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Diabetic Drugs
| Question | Answer |
|---|---|
| Biguanide | improves insulin sensitivity decreases intestinal absorption of glucose decreases hepatic production Metformin t500, 850, 1000 max 2550 tXR 500, 750 max 2000 CI: SCr >1.5 or >1.4 in M/F hold dose 48hr angiogram/pyelogram |
| Sulfonylureas | Stimulate insulin secretion, highly protein bound dosed daily |
| 1st generation SUs | Tolbutamide, Acetohexamide, Tolazamide, Chlorpropamide |
| 2nd generation SUs | Diabeta/Micronase (Glyburide) max 20mg/d Glynase (Glyburide) max 12mg/d Glucotrol & XL (Glipizide) max 40mg/d & 20mg/d empty stomach!! Amaryl (Glimepiride) 1-8mg/d |
| Meglitinides | stimulates release of insulin from pancreas, fast acting & short duration skip the meal, skip the dose used with metformin or TZDs Prandin (Repaglinide) max 16mg/d (t 0.5, 1, 2mg) Starlix (Nateglinide) t60, 120mg |
| Thiazolidinediones | improves insulin sensitivity & depend on presence of insulin CHECK LFTS may be given with metformin & SUs, not recommended WITH insulin or nitrates WARNING: CHF Avandia (Rosiglitazone) max 8mg (t2, 4, 8mg) Actos (Pioglitazone) 15-30mg (t15, 30, 45mg) |
| Combo | Avandamet (rosiglitazone/metformin) Metaglip (glipizide/metformin) Glucovance (glyburide/metformin) Avandaryl (rosiglitazone/glimepiride) Janumet (sitagliptin/metformin) Prandimet (Repaglinide/Metformin) |
| Incretin Mimetic | promotes insulin release from beta cells in presence of elevated glucose concentrations moderates glucagon secretion, decreased glucose output during periods of hyperglycemia, delays stomach emtpying Type2 ONLY |
| Incretin Mimetic | Byetta (Exanatide) SC BID 60min before morning/evening meals NAUSEA, hypoglycemia with metformin, SUs pen 5, 10ug 30 days at room temp |
| Incretin Enhancer | inh DPP-4 enzyme (breaks down incretins) for 24 hours, reduced hepatic glucose production Januvia (Sitagliptin) t25, 50, 100mg TYPE II ONLY monotx AND combo |
| Alpha-Glucosidase Inhibitors | works at brush border of small intestine to inh brkdwn large saccharides to glucose synergistic with SUs Precose (Acarbose) t25, 50, 100 max >60kg 100mgTID <60kg 50mgTID Glyset (Miglitol) t25,50,100mg 25mgTID gas, diarrhea, NO hypoglycemia |
| Amylinomimetic | modulation gastric emptying, prevention postprandial rise in plasma glucose, satiety (WEIGHT LOSS) Symlin (Pramlintide) pen60 - 15, 30, 45, 60mcg pen120 - 60, 120mcg 5mL bottle 600mcg/mL Type 2 60-120mcg, Type 1 15-60mcg ac hypogly with insulin tx combo |
| OTC insulins | Short acting (Humulin R, Novolin R) Intmdt acting (Humulin N, Novolin N) Premixed (Humulin 70/30, 50/50, Novolin 70/30) |
| Rapid Acting Insulin | Humalog (Lispro) 15-30min Novolog (Aspart) 10-20min Apidra (Glulisine) 10-15min |
Created by:
char1217
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