Whittker Drugs Flashcards
Biguanides
Drugs: Metformin (Fortament, Glucophage, Glumetza, Riomet)
Initial dose: 500 mg daily - 500 mg BID
MOA: Decreases hepatic glucose production, Decreases intestinal absorption of glucose, improves insulin sensitivity
Adverse Events: GI (N/V), flatulence, diarrhea, Lactic acidosis (rare), Decreased Vit B12 levels (leads to anemia)
Warnings: Do not use in DHF and avoid in hypoxemia (this is due to inc in anaerobic metabolism and more lactic acid production). Avoid in renal dysfunction and hepatic dysfunction (again issue with lactic acid)
Renal Recommendations: Do not start is pt eGFR < 45 then D/C if pt eGFR is <30 (do yearly eGFR)
Treatment pearls of Metformin
Name brands: Fortamet, Glucophage, Glumetza, Riomet
Reduces A1C y 1-2% (high amount)
Reduces FPG
FIRST LINE TREATMENT
Take with meals to decrease GI effects
DOES NOT CAUSE HYPOglycemia
weigh loss neutral
Alpha Glucosidase inhibitors
Drugs: Acarbose (precose), Miglitol (glyset)
MOA: Competitively inhibits a-glucosidase enzymes in small intestine (this causes slow absorption of carbs which helps to keep insulin from spiking)
Adverse Effects: abdominal pain, bloating, flatulence, diarrhea
Treatment pearls of Alpha glucosidase inhibitors
Drugs: Acarbose (Precose), Miglitol (Glyset)
Reduces A1C y 0.3-1% (no very good and never given as mono therapy)
Reduces PPG, and must be taken with first bite of meals
Treat hypoglycemia with glucose
Do not give Scr > 2
Weight neutral
GLP-1 Agonists
Drugs: Exenatide (Byetta IR, Bydureron (ER)), Liraglutude (Victoza), Dulaglutide (Trulicity), Semaglutide (ozempic)
Dosing:
Byetta - initial 5mcg within 1 hour of meal, max 10 mcg subs BID**do no use is CrCl <30
Bydureon - 2mg Subq weekly ** Don’t use if CrCl < 45
Litaglutide : 0.6mg subq daily for 1 week then up to 1.2 daily
Dulaglutide: 0.7mg SQ weekly
Semaglutide: .25 SQ weekly
MOA: Binds to GLP1 on beta cells, increases glucose- dependent insulin secretion, decreases glucose secretion, slows gastric emptying, dec food intake
Adverse events of GLP1
N/V
Decreased appetite
Pancreatitis
Thyroid C-cell tumors
Hypoglycemia (ONLY WHEN USED IN COMBO WITH OTHER MEDS)
Injection site issues
Treatment Pearls of GLP1s
Reduces A1C by 0.5-2%
Reduces PPG and some FPG (longer acting products)
Extenatide (IR), Lixisenatide: 1 hour before meals
Exenatide (ER), liraglutide, Semaglutide, Dulaglutide: with or with out meals
Liraglutide (Saxenda) used for weight loss
Has CV benefits
DPP-4 inhibitors drugs and CrCl cut offs
Sitagliptin (Januvia)
Cr> 45: 100 mg daily
Cr 30-44: 50 mg daily
Cr< 30 or ESRD: 25 mg daily
Saxagliptin (Onglyza)
Cr> 45: 2.5-5 daily
Cr <45 2.5 daily
ESRD: 2.5 mg daily - give after dialysis
Linagliptin (Tradjenta)
5 mg Po daily
Alogliptin (Nesina) Cr> 60 25 daily 30-59: 12.5 15-29: 6.25 <15 or HD 6.25 (without regard for dialysis)
MOA of DPP4 inhibitors and adverse effects
Prolongs half-life of GLP1 and glucose dependent insulinotropic polypeptide
Blocks activity of DPP4 enzyme activity for at least 12 hours
Dec glucagon secretion
ADE: Peripheral edema Nausea Arthralgias Hypersensitivity reactions Pancreatitis Bullous pemphigoid
Treatment pearls of DPP4 inhibitors
Reduces A1C by .7-1
Reduces PPG
Weight neutral
Watch saxagliptin n HF (can worsen it)
What are the drugs and dosing in Amylin analogs and MOA
Pramlintide (SymlinPen)
Type 1 : 15 mcg SQ before meals
Type 2: 60 mcg SQ before meals
MOA:
Mimics action of amylin
Suppresses high post prandial glucagon secretion - this is due to slowing gastric emptying allowing lower spikes
Increases satiety
ADE of Amylin products and treatment pearls
ADE: N/V Anorexia Headache (common) Hypoglycemia (ONLY because you give this product with insulin)
Treatment pearls:
Reduces A1C by .3-.5
Reduces PPG
USED SO THAT YOU CAN REDUCE INSULIN REQUIREMENTS
weight loss
Sulfonylurea drugs and dosing
Glimepiride (Amaryl)
1-2 mg daily with breakfast or first meal
Glipizide (Glucotrol and XL) 5mg daily (same for XL)
Glyburide (Glynase PresTab)
Regular tabs: 2.5-5 with first meal of the day
Micronized tabs: 1.5-3 with first meal of the day
MOA and Adverse effects of sulfonylureas
Binds to sulfonylurea receptors on Beta cells, this closes K channels which decreases K efflux and depolarizes the membrane
This leads to opening of Ca channels and Ca enters which causes insulin secretion
ADE: Hypoglycemia (huge risk) Weight gain Dizziness Hyponatremia (SIADH)
Treatment Pearls of sulfonylureas
Reduces A1C by 1.5-2
Reduces PPG and FPG
Glyburide is not recommenced on AFA
Watch for severe hypoglycemia
Can cause weight gain
What are the meglitinides and their MOA
Nateglinide (Starlix)
Repaglinide (Prandin)
MOA:
Blocks ATP-dependent K channels, depolarizing the membrane and caused Ca to enter and increase insulin release
**not as strong of an effect as sulfonylureas
What are the ADE and treatment pearls of meglitinides
ADE:
Weight gain
Hypoglycemia
URTI (this is something that is common in diabetics so it might not really cause it)
Treatment pearls: Reduces A1C by around 1% Reduces PPG Always take before meals, skip dose with you cant Weight gain
What are the TZD drugs their dosing and the MOA
Pioglitazone (Actos)
15-30 mg daily
Rosiglitazone (Avandia)
4 mg daily
MOA:
Binds and activates PPAR gamma, this improves peripheral muscle and adipose tissue sensitivity to insulin. And allows for more glucose to be taken up not fat and muscle. Can take weeks to months in order to get the full effect of this drug
What are the ADE and treatment pearls of TZDs
ADE:
Peripheral edema, HF, weight gain (Can be do to the fact you retain H2O)
Increased Transaminases
Fractures
Anemia
**DO not use in NYHA III or IV HF
Treatment pearls:
Reduces A1C by 1-1.5%
Reduces FPG + PPG
Increased HDL, decreased TG (pioglitazone)
Increased HDL, LDL and TC (rosilitazone)
Benefits takes months and can cause weight gain
What are the SGLT2 inhibitors their dose and MOA
Canagliflozin (Invokana)
100mg daily
eGFR 45-59: 100 mg MAX
<45: D/C
Dapagliflozin (Farxiga)
5mg daily
eGFR<45: D/C
Empagliflozin (Jardiance)
10mg daily
EGFR< 45: D/C
Ertugliflozin (Steglatro)
5mg Daily
eGFR< 60: D/C
MOA: blocks SGLT2 in proximal renal tubes and blocks the reabsorption of glucose and results in increases renal excretion of glucose
What are the ADE and treatment pearls of SGLT2 inhibitors
ADE: Genital mycotic infections UTIs Hypotension (due to fluid loss) HyperK Lipid abnormalities Renal insufficiency Keto acidosis Bone fractures
Treatment Pearls: Reduce A1C by .7-1% Reduces PPG Take without regard to meals but recommended to take drug before first meal of the day Weight loss HAS CV BENEFITS
Bile Acid sequestrants drug and MOA
Colesevelam (Welchol)
MOA:
Unknown how it actually works in diabetes but may reduce hepatic glucose production
May increase incretin lvls
ADE and Treatment pearls of BAS
ADE: Constipation Dyspepsia Nausea Can cause an increase in hypertriglyceridemia
Treatment Pearls: Reduces A1C by .4-.6% Reduces PPG Take with meals Lowers LDL, inc TG Do not use when TG > 500 Weight neutral
Bromocriptine name brand, MOA, ADE and pearls
Cycloset
MOA:
Unknown, but this that DA effects circadian rhythm which plays a role in obesity and insulin resistance. Giving it in the morning may correct circadian activities which were effecte day obesity which will result in reversal of insulin resistance and decrease glucose production with inc insulin
ADE: N/V Dizziness Fatigue Headache Weakness
Pearls: A1C < 0.5% Take with food Take within 2 hours of waking up in the morning Weight neutral
