Diabetes - Oral Flashcards
(40 cards)
DPP-4 Inhibitors: Names and MOA
-gliptins
Sitagliptin
Saxagliptin
Linagliptin
Alogliptin
Prolong GLP1, increasing insulin, decreasing glucagon, improved satiety
DPP-4 Inhibitors: Indications
2nd line, 1st line if no metformin
Less hypoglycemia
Weight neutral
A1C: 0.7-1.0%
DPP-4 Inhibitors: Side Effects
Headache
Nasopharyngitis
Pancreatitis??
Saxagliptin: Strong 3A4 inhibitor
All require renal adjustment except linagliptin
Bile Acid Sequestrant
Colesevelam Minimal A1C Reduction, Lowers LDL 3rd line tx 6 tabs Qday or 3tabs BID Prevents absorption of: Synthroid, OCP, phenytoin, warfarin, digoxin Malabsorption ADEK
SGLT2 Inhibitors: Names and MOA
-flozin
Canagliflozin
Dapagliflozin
Empagliflozin
Ertugliflozin
SGLT2 Inhibitors: Indication
Weight loss Slight BP reduction May increase LDL Don't use in renal dysfxn Expensive Add-on to metformin
SGLT2 Inhibitors: Side Effects
Genital fungal (yeast)
UTI
Polyuria
Hypotension
Canagliflozin: May increase stroke risk
Dapagliflozin: May increase bladder cancer risk
Thiazolinideiones (TZDs): Name and MOA
-glitazone
Pioglitazone
Rosiglitazone: risk of MI, minimal use
Nuclear modifier: Stimulates PPAR-gamma, increasing insulin sensitivity, decreasing plasma fatty acids.
Up to 12 weeks max effect
TZDs: Side Effects and Indications
Lower A1C 1.0-1.5%
Fluid retention, edema. NO HEART FAILURE.
Hepatotoxicity.
Promotes ovulation.
Increases risk of upper/lower limb fracture
Increases risk of bladder cancer
Weight gain
Low hypoglycemia risk
Alpha Glucosidase Inhibitors
Acarbose
Miglitol
TID w/ meals (containing carbohydrates), can skip if no carbs. Delays absorption.
3rd Line
Lower effectiveness 0.3-1.0%
SEs: gas, abd discomfort, diarrhea
Contraindication: IBD, Short Bowel, Creatinine >2
Metformin!
Biguanide. Max 2550 IR or 2000 XR.
1st line for everything? Reduces A1C 1.5-2% AVOID in liver or renal dz (cr < 30)
Weight neutral, low hypoglycemia risk, inexpensive.
WITHHOLD for surgery or contrast. Check renal fxn 48 hours after, can then restart.
SEs: Lactic acidosis. B12 absorption. GI, N/D.
MOA unclear: Increases insulin sensitivity, decreases hepatic glucose prod, improves lipids!
Non-Sulfonylurea Secretagogues AKA Meglitinides
-glitinides, -glinides
Nateglinide
Repaglinide (more effective)
MOA: Increase insulin by blocking ATP-sensitive K Channels. Shorter onset and duration that sulfonylureas.
Lower A1C 0.8-1.0%. Take 15-30min before meal.
Weight neutral, hypoglycemia.
2nd Line, 1st line of no metformin
No sulfa allergy
Use in combination, but NOT with sulfonylureas
Sulfonylureas: Med Names
1st gen: (not preferred)
Chlorpropamide (avoid in renal impairment or elderly)
Tolazamide
Tolbutamide (no renal adjustment needed)
2nd Gen: (2nd line tx after metformin)
Glyburide (not preferred, more weight gain and hypoglycemia)
Glipizide
Glimeprimide
Sulfonylureas: MOAs and Side effects
2C9 Metabolism, first class of antihyperglycemics in US Block ATP sensitive K channels to increase insulin secretion
Lower A1C 1.0-1.5%
HYPOGLYCEMIA + weight gain. Reduced efficacy over time. Start slow (esp elderly)
Dopamine Receptor Agonist
(Bromocriptine)
Rapid Acting Insulins: Names
Aspart (Novolog)
Lispro (Humalog)
Glulisine (Apidra)
Analogs!
Rapid Acting Insulins: Onset, Peak, Duration
Onset: 10-30 Min
Peak: 1 hour to 3 (aspart), 4.3 (Humalog), 1.5 (glulusine)
Duration: 3-5 (aspart, glulisine), 4-6 (Humalog)
Short Acting Human
Regular (Humulin, Novolin)
Onset: 0.5-1 hr. Peak 2-3 hours. Duration 3-6 hours.
Intermediate Acting Human
NPH; cloudy
Onset: 1-2 hours, peak 6-14 hours, duration 16-24 hours
Long Acting
Detemir (Levemir): Onset 1-2, Peak 6-8, Duration 24
Glargine (Lantus): Onset 1, Peak 2-20, Duration 24
Premixed: (Longer/Shorter)
Analogs:
Novolog, Novolin Mix (70/30)
Humalog 75/25, 50/50
Human:
Humulin, Novolin 70/30
Humalin 5050
Correction Factor
How much will one unit of insulin drop blood sugar?
Rapid: 1700/TDD
Regular: 1500/TDD
Insulin : Carbs Ratio
How many grams of carbs will one unit of insulin cover?
Rapid: 500/TDD
Regular: 450/TDD
When to add insulin?
A1C > 9% and symptomatic
A1C >7.5% after 3mo of triple therapy
If A1C > 8.5%; multidose insulin. If 7.5-8.5; once-daily.
Simplest: Add basal or premixed
