Week 8: Biguanides and TZDs - Insulin Sensitizers

Question 1

Biguanides - Metformin (Glucophage) MOA

Answer 1

1) improves the sensitivity of insulin @ muscle cells
2) decreases hepatic glucose production (gluconeogenesis)
3) decreases intestinal absorption of glucose
Does not cause hypoglycemia - Weight negative

Question 2

Metformin (Glucophage) contraindications

Answer 2

Renal failure - Serum Cr >1.5 males; >1/4 females

Question 3

Biguanides/Metformin ADRs

Answer 3

GI- diarrhea/gas
Lactic Acidosis (in dehydration)

Question 4

Metformin pt counseling

Answer 4

Hold for 48 hours before and after radiologic studies with contrast

Question 5

Thiazolidinediones (TZDs) - Pioglitazone (Actos) MOA

Answer 5

1) enhances insulin sensitivity
2) increases utilization of available insulin by the liver and muscle cells as well as adipose tissue.
3) decreases hepatic glucose production
* *works exactly like Metformin then went terribly wrong**
- Does not cause hypoglycemia - Weight positive

Question 6

TZDs - Pioglitazone (Actos) ADRs

Answer 6

• peripheral edema

- small bone fracture

Question 7

Pioglitazone (Actos) contraindications

Answer 7

• heart failure
• active liver dz
• hx of bladder cancer

Question 8

Actos (TZDs) pt education

Answer 8

• monitor ALT