Difference between revisions of "Diabetes medications"

(Biguanides (Metformin))
Line 1: Line 1:
 
==Background==
 
==Background==
#Hypoglycemics
+
*Hypoglycemics
##Sulfonylureas
+
**Sulfonylureas
##Benzoic acid derivatives
+
**Benzoic acid derivatives
#Antihyperglycemics
+
*Antihyperglycemics
##Biguanides
+
**Biguanides
##Alpha glucosidase inhibitors
+
**Alpha glucosidase inhibitors
##Thiazolidinediones
+
**Thiazolidinediones
  
 
==[[Insulin]]==
 
==[[Insulin]]==
Line 14: Line 14:
 
===Dose===
 
===Dose===
 
Metformin 500mg PO BID is first-line agent for type II diabetics
 
Metformin 500mg PO BID is first-line agent for type II diabetics
#Do not prescribe if Cr > 1.4 (GFR <40), CHF, hepatic insufficiency, ETOH abuse
+
*Do not prescribe if Cr > 1.4 (GFR <40), CHF, hepatic insufficiency, ETOH abuse
#Should be withheld for 48hr after IV contrast
+
*Should be withheld for 48hr after IV contrast
 
===Side Effects===
 
===Side Effects===
#Lactic acidosis (due to increased lactate production)
+
*Lactic acidosis (due to increased lactate production)
##Seen almost exclusively in patients with renal failure
+
**Seen almost exclusively in patients with renal failure
#Nausea, diarrhea, crampy abdominal pain
+
*Nausea, diarrhea, crampy abdominal pain
 
===Toxicity===
 
===Toxicity===
#Almost never causes hypoglycemia when taken alone, but can exacerbate hypoglycemia when taken in combination with hypoglycemic agents
+
*Almost never causes hypoglycemia when taken alone, but can exacerbate hypoglycemia when taken in combination with hypoglycemic agents
#Toxic dose unknown
+
*Toxic dose unknown
#Management: Supportive care
+
*Management: Supportive care
  
 
==Sulfonylureas==
 
==Sulfonylureas==
#Increases insulin secretion (glipizide, glyburide)
+
*Increases insulin secretion (glipizide, glyburide)
#Hypoglycemia is the major adverse effect (esp w/ glyburide)
+
*Hypoglycemia is the major adverse effect (esp w/ glyburide)
  
 
==Alpha Glucosidase Inhibitors==
 
==Alpha Glucosidase Inhibitors==
#acarbose, miglitol, voglibose
+
*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
+
*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
+
*does not affect lactose absorption
#if hypoG- sucrose/ table sugar will not work- use glucose- po or iv
+
*if hypoG- sucrose/ table sugar will not work- use glucose- po or iv
#take these meds with each meal with first bite
+
*take these meds with each meal with first bite
#since limited aborption, stays in gut and side effects mostly GI- bloating, gas, diarrhea
+
*since limited aborption, stays in gut and side effects mostly GI- bloating, gas, diarrhea
#contraindications- cirrhosis, IBD, malabsorption synd
+
*contraindications- cirrhosis, IBD, malabsorption synd
#alpha glucs do not cause hypoG when used as monotx
+
*alpha glucs do not cause hypoG when used as monotx
#acarbose- can cause transaminitis/ liver inj
+
*acarbose- can cause transaminitis/ liver inj
#since min absorption- systemic tox from OD unlikely
+
*since min absorption- systemic tox from OD unlikely
  
 
==Thiazolidinediones==
 
==Thiazolidinediones==
#rosiglitazone and poiglitazone
+
*rosiglitazone and poiglitazone
#enhance insulin effect on muscle, fat, liver without increasing panc insulin secretion
+
*enhance insulin effect on muscle, fat, liver without increasing panc insulin secretion
#protein bound and hep metab- not good if liver dz
+
*protein bound and hep metab- not good if liver dz
#side effects- induce ovulation, increase plasma vol bad if CHF, decrease effectiveness of OCP's
+
*side effects- induce ovulation, increase plasma vol bad if CHF, decrease effectiveness of OCP's
  
 
==Benzoic Acid Derivatives==
 
==Benzoic Acid Derivatives==
#repaglinide- mono or combo tx c metformin
+
*repaglinide- mono or combo tx c metformin
#binds to atp dependent potassium channel like sulfonyls but at different site.
+
*binds to atp dependent potassium channel like sulfonyls but at different site.
#Unlike sulfonyls, it decreases insulin lvls
+
*Unlike sulfonyls, it decreases insulin lvls
#Dose 30 min before meal to decrease post prandial hyperglycemia
+
*Dose 30 min before meal to decrease post prandial hyperglycemia
  
 
==See Also==
 
==See Also==
 
*[[Diabetes Mellitus (Main)]]
 
*[[Diabetes Mellitus (Main)]]
  
==Source ==
+
==References==
 
Tintinalli
 
Tintinalli
  
 
[[Category:Endo]]
 
[[Category:Endo]]
 
[[Category:Drugs]]
 
[[Category:Drugs]]

Revision as of 21:17, 26 November 2015

Background

  • Hypoglycemics
    • Sulfonylureas
    • Benzoic acid derivatives
  • Antihyperglycemics
    • Biguanides
    • Alpha glucosidase inhibitors
    • Thiazolidinediones

Insulin

Biguanides (Metformin)

Suppresses liver glucose production

Dose

Metformin 500mg PO BID is first-line agent for type II diabetics

  • Do not prescribe if Cr > 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

  • Increases insulin secretion (glipizide, glyburide)
  • Hypoglycemia is the major adverse effect (esp w/ 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
  • if hypoG- sucrose/ table sugar will not work- use glucose- po or iv
  • take these meds with each meal with first bite
  • since limited aborption, stays in gut and side effects mostly GI- bloating, gas, diarrhea
  • contraindications- cirrhosis, IBD, malabsorption synd
  • alpha glucs do not cause hypoG when used as monotx
  • acarbose- can cause transaminitis/ liver inj
  • since min absorption- systemic tox from OD unlikely

Thiazolidinediones

  • rosiglitazone and poiglitazone
  • enhance insulin effect on muscle, fat, liver without increasing panc insulin secretion
  • protein bound and hep metab- not good if liver dz
  • side effects- induce ovulation, increase plasma vol bad if CHF, decrease effectiveness of OCP's

Benzoic Acid Derivatives

  • repaglinide- mono or combo tx c metformin
  • binds to atp dependent potassium channel like sulfonyls but at different site.
  • Unlike sulfonyls, it decreases insulin lvls
  • Dose 30 min before meal to decrease post prandial hyperglycemia

See Also

References

Tintinalli