Diabetes Drugs.txt

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mct12188
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98813
Filename:
Diabetes Drugs.txt
Updated:
2011-08-28 22:45:14
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diabetes
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Diabetes drugs
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  1. sulfonylureas
    MOA - stumlate pancreatic secretion of insulin in a glucose-INDEPENDENT manner

    dec. FPG > PPG

    HbA1c - 1-2%

    AE: Hypoglycemia - wt gain - SIADH - HYPERinsulemia
  2. Acetohexamide
    brand - Dymelor
  3. Chlorpropamide
    Brand - Diabinese
  4. Tolazamide
    Brand - Tolinase
  5. Tolbutamide
    Brand - Orinase
  6. Glimepiride
    Brand - Amaryl

    Max. Dose - 8mg/day
  7. Glipizide
    Brand - Glucatrol (XL)

    App. Max Dose = 40 mg/day

    XL Max Dose = 20 mg/day

    • DI: INC. Hypogylcemia = salicylates, SMP_TMZ, miconazole
    • DEC. Hypoglycemia = Cholestyramine, rifampin
  8. Glyburide
    • Brand - Diabeta & Micronase
    • Micronized - Glynase

    AMD - 20 mg/day

    Glynase - AMD - 12 mg/day
  9. Non-Sulfonylurea Secretagogues
    MOA - Stimulate insulin secretion in a glucose-DEPENDENT manner

    OMIT dose if miss a meal

    AE: Hypoglycemia, Wt. gain, Inc. LFT, safe for pts in renal/hepatic failure
  10. Neteglinide
    Brand - Starlix

    PPG

    HbA1c - 0.6-0.8%

    Dose: 120mg/day TID

    NO dose titration
  11. Repaglinide
    Brand - Prandin

    PPG

    HbA1c - 1.5%

    • Dose - Max (16mg/day)
    • A1c <8% = 0.5mg before meals
    • >8% 1-2mg before meals

    MED - 2 mg w each meal
  12. Metformin
    Brand - Glucophage (XR) & Fortamet

    • MOA - Reduce hepatic glucose production
    • Reduce Intestinal absorption of glucose
    • Inc. peripheral glucose uptake (Improves insulin sensitivity)

    HbA1c = 1-2%

    FPG

    • AE & CI = Unstable w/ CHF
    • -NO wt gain, hyperinsulemia or hypoglycemia
    • -Lactic Acidosis = Scr >1.5 (males) >1.4 (females)
    • -Malabsorption of B12 and Folate
    • -STOP before radiology and do not resume for 48 hrs
  13. Alpha - Glucosidase Inhibitors
    MOA -Delay digestion of carbs and absorption of glucose => reduce PPG

    Take with first bite of meals

    HbA1c - 0.5-0.8%

    • - High incidence of GI SE
    • - Increase in LFTs (Acarbose)
    • - Not metabolized and cleared by kidney (Miglitol)
    • - IF hypoglycemia - GLUCOSE TABS
  14. Acarbose
    Brand - Precose

    • Indication - adjunct to diet or in combo. w sulfonylureas, metformin, or insulin.
    • - Inc. LFTs occur at doses > 150mg/day

    CI - Pts with Scr > 2.0 mg/dL
  15. Miglitol
    Brand - Glyset

    Indication - Adjunct to diet or in comno with sulfonylureas

    Not metabolized and cleared by kidney
  16. Thiazolidinediones (TZD) = Glitazones
    • MOA - Dec. insulin resistence by stimulation PPAR-Gamma
    • - Dec. hepatic gluconeogensis
    • HbA1c = 0.5-1.4%
    • FPG, PPG

    • - up to 3 months to see full effect
    • - NOT for T1DM
    • AE - wt gain, Edema, Dec. Hct and Hb, hepatotoxicity - FRACTURES in women
  17. Rosiglitazone
    Brand - Avandia

    dose = 4-8 mg

    • - Does NOT inhibit any major CYP enzyme
    • Gemfibrozil - (Dec. dose)
    • - Do NOT give w Insulin or Nitrates
    • - BBW - Inc. myocardial events
    • - Inc. TG and LDL
  18. Pioglitazone
    Brand - Actose

    • dose = 15-15 mg
    • - can inc. HDL

    • DI- Inducer of CYP3A4
    • - ketoconazole inc. [ ]
    • - Dec. plasma conc. of BC
    • - Gemfibrozil - (dec. dose)
  19. DPP-4 Inhibitors
    • MOA - Increase insulin --> glucose-DEPENDENT
    • - Decrease glucagon
  20. Sitagliptan
    Brand - Januvia

    • HbA1c - 0.6-1%
    • PPG
    • - 100mg QD
    • AE: Wt neutral, Steven Johnsons Syndrome (rash)
    • Adjust dose in renal failure
  21. Saxagliptan
    • Indication = >18 YO w T2DM
    • Brand - Onglyza

    • HbA1c - 0.5%
    • PPG

    • -Metabolized by CYP3A 4/5
    • - Dose on renal funcation
    • - NO CI'S
  22. Exenatide
    • MOA = Incretin Mimetic
    • Brand - Byetta

    • HbA1c - 0.5-1%
    • PPG

    • AE - wt loss, hypoglycemia, Pancreatitis, do NOT sub. for insulin, Dec. absorption of oral drugs
    • CI - ESRD or CrCl < 30ml/dL
  23. Liraglutide
    • MOA - GLP-1 Analogue
    • Brand - Victoza

    • HbA1c - 1%
    • dec. FPG & PPG

    • NOT 1st line Tx
    • WARNING - thyroid c-cell tumors
    • - Pancreatitis
  24. Pramlintide
    • MOA - Synthetic analogue of human Amylin
    • Brand - Symlin

    • **Tx for BOTH Type 1/2 DM pts
    • HbA1c - 0.5-0.7%
    • PPG

    • - NEVER mix with insulin
    • - NO Hypoglycemia (when used alone)
    • - Not for pts w poor compliance

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