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Glucophage, Fortamet, and Glumetza
- Metformin - Biguanide - decreases hepatic glucose production, decreases intestinal absorption of glucose, improves insulin sensitivity
- Decreases A1c 1 to 2%
- CI with SCr less than 1.5 in males and 1.4 in females or CrCl less than 60
- Weight neutral, hypoglycemia, lactic acidosis, GI, vitamin B12 deficiency
- Stop in cases of hypoxia such as Dec HF, respiratory failure, and sepsis
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Glucovance
Glyburide and Metformin
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Diabeta and Micronase
- Glyburide - SU - stimulate increase secretion from pancreas
- Do not use if CrCl less than 50
- 1.25 to 5 daily, DNE 20 daily
- Decreases A1c 1 to 2 %
- Weight gain, hypoglycemia
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Amaryl
- Glimepiride - SU
- 1 to 4 daily, DNE 8 daily
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Glucotrol
- Glipizide - SU
- Max 20 daily
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Prandin
- Repalinide - Meglitinides - stimulate insulin release from pancreas
- Hypoglycemia, weight gain, upper resp infection
- Decrease A1c by 0.5 to 1.5 %, used for postprandial BG
- Do not use with SU
- Take 15 to 30 min before meal
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Starliz
- Nateglinide
- Slightly less effective than repaglinide
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Actos
- Pioglitazone - TZDs - PPAR gamma agonists causing peripheral insulin sensitivity
- 15 to 30 gm daily max 45 daily
- Decrease A1c 0.5 to 1.4 %
- Peripheral edema, weight gain, increase LFTs, CHF, increase in fracture risk, increase in LFTs, pioglitazone has increased risk of bladder cancer after 1 year
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Avandia
- Rosiglitazone
- 4 to 8 mg daily
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Precose
- Acarbose - alpha glucosidase inhibitor in intestines resulting in delayed absorption of glucose
- decrease A1c 0.5 to 0.8 %, used to decrease pstpranidal BG
- Decrease TGs and TC, weight neutral, GI side effects
- Start at 25 mg with first bite of each main meal, max 300 mg daily
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Januvia
- Sitagliptin - DPP4 inhibitors, incretin enhancer
- 100 daily, or can start 50
- decrease A1c 0.5 to 0.8% used for postprandial BG
- Weight neutral, nasopharyngitis, URI, periphral edema, rash, hypoglycemia, rarely can cause acute pancreatitis
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Janumet
Sitagliptin and metformin
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Onglyza
- Saxagliptin and metformin
- 5 mg daily
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Byetta
- Exenatide - GLP-1 Agonists, incretin mimetics
- Decrease A1c 0.5 to 1%, for postprandial BG
- IR start 5 mcg SC BID for 1 month, then 10 mcg
- Risk for pancreatitis especially in people with hx of pancreatitis, gallstones, alcoholism, and high TG
- avoid in crcl less than 30
- Nausea, hypoglycemia, weight loss, can cause pancreatitis
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Bydureon
- Exenatide ER
- 2 mg SC every 7 days
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Victoza
- Liraglutide
- Start t 0.6, then 1.2 then 1.8
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Symlin
- Pramlintide - synthetic analog of amylin
- start at 15 mcg prior to meals, then increase up to 60 for type 1
- for type 2, start at 60 and increase to 120
- Hypoglycemia, nausea, weight loss, decrease insulin by 50% when starting
- CI gastroparesis, hypoglycemia unaware
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Welchol
- Colesevelam - bile acid resin
- Decrease LDL by 20%, decrease A1c by 0.5%, decrease postprandial BG
- CI: bowel obstruction, TG greater than 500, history of TG induced pancreatitis
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Cycloset
- Bromocriptine
- Dopamin agonist works in CNS to decrease insulin resistane
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Humulin R, Novolin R
- Regular insulin
- Injected 30 minutes before a meal, last 4 to 6 hours
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Humilin N, Novolin N
- Intermediate Insulin NOH
- Cloudy
- Onset 1 to 2 hours, peak 4 to 14 hours, duration up to 24 hours
- Can be mixed with regular and fast acting insulin
- Clear before cloudy
- In mixed preps, the larger number is always the NPH
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Detemir
- Levemir
- Onset of 4 hours, lasts 24 hours, no peak
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Lantus
- Glargine
- Onset of 1 hour, lasts 24 hours, no peak
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Propyl-Thyracil
- Propylthioracil 50 mg TId initially until reduction of symptoms
- Also blocks converstion of T4 to T3
- BBW - can cause liver damage and failure
- GI upset, hepatitis, agranulocytosis
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Tapazole
- Methimazole
- 5 to 15 mg daily
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Glyset
- Miglitol
- Alphaglucosidase inhibitors
- Taken with each meal, start at 25 mg with first bite of each main meal
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Drug induced lupus most commonly associated with:
procainamide, hydralazine, isoniazid, quinidine, chlorpromazine, methyldopa, and minocycline
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