Difference between revisions of "Diabetes medications"
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==Background== | ==Background== | ||
| − | + | *Hypoglycemics | |
| − | + | **Sulfonylureas | |
| − | + | **Benzoic acid derivatives | |
| − | + | *Antihyperglycemics | |
| − | + | **Biguanides | |
| − | + | **Alpha glucosidase inhibitors | |
| − | + | **Thiazolidinediones | |
| − | ==Insulin== | + | {{Common Anti-hyperglycemic Drugs and Pharmacology}} |
| − | [[ | + | |
| + | ==[[Insulin]]== | ||
| + | |||
| + | ==Biguanides (Metformin)== | ||
| + | Suppresses liver glucose production | ||
| + | ===Dose=== | ||
| + | [[Metformin]] 500mg PO BID is first-line agent for type II diabetics | ||
| + | *Do not prescribe if creatinine > 1.4 (GFR <40), CHF, hepatic insufficiency, ETOH abuse | ||
| + | *Should be withheld for 48hr after IV contrast | ||
| + | ===Side Effects=== | ||
| + | *Lactic acidosis (due to increased lactate production) | ||
| + | **Seen almost exclusively in patients with renal failure | ||
| + | *Nausea, diarrhea, crampy abdominal pain | ||
| + | ===Toxicity=== | ||
| + | *Almost never causes hypoglycemia when taken alone, but can exacerbate hypoglycemia when taken in combination with hypoglycemic agents | ||
| + | *Toxic dose unknown | ||
| + | *Management: Supportive care | ||
==Sulfonylureas== | ==Sulfonylureas== | ||
| − | + | *[[Glipizide]], [[glyburide]] | |
| − | + | *Increase insulin secretion | |
| − | + | *[[Hypoglycemia]] is the major adverse effect (especially with glyburide) | |
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==Alpha Glucosidase Inhibitors== | ==Alpha Glucosidase Inhibitors== | ||
| − | + | *Acarbose, miglitol, voglibose | |
| − | + | *Competitively and reversibly inhibit alpha glucosidase brush border hydrolase enzyme- makes postprandial decrease in carbohydrate absorption since complex polysaccharides not broken down into absorbable monosaccharides. Does not affect lactose absorption | |
| − | + | *Taken with first bite of each meal | |
| − | + | *Since limited absorption, stays in gut and side effects mostly GI- bloating, gas, [[diarrhea]] | |
| − | + | **acarbose- can cause transaminitis/ liver inj | |
| − | + | *Contraindications- [[cirrhosis]], [[IBD]], malabsorption syndrome | |
| − | + | *Do not cause [[hypoglycemia]] when used as monotherapy | |
| − | + | **If [[hypoglycemia|hypoglycemic]]- sucrose/ table sugar will ''not'' work- use glucose- PO or IV | |
| − | + | *Since minimal absorption- systemic toxicity from OD unlikely | |
| − | |||
==Thiazolidinediones== | ==Thiazolidinediones== | ||
| − | + | *Rosiglitazone and poiglitazone | |
| − | + | *Enhance insulin effect on muscle, fat, liver without increasing pancreatic insulin secretion | |
| − | + | *Protein bound and hepatic metabolism - avoid in patients with liver disease | |
| − | + | *Side effects- induces ovulation, decreases effectiveness of OCP's, increases plasma volume (bad if CHF) | |
==Benzoic Acid Derivatives== | ==Benzoic Acid Derivatives== | ||
| − | + | *Repaglinide- monotherapy or combined with metformin | |
| − | + | *binds to ATP dependent potassium channel like sulfonyls but at different site. | |
| − | + | *Unlike sulfonyls, it ''decreases'' insulin levels | |
| − | + | *Dose 30 min before meal to decrease postprandial hyperglycemia | |
| + | |||
| + | ==[[GLP-1 agonists]]== | ||
| + | *Exanatide (Byetta and Bydureon), Liraglutide (Victoza) | ||
| + | *Synthetic glucagon-like peptide-1 (GLP-1) receptor agonists | ||
| + | *Stimulates insulin release from pancreatic islet cells | ||
| + | *May promote weight loss by slowing gastric emptying and increasing satiety | ||
| + | |||
| + | ==[[DPP-4 inhibitors]]== | ||
| + | *Sitagliptin, saxagliptin, linagliptin, alogliptin | ||
| + | *Block DPP-4, which leads to increased activity of incretins, which inhibit glucagon release, which in turn increase insulin secretion and slow gastric emptying, ultimately decreasing blood glucose levels | ||
| + | *Potential serious adverse events include acute [[pancreatitis]], [[anaphylaxis]]/[[angioedema]], [[SJS]] | ||
| + | |||
| + | ==[[SGLT-2 inhibitors]]== | ||
| + | *Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance) | ||
| + | *Inhibit sodium-glucose cotransporter 2, decreasing glucose reabsorption in the proximal tubule | ||
| + | *Potential serious adverse event: euglycemic [[DKA]] | ||
| + | |||
| + | ==See Also== | ||
| + | *[[Diabetes Mellitus (Main)]] | ||
| − | == | + | ==References== |
| − | + | <references/> | |
| − | [[Category: | + | [[Category:Endocrinology]] |
| − | [[Category: | + | [[Category:Pharmacology]] |
Latest revision as of 15:44, 28 September 2019
Contents
Background
- Hypoglycemics
- Sulfonylureas
- Benzoic acid derivatives
- Antihyperglycemics
- Biguanides
- Alpha glucosidase inhibitors
- Thiazolidinediones
Common Anti-hyperglycemic Drugs and Pharmacology
| Drug | Pharmacology | ||
|---|---|---|---|
| Onset | Peak | Duration | |
Rapid-acting insulin
|
15-30min | 1-2h | 3-5h |
Short-acting insulin
|
30-60min | 2-4h | 6-10h |
Intermediate-acting insulin
|
1-3h | 4-12h | 18-24h |
Long-acting insulin
|
2-4h | None | 24h |
Sulfonylurea
|
– | 2-6h | 12-24h |
Insulin
Biguanides (Metformin)
Suppresses liver glucose production
Dose
Metformin 500mg PO BID is first-line agent for type II diabetics
- Do not prescribe if creatinine > 1.4 (GFR <40), CHF, hepatic insufficiency, ETOH abuse
- Should be withheld for 48hr after IV contrast
Side Effects
- Lactic acidosis (due to increased lactate production)
- Seen almost exclusively in patients with renal failure
- Nausea, diarrhea, crampy abdominal pain
Toxicity
- Almost never causes hypoglycemia when taken alone, but can exacerbate hypoglycemia when taken in combination with hypoglycemic agents
- Toxic dose unknown
- Management: Supportive care
Sulfonylureas
- Glipizide, glyburide
- Increase insulin secretion
- Hypoglycemia is the major adverse effect (especially with glyburide)
Alpha Glucosidase Inhibitors
- Acarbose, miglitol, voglibose
- Competitively and reversibly inhibit alpha glucosidase brush border hydrolase enzyme- makes postprandial decrease in carbohydrate absorption since complex polysaccharides not broken down into absorbable monosaccharides. Does not affect lactose absorption
- Taken with first bite of each meal
- Since limited absorption, stays in gut and side effects mostly GI- bloating, gas, diarrhea
- acarbose- can cause transaminitis/ liver inj
- Contraindications- cirrhosis, IBD, malabsorption syndrome
- Do not cause hypoglycemia when used as monotherapy
- If hypoglycemic- sucrose/ table sugar will not work- use glucose- PO or IV
- Since minimal absorption- systemic toxicity from OD unlikely
Thiazolidinediones
- Rosiglitazone and poiglitazone
- Enhance insulin effect on muscle, fat, liver without increasing pancreatic insulin secretion
- Protein bound and hepatic metabolism - avoid in patients with liver disease
- Side effects- induces ovulation, decreases effectiveness of OCP's, increases plasma volume (bad if CHF)
Benzoic Acid Derivatives
- Repaglinide- monotherapy or combined with metformin
- binds to ATP dependent potassium channel like sulfonyls but at different site.
- Unlike sulfonyls, it decreases insulin levels
- Dose 30 min before meal to decrease postprandial hyperglycemia
GLP-1 agonists
- Exanatide (Byetta and Bydureon), Liraglutide (Victoza)
- Synthetic glucagon-like peptide-1 (GLP-1) receptor agonists
- Stimulates insulin release from pancreatic islet cells
- May promote weight loss by slowing gastric emptying and increasing satiety
DPP-4 inhibitors
- Sitagliptin, saxagliptin, linagliptin, alogliptin
- Block DPP-4, which leads to increased activity of incretins, which inhibit glucagon release, which in turn increase insulin secretion and slow gastric emptying, ultimately decreasing blood glucose levels
- Potential serious adverse events include acute pancreatitis, anaphylaxis/angioedema, SJS
SGLT-2 inhibitors
- Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance)
- Inhibit sodium-glucose cotransporter 2, decreasing glucose reabsorption in the proximal tubule
- Potential serious adverse event: euglycemic DKA