Meglitiniedes/Phenylalanines

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Author:
jcu1
ID:
236088
Filename:
Meglitiniedes/Phenylalanines
Updated:
2013-09-21 00:51:55
Tags:
Endo
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Dr. Drab
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  1. Meglitinides/phenylalanines in combination
    repaglinide and nateglinide often used in combo with metformin and TZDs
  2. meglitinides MOA
    • stimulates insulin release from beta cells
    • insulin levels rise with postprandial glucose peak at:
    • nateglinide 45 min (DOA 3-4h)
    • repaglinide 60 min (DOA 4-6h)
  3. meglitinides target fasting or post prandial
    post prandial
  4. meglitinides insulin release glucose dependent or independent
    dependent - less hypoglycemia
  5. meglitinides compared to sulfs
    • shorter duration of action
    • more glucose dependent stimulation of insulin release --> less hypoglycemia
  6. repaglinide metabolism and elimination
    • metabolism: liver (inactive metabolites)
    • elimination: feces
  7. nateglinide metabolism and elimination
    metabolism: liver (less potent metabolites)

    elimination: urine
  8. nateglinide vs. repaglinide
    onset/DOA
    potency
    • nateglinide more rapid onset and shorter DOA
    • repaglinide more potent
  9. meglitinide contraindications
    • type 1 dm
    • diabetic ketoacidosis
    • repaglinide + gemfibrozil
  10. repaglinide has DDI with what? why?
    gemfibrozil

    • rep metabolized by CYP 2C8
    • gem is CYP 2C8 inhibitor
    • --> 8x inc in repaglinide; 3x t1/2
  11. meglitinides side effects
    • hypoglycemia (less than sulf; great with repaglinide+gemfibrozil)
    • weight gain
    • headache
    • URI
    • dizziness
    • neuromuscular (arthralgia, back pain, paresthesia)
    • GI (N/D/C, epigastric fullness, heartburn)
  12. when to take a meglitinide
    take 15 min bf a meal (can be taken up to 30 min before the meal)
  13. missing a meal with meglitinide
    • skip a dose if meal is skipped
    • add dose if extra meal eaten

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