Diabetes 1 Flashcards
Metformin
IND: T2DM, FIRST LINE in combo w/lifestye
MOA: Decreases glucose production in liver, absorption in small intestine. Sensitizes peripheral cells in fat and skeletal muscles to improve glucose uptake from the blood
BOX: Lactic Acidosis risk resulting in hypothermia, hypotension, bradyarrhythmia, and death
CON: Severe renal impairment, acute or chronic metabolic acidosis including DKA.
ADR: VB12 deficiency, over years. GI; Diarrhea if not titrated slowly. Little to no hypoglycemia if used alone.
Routinely used in liver dysfunction but risk v benefit of lactic acidosis. Renal adjustment necessary.
Dipeptidyl Peptidase 4 Inhibitors
IND: T2DM. 2nd line when metformin is insufficient or not tolerated. Modest decrease in A1C ~.5%
MOA: Enhance effects of incretins via inhibition of the enzyme that breaks them down.
BOX: N/A
CON:
ADR: PANCREATITIS. SJS and TEN. Hypersensitivity rxns
Glucagon-like Peptide 1 Receptor Agonists
IND: T2DM. Decrease A1C ~1%
MOA: Increases insulin secretion, decreases glucagon, slows gastric emptying
BOX: Thyroid C cell tumor risk
CON: Hx or FMHx of MTC, MEN. Not recommended as agents to control gestational diabetes, poorly cross the placenta
ADR: PANCREATITIS. Hypoglycemia, Injection site rxns, GI
GLP1 Agents
Liraglutide (Saxenda): Contraindicated in Pregnancy since its a weight loss drug
Exenatide: Potential for Ab development, can lead to attenuated glycemic response
Dulaglutide
Lixisenatide: Potential for Ab development
Semaglutide: Rybelsus is THE ONLY AVAILABLE ORAL GLP-1 AGONIST. Taken first thing in the am before food/drink/meds. Wegovy is CON in pregnancy since weight loss
Albiglutide: D/c’d
Sodium-Glucose Co-transporter 2 (SGLT-2) Inhibitors
IND: T2DM, HF
MOA: Reduces renal reabsorption of glucose and lowers threshold for glucose RTg; increased urinary excretion of glucose
BOX: N/A
CON: Dialysis
ADR: UTIs and increased urinary output. GU fungal infections. Hypotension/hypovolemia
SGLT2 Inhibitor agents
Dapagliflozin
Canagliflozin: US BOX for amputations has been removed
Empaglaflozin
Ertugliflozin: Contraindicated in severe renal impairment and dialysis
DPP4 Inhibitor agents
Sitagliptin
Linagliptin
Saxagliptin
Alogliptin
Pioglitazone
IND: T2DM
MOA: PPARgamma. Increases cell response to insulin and glucose and lipid metabolism
BOX: Can cause or exacerbate CHF
CON: Initiation of therapy with CHF class 3 or 4. Canada has it CON in all CHF classes.
ADR: Edema, Hypoglycemia when used in combination.
Stop treatment if hepatic impairment occurs during treatment and only restart if you can prove other etiology
Sulfonylureas
IND: DMT2
MOA: Stimulate insulin release from Beta cells in pancreas! Also decrease liver glucose output, sensitizes peripheral cells to insulin. Administer 30 mins before a meal.
BOX: N/A
CON: DMT1, DKA. Not preferred in ASCVD. D/c 2 weeks prior to delivery date in pregnant pts.
ADR: HYPOGLYCEMIA (most prevalent of all orals)
Sulfonylurea agents
Glipizide
Glimepiride
Glyburide
