Diabetes

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Author:
capnhue
ID:
278020
Filename:
Diabetes
Updated:
2014-07-02 00:34:41
Tags:
Diabetes Black Box Warning Side Effects
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Description:
Diabetes Black Box Warning/Side Effect
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  1. Metformin
    • Black Box: Lactic Acidosis
    • Contra: Scr 1.4 Females / 1.5 males
    • S/E: vitamin B12 deficiency
    • Notes: hold prior to IV contrast dye and wait 48 hrs
  2. Sulonylureas
    • MOA: stimulates insulin secretion from pancreatic beta cells
    • glipizide - glucotrol
    • glimepiride - amaryl
    • glyburide - diabeta/micronase
    • chlorpropamide - diabinese
  3. Sulonylureas
    • glyburide -¬†Contra: CrCl - <50ml/min
    • S/E: hypoglycemia, weight gain
    • Notes: after 3 yrs efficacy decreases
  4. Meglitinides
    • Repaglinide - Prandin
    • Nateglinide - Starlix
    • Similar MOA to sulonylureas - Do NOT use with sulonylureas
  5. Thiazolidinediones (TZDs)
    • MOA: PPARy (peroxisome proliferator-activated receptor gamma) agonists increase peripheral insulin sensitivity¬†
    • pioglitazone - Actos
    • rosiglitazone - Avandia
  6. TZDs adverse effects
    • Black Box: may cause Heart Failure, Do NOT use in NYHA class III/IV heart failure
    • Warnings: bladder cancer
    • S/E: peripheral edema, weight gain, URTIs
  7. Alpha Glucosidase Inhibitors
    • acarbose - Precose
    • miglitol - Glyset
    • Contra: IBD, intestinal obstruction
    • S/E: GI
  8. DPP-4 Inhibitors
    • MOA: Prevents DPP-4 enzyme from breaking down incretin hormones, GLP-1 and GIP. Increasing these hormones
    • sitagliptin - Januvia
    • metformin/sitagliptin - Janumet
    • saxagliptin - Onglyza
    • linagliptin - tradjenta
    • aloglipitin - Nesina
  9. DPP-4 Inhibitors
    • S/E: nasopharyngitis, URTIs, UTIs, hypoglycemia
    • Notes: weight neutral
  10. Medications that can cause hypoglycemia?
    • sulonylureas
    • meglitinides
    • DPP-4 inhibitors
    • SGLT2 inhibitor (canagliflozin)
    • GLP-1 agonists
  11. SGLT2 Inhibitor (Sodium Glucose Co-Transporter-2)
    • MOA: in the proximal renal tubules inhibits the reabsorption of glucose, increases glucose excretion
    • canagliflozin - Invokana
  12. canagliflozin - Invokana
    • Contra: CrCl - <30ml/min, ESRD / dialysis
    • S/E: female genital mycotic infections, UTIs, hyperkalemia, increase urination, hypoglycemia
  13. GLP-1 (Glucagon-like peptide-1) agonists
    • MOA: analogs of glucagon-like peptide-1, increases insulin secretion and decreases glucagon secretion
    • exenatide - Byetta
    • exenatide ER - Bydureon
    • liraglutide - Victoza
  14. GLP-1 adverse effects
    • Black Box: Thyroid C-cell carcinomas
    • Warnings: pancreatitis, gallstones, avoid in CrCl < 30ml/min
    • S/E: weight loss, hypoglycemia
  15. Rapid-acting insulins
    • lispro - Humalog
    • aspart - Novolog
    • glulisine - Apidra
  16. Regular or "short-acting" insulin
    • Regular Insulins
    • Humulin R
    • Novolin R
    • OTC
  17. Basal Insulins
    • NPH
    • Humulin N
    • Novolin N
    • OTC
  18. Long-Acting Insulin
    • detemir - Levemir
    • glargine - Lantus
  19. Insulin Dosing
    • Typical starting dose: 0.6units/kg/day
    • basal-bonus insulin: 50% of TDD for basal insulin. 50% for bolus divided among 3 meals
    • NPH-regular insulin: 2/3 for NPH dose and 1/3 for regular insulin dosed BID
  20. Rule 500 rapid, rule 450 regular
    • 500 / TDD = gms of carb covered by 1 unit of rapid insulin (what are your rapid insulins)
    • 450 / TDD = gms of carb covered by 1 unit of regular insulin (what are your regular insulins)
  21. Correction Factor dosing
    • 1800 rule: 1800 / TDD = correction factor for 1 unit of rapid acting insulin
    • 1500 rule: 1500 / TDD = correction factor for 1 unit of regular insulin
    • Correction dose: (blood glucose now - target blood glucose) / correction factor

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