Biguanides

Question 1

What is the single available Biguanide agent?

Answer 1

Metformin

Question 2

What is the MOA for biguanides?

Answer 2

Reduces production of glucose by the liver
Slows intestinal absorption of sugar
Increases insulin sensitivity

Question 3

Biguanides expected change in A1c

Answer 3

High

Question 4

What is the dosing frequency for immediate release biguanides?

Answer 4

Twice daily

Question 5

What is the dosing frequency for extended release biguanides?

Answer 5

1-2x daily

Question 6

How are biguanides administered?

Answer 6

Orally

Question 7

What are the ADEs of biguanides?

Answer 7

GI Upset (diarrhea, NV)
Vitamin b12 deficiency

Question 8

What is the risk of hypoglycemia for biguanides?

Answer 8

Low

Question 9

Biguanides have what kind of effect on weight?

Answer 9

Neutral to slight weight LOSS

Question 10

What are biguanides impact on cardiovascular health?

Answer 10

may improve outcomes

Question 11

What are biguanides impact on renal function?

Answer 11

May improve outcomes

Question 12

When are bigunaides contraindicated?

Answer 12

eGFR < 30 or risk of acute renal failure
Elderly
Heart failure
Increased risk of hypoxia

Question 13

Do not initiate biguanides when eGFR is

Answer 13

< 45

Question 14

What is CI in a px taking metformin?

Answer 14

IV radiocontrast dye

Question 15

What are drug-drug interactions of metformin?

Answer 15

Fluoroquinolones
IV radiocontrast dye

Question 16

What do you need to monitor in a px taking metformin?

Answer 16

Blood sugar, A1c
Vitamin b12

Question 17

What is the cost of biguanides?

Answer 17

Low

Question 18

Clinical pearls of biguanides

Answer 18

Start low, go slow
Start px w/ ER