Biguanides

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Author:
Anonymous
ID:
236119
Filename:
Biguanides
Updated:
2013-09-21 12:00:36
Tags:
Endo
Folders:

Description:
Dr. Drab
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  1. Metformin MOA
    • 1. decreases hepatic glucose production
    • 2. improve insulin sensitivity and dec intestinal absorption of glucose
  2. Metformin elimination
    urinary excretion
  3. metformin starting dose elderly and non elderly
    • noneld: 500-1000mg
    • eld: 500 mg
  4. metformin and endothelial function
    • improves
    • inc Ach stimulated arterial blood flow in PVD
  5. Metformin Contraindications
    • SCr ≥1.5 (males) 
    • SCr ≥1.4 (females)
    • CrCl < 60 ml/min

    • acute or chronic metabolic acidosis
    • radiologic studies w/ iodinated contrast materials (+ 48 hrs after)--> renal dysfuntion
  6. Metformin precautions
    • ≥ 80 yrs; not max dose
    • meds that affect renal fx (cationic drugs --> amiloride, digoxin, procainamide, quinidine, ranitidine, triamterene trimethoprim)
    • conditions predisposing pt to renal insufficiency or hypoxia (CHF, COPD, shock, MI)
    • before surgical procedures
    • alcohol --> lactate metabolism pts
    • hepatic disease
  7. metformin side effects
    • GI: diarrhea (slow titration), N/V, epigastric fullness
    • Dermatologic: rash, photosensitivity, urticaria
    • dec vitamin B12 absorption: anemia
    • lactic acidosis: rare

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