Therapeutics - T2DM
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What is the brand name for Metformin?
What is the Generic name for Glucophage?
What are the benefits of Metformin (Glucophage)?
- No hypoglycemia
- Weight loss
- Slight TG decrease
- Controls hyperglycemia by >90%
- Obese: better CV outcomes
What are the AE of Metformin (Glucophage)?
- Anorexia upon initiation
- B12 deficiency overtime (supplement)
- Lactic acidosis
What are the CIs/Precautions of Metformin (Glucophage)?
- Renal impairment: male >1.5, female >1.4
- Hypoxia (severe cardiac or pulmonary disease), alcohol abuse, > 80 years
What are the DDIs of Metformin?
- Iodinated contrast materials
Which Sulfonylurea is preferred in renal impairment?
What are the adverse reactions of Sunfonylureas?
- GI disturbance
- Increased mortality as first line
- Increased risk for bone fractures
- Weight gain
What are the sulfonylureas?
- Glipizide (Glucotrol)
- Glimepiride (Amaryl)
- Glyburide (Micronase, Glynase or Diabeta) – Don’t use
What is the brand name for Glipizide?
What is the brand name for Glimepiride?
What is the generic name for Glucotrol?
What is the generic name for Amaryl?
What are the Glinides?
- Repaglinide (Prandin)
- Nateglinide (Starlix)
What is the brand name for Repaglinide?
What is the brand name for Nateglinide?
What is the generic name for Prandin?
What is the generic name for Starlix?
What are the kinetics of Glinides?
- OOA: 15 minutes
- Peak: 60–90 minutes
- DOA: less than 4 hours
- Metabolized by: CYP 3A4
What are the advantages of Glinides?
- Rapid onset and short duration of action compared with sulfonylurea.
- Elimination is primarily through feces= good in renal insufficiency
- May be useful in patients who skip meals.
What are the Alpha-glucosidase inhibitors?
- Acarbose (Precose)
- Miglitol (Glyset)
What are the AE of Alpha-glucosidase inhibitors?
- Abdominal pain, flatulence, diarrhea
- Acarbose: increased liver function tests at doses of 100 mg and more than TID
Which T2DM drugs are Weight neutral?
- Alpha-glucosidase inhibitors
- SGLT2 inhibitor
What are the CI/precautions to using Alpha-glucosidase inhibitors?
GI disorders including inflammatory bowel disease, chronic ulceration, and partial obstruction
How do you treat hypoglycemia in a patient taking an Alpha-glucosidase inhibitor?
Use glucose tablets, not sucrose like in a candy bar or any other complex carbohydrate
What is the MOA of Thiazolidinediones?
- Peroxisome proliferator activated receptor agonist to promote glucose uptake into target cells (skeletal muscle/adipose)
- 1. Decreases insulin resistance
- 2. Increases insulin sensitivity
- 3. No effect on insulin secretion
What are the Thiazolidinediones?
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
What is the brand name for Pioglitazone?
What is the brand name for Rosiglitazone?
What is the generic name for Actos?
What is the generic name for Avandia?
What are the adverse effects of Thiazolidinediones?
- Fracture risk is increased
- Weight gain
- Resumption of ovulation
- Bladder cancer risk
- macular edema
What are the DDIs of Thiazolidinediones?
Decrease conc. of oral estrogens
What are the CIs/Precautions of Thiazolidinediones?
- Edema may cause worsensing of CHF
- CI: LFTs >2.5 or >3x UL of normal
What is the MOA of incretin mimetics?
- Stimulates glucagon-like peptide 1 receptor.
- Stimulates the production of insulin in response to high glucose concentrations
- Inhibition of the release of glucagon after meals
- Slows the rate of gastric emptying
What are the incretin mimetics?
- Exenatide (Byetta)
- Liraglutide (Victoza)
- Exenatide-Extended Release (Bydureon)
- Albiglutide (Tanzeum)
- Dulaglutide (Trulicity)
What is the brand name for Exenatide?
What is the brand name for Liraglutide?
What is the brand name for Exenatide-Extended Release?
What is the brand name for Albiglutide?
What is the brand name for Dulaglutide?
What is the generic name for Byetta?
What is the generic name for Victoza?
What is the generic name for Bydureon?
What is the generic name for Tanzeum?
What is the generic name for Trulicity?
What are the AE of Exenatide (Byetta)?
- Hypoglycemia (greater in combination with sulfonylurea than with metformin)
- Diarrhea, feeling jittery, dizziness, headache, dyspepsia
- Anti-exenatide antibodies
- Possible increased risk of pancreatitis; class effect?
What are the DDIs of Exenatide Byetta?
May affect the drug absorption that requires peak concentrations (oral contraceptives and antibiotics)
What are the precautions of Exenatide (Byetta)?
- Cannot be used as a substitute for insulin in type 1 diabetes.
- Hypoglycemia in combination with a sulfonylurea.
- Do not use in severe renal impairment (ClCr < 30 mL/minute or
- end-stage renal disease); caution in ClCr 30-50 mL/min.
- Do not use in patients with severe GI disease.
- Pregnancy Category C
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