Diabetes meds Flashcards
(37 cards)
How does metformin work
inhibits gluconeogenesis= less hepatic glucose output
Increases insulin mediated glucose utilization in peripheral tissues
Yields 1-2% drop in A1c!
Weight neutral!
Side effects of Metformin are
GI s/e (diarrhea during titration)
Reduce intestine absorption of B12
IV contrast concerns; stop w/ IV contrast
CI if GFR <30
What are the Sulfonylureas
Glipizide
Glyburide
Glimepiride
How do Sulfonylureas work
stimulate insulin secretion from beta cells
yield 1-2% drop in A1c, but mildly less than metformin
Side effects of sulfonylureas are
high risk of hypoglycemia
weight gain
What are the GLP-1 agonists
TIDE's Exenatide Liraglutide Dulaglutide Albiglutide Lixisenatide Semaglutide
What is the “incretin effect”
oral glucose > IV glucose at stimulating insulin secretion 2/2 GI peptides (GLP) released in response to a meal
How do GLP agonists work
stimulate insulin release from beta cells slow gastric emptying inhibit post-meal glucagon secretion Yields 0.5-1% drop in A1c *Usu add on Tx*
Side effects of GLP agonists are
weight loss
N/V/D (warn pt)
Which GLP agonists yield improved cardiac outcomes
Liraglutide
Semaglutide
What are the DPP4 inhibitors
GLIPTAN's Sitagliptan Saxagliptin Linagliptin Alogliptin
How do DPP4 inhibitors work
DPP4 usually inactivates GLP-1 Block DPP4= allow GLP-1 to stimulate insulin, inhibit glucagon, and slow gastric emptying Yield 0.5-0.8% drop in A1c *Usu add on Tx* Weight neutral!
What are the SGLT2 inhibitors
FLOZIN’s
Empagliflozin
Canagliflozin
Dapagliflozin
How do SGLT2 inhibitors work
Sodium glucose cotransporters are in the proximal tubule and cause reabsorption of 90% of glucose
Inhibit transporters= increase glucose urine excretion= reduced blood glucose
Yield 0.5-0.7% drop in A1c
Usu add on Tx
Side effects of SGLT2 inhibitors are
Weight loss
reduced BP
+/- CV mortality
Vulvovaginal candidiasis, UTI
What are the Thiazolidinediones (TZD)
*Pioglitazone
Rosiglitazone
How do Thiazolidinediones work
Improve insulin action
increase insulin sensitivity in adipose, muscle, and liver
Yield 0.5-1.4% drop in A1c
Usu add on Tx
ADE of Thiazolidinediones are
fluid retention, HF weight gain bone fractures \+/- increase in MI w/ Rosiglitazone \+/- increase in bladder cancer w/ Pioglitazone
Thiazolidinediones are contraindicated in
Sx HF Class III-IV HF bladder cancer high fracture risk liver disease
What are the Meglitinides
Nateglinide
Repaglinide
How do Meglitinides work
Stimulate insulin secretion from beta cells
take WITH MEALS to reduce post-prandial hyperglycemia
Yield 0.5-1% drop in A1c
Usu add on Tx
Side effects of Meglitinides are
risk of hypoglycemia
weight gain
What are the alpha glucosidase inhibitors
Acarbose
Miglitol
How do alpha glucosidase inhibitors work
decrease absorption of glucose (take WITH meals)
Yield 0.5-0.8% drop in A1c
Usu add on Tx
Weight neutral!
