Oral Diabetes medications Flashcards
Canagliflozin
Invokana
Hyperglycemic lowering agent
SGLT-2 (sodium glucose cotransporter 2)
Type 2 Diabetes
yeast infections; urinary tract infections; hyperkalemia; dehydration
ACE-I/ARB, Digoxin
Warings: Risk of serious UTIs; increased prevalence of foot/leg amputations, acute kidney injury, dehydration, hyperkalemia; No BOXED warnings
Patient counseling
Counsel patients on signs and symptoms of yeast infections and UTI and dehydration
Glimeperide
Amaryl
Diabetes
Hypoglycemic
Sulfonylurea
Type 2 Diabetes
hypoglycemia/weight gain
beta blockers; insulin/DPP-IV
precaution: elderly; warnings: hypoglycemia, secondary failure, cardiovascular mortality; NO BOXED WARNING
Glipizide
Glucotrol,Glucotrol XL
Diabetes
Hypoglycemic
Sulfonylurea
Type 2 Diabetes
hypoglycemia/weight gain
beta blockers; insulin/DPP-IV
precaution: elderly; warnings: hypoglycemia, secondary failure, cardiovascular mortality; NO BOXED WARNING
Glyburide
DiaBeta, Micronase 3-Glynase (micronized)
Diabetes
Hypoglycemic
Sulfonylurea
Type 2 Diabetes
hypoglycemia/weight gain
beta blockers; insulin/DPP-IV
precaution: elderly; warnings: hypoglycemia, secondary failure, cardiovascular mortality; NO BOXED WARNING
Glyburide/Metformin
Glucovance
Diabetes
Hypoglycemic/Hyperglycemic lowering combination
Sulfonylurea/Biguanide
Type 2 Diabetes
Metformin
Glucophage, Glucophage XR
Diabetes
Hyperglycemic lowering agent
Insulin sensitizer; decrease liver production of sugar (Biguanide)
Type 2 Diabetes
GI (nausea, vomiting, diarrhea), weight loss, metallic taste
Alcohol, iodonated contrast media
Boxed warning: lactic acidosis, precaution: stop 48 hours before contrast, acute HF; CI: elderly (>80), kidney dysfunction
Patient counseling
Take with food to minimize GI side effects
Clinical pearls
Metformin does not cause hypoglycemia when used as monotherapy
Can switch to XR formulation to minimize GI side effects
Patient should slowly increase dose to minimize GI side effects
First line agent
Pioglitazone
Actos
Diabetes
Hyperglycemic lowering agent
PPAR-gamma agonists
Type 2 Diabetes
edema, weight gain
contraceptives
Boxed Warning: heart failure (NYHA III and IV); precautions: bladder cancer, fracture, edema;
Patient counseling
Watch for weight gain, edema, and jaundice ( yellow skin and eye)
Sitagliptin
Januvia
Diabetes
Hyperglycemic lowering agent
DPP-IV Inhibitor
Type 2 Diabetes
GI (nausea, vomiting); hypoglycemia (if with other medications); cold-like symptoms
digoxin
warnings: pancreatitis, joint pain, kidney dysfunction; No boxed warnings
Patient counseling
Discuss signs and symptoms of hypoglycemia
Increased rush if patient also on sulfonylurea or insulin
Patenting counseling for sulfonylureas
Take 15-30mins before eating
-if you skip meal, skip dose
Counsel patients on how to recognize and treat hypoglycemia
- should always have a source of sugar
Clinical pearls on sulfonyureas
Glyburide formations are not equal
Therefore not interchangeable
Diabeta does not have generic
What type of diabetes requires insulin
therapy?
A. Type 1 Diabetes
B. Type 2 Diabetes
A. Type 1 Diabetes
Which medication represents a biguanide?
A. Metformin®
B. Levemir®
C. Januvia®
D. Glucotrol XL®
A. Metformin®
What do you think an appropriate
counseling point would be for Metformin?
A. This may cause low blood sugar B. Take with food to decrease stomach upset C. Take on an empty stomach to avoid stomach upset D. Looses effect as you age
B. Take with food to decrease
stomach upset
Based on the mechanism of action for
Sulfonylureas, would it cause hypoglycemia?
A. Yes
B. No
A. Yes –sulfonylureas cause the pancreas to release insulin, if too much insulin is released compared to blood sugar levels, the patient can get hypoglycemia
Which of the following medications is a
DPP-IV inhibitor?
A. Jantoven®
B. Actos®
C. Januvia®
D. Victoza®
C. Januvia®
