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Home , Empagliflozin

Diabetes Drug Grid

Class Drugs & Individual Pearls MOA Adverse Labs affected CI/DD intrxn Uses Other pearls Effects 1st generation -Stimulates release -** due to secreting -FBG dec 50-60 -Hypoglycemia worse -good response in -Signs of hypoglycemia (<70): rapid -oral -acetohexamide (Dymelor) from beta cell pancreas insulin throughout day mg/dl with NSAIDs, fluoxetine, people that were HR, sweating, SOB, weakness, secretagogues daily (secretagogues) -weight gain -A1c dec 1-1.5% quinolones, diagnosed in less fatigue, malaise (Diabinese): -receptor on beta cell  -hematologic (leukopenia, - reduces FBG + clarithromycin, salicylates, than 5 years, 40+ -Frequently used in combination not used much (long close ATP dependant K+ thrombocytopenia, hemolytic PPBG sulfonamides, yo, weight inn therapy with insulin and other oral t1/2=more hypoglycemia); channel  depolarize cell anemia) chloramphenicol, 110-160% IBW, antidiabetic meds disulfiram like rxn; memb  Open Ca2+ -dermatological (rash, puritis, coumarins, probenecid, FBG <200, never hyponatremia; cholestatic channel  inc intracel purpura) MAOIs, beta blockers, required insulin jaundice. daily [Ca2+]  release insulin -GI (n/v, cholestasis) disopyramide or less than -tolozamide(Tolinase) daily 40u/day -(Orinase) daily -Need to still or BID have decent beta 2nd generation function - (Amaryl) daily - (Glucotrol): metab to inactive metabolites so less hypoglycemia. daily -glyburide (Glynase) daily Meglitanides/ -(Starlix)-more -Stimulates insulin release -less hypoglycemia since extent -A1c dec 1-2% - w/gemfibrozil -causes -take within 15 minutes of meal Phenylalanies physiologic (more rapid from beta cells of pancreas of insulin release is glucose alone and 2-3% hypoglycemia but but up to 30 minutes -oral onset and shorter duration) (closely mimics dependent in combo less than -take 3-4x/day compliance! Don’t secretagogues TID before meals physiological response) -weight gain -reduces PPBG sulfonylureas take dose if skipping meal (short acting ones -repaglinide(Prandin)- more -headache so give with meals) potent; CI if taken with -URI gemfibrozil because causes -Flu like symptoms hypoglycemia TID with -Dizziness meals -Neuromuscular (arthralgia, back pain, paresthesia) -GI (n/d, epigastric fullness, heartburn, constipation) Alpha-glucosidease - (Precose) TID -inhibit action of intestinal -GI (flatulence, ab pain, diarrhea) -A1c: dec 0.5- -intestinal disease -early in course of -dose should be taken with first inhibitors - (Glyset) TID amylase and alpha- -Inc transaminases (dose related) 1% -charcoal diabetes when bite of each meal -oral glucosidase action causing -PPG: dec by 50- -digestive enzymes post-prandial -does not affect simple sugar antihyperglycemics a delay in breaking down 60 mg/dl glucose values (glucose and lactose) absorption complex carbs to glucose - reduces PPBG are high -if hypoglycemia occurs, you need -absorption delayed in to administer simple sugars distal portion of s. intestine because carbs would be delayed so less peak in post prandial blood glucose

Diabetes Drug Grid

Biguanides -(Glucophage) -Primary: dec hepatic -GI (diarrhea, n/v, epigastric -A1C: dec 1- -eGFR<30 -dec all cause -Dose adjust for renal insufficiency -oral QD or BID glucose function fullness) 1.5% -pts with acute or chronic mortality in -impaired hepatic function could antihyperglycemics -Glucophage XR QD -Secondary: improve insulin -dermatologic (rash, --reduces FBG metabolic acidosis obese pts cause lactic acidosis -Riomet sol 500mg/5mL sensitivity via inc peripheral photsensitivity, urticarial) -caution with meds that -modest weight -no excessive alcohol glucose uptake and -dec Vitamin B12 absorption affect renal function: loss -suspend metformin temporarily utilization & dec intestinal -lactic acidosis amiloride, digoxin, -help w/lipids: before surgery absorption so some glucose procainamide, quinidine, dec total -lactic acidosis symptoms: severe never absorbed ranitidine, triamterene, , dec flu (n/v, SOB, malaise), weak or trimethoprim LDL and trigs tired, unusual muscle pain, cold, -conditions predisposing -improve dizzy, lightheaded, slow or to renal insuf or hypoxia: endothelial irregular heartbeat) acute CHF, COPD, shock, function acute MI -dec cancer rates -do not take with alcohol, may potentiate effect of metformin on lactate metabolism - (Avandia): -direct stimulation of -fluid retention -A1c: dec 1.5- -NYHA class III or IV heart -hepatically metabolized so -oral inc LDL bworse with heart PPARPy (peroxisome -macular edema 2.5% failure monitor LFTs before and antihyperglycemics failure (do not give with proliferator-activated -inc bone fractures in females -dec blood periodically; don’t stop/start in pts insulin) QD or BID receptor-gamma) on -resumption of ovulation in glucose in 2-4 with inc baseline LFTs (ALT>2.5 x -(Actos): good nuclear surface causing inc premenopausal anovulatory weeks; max ULN) if pt has cholesterol in production and women  inc risk pregnancy effect in 12 -test if fatigue, anorexia, n/v, ab problems; inc risk of translocation of GLUT-4 to -weight gain weeks pain, dark urine, jaundice bladder cancer QD cell surface -dec Hbg and Hct -may maintain -dc meds if pt develops jaundice or -change in GLUT-4 activity -headache or improve beta ALT levels remain >3x normal  inc insulin dependent -muscle aches function over -take QD in morning glucose disposal in skeletal time -if you miss a dose, take it as soon muscle and adipocytes  -perseverance as you remember dec hepatic glucose of effect up to 2 -consider cholesterol panel prior to production years initiating therapy -improves nsulin sensitivity -reduces FBG + in skeletal muscle and in PPBG adipose tissue -secondarily, dec hepatic glucose output

Diabetes Drug Grid

DPP IV inhibitors -(Januvia)-no drug -inhibit action of DPP-IV -joint pain -A1c: dec is -intrxns are drug specific -renal dose adjust for everything -oral incretins interactions QD enzyme  inc and prolongs - (sax and alo) 0.5% with each except -saxaglipitn (Onglyza)-inc active incretin levels -pancreatitis drug risk of heart failure; -inc insulin release and dec -hepatic failure (alo) -FBG: small dec interacts with ketoconazole secretion in a -nasopharyngitis (lin, alo, sit) -2HPPG dec QD glucose dependant manner -arthralgia (lin) - Reduces PPBG -linagliptin (Tradjenta)-does **doesn’t inc GIP and GLP -back pain (lin) not need renally dosed; levels enough to give -headache (lin, alo, sax, sit) strong P-gp and CYP3A4 fullness and satiety no -URI (alo, sax) inducer dec concentration weight loss -UTI (sax) QD -hypersensitivity rxn - (Nesina)- few -GI SE low drug interactions; inc risk of -inc risk heart and hepatic failure heart or hepatic failure QD (alogliptin) SGLT2 inhibitors - (Invokana)- -block SGLT2  can’t - -A1c: dec 0.75- -CI in GFR <30, ESRD, -insulin -drink lots of water since urinate -oral blocks SGLT1 + 2 so that’s reabsorb glucose as much -small bump in SCr 1% dialysis independence more often antihyperglycemics why there’s extra issues and dec renal threshold for -hyperkalemia (canag) -FBG: dec 22-35 -canag and digoixin  inc -weight loss and most effective; best glucose  inc excretion of -genital mycotic infections -2HPPG dec AUC of digoxin -low risk A1c lowering; hyper K; bone glucose in urine -inc risk UTI -reduces FBG + -canag stubstrate of hypoglycemia fracture; leg and foot -dec glucose in body causes -bladder cancer (dapag) PPBG UGT1A9 and UGT2B -dec SBP by 4% amputation; GI distress; dec calories  weight loss -inc risk bone fractures -UGT enzyme inducers -inc HDL intrxn with digoixin, -ketoacidosis (rifampin, ritonavir, rifampin, ritonavir, -leg and foot amputations (canag) phenobarbital, phenytoin) phenobarb, phenytoin QD -inc urination dec AUC of canag by 50% - (Farixga): best -vulvovaginal pruritis PPG lowering; bladder cancer QD -empagliflozin (Jardiance): PPG dec unknown; good for cardio and kidney disease QD Bile acid Colesevelam(Welchol) QD -binds bile acids -inc prevelance of -A1c: dec a little -history of bowel -may be used in -takes about 4-6 weeks to start sequestrants or BID -decreased cholesterol in hypertriglyceridemia and (0.5%) obstruction pregnancy effects and 12-18 weeks for max -oral liver increasing LDL gallbladder disease -FBG: dec a little -serum trig > [500] effects antihyperglycemics receptor production and -dec absorption of fat soluble (14mg/dl) -history of -should be taken with meal or removal of LDL from vitamins (A, D, E, K) hypertriglyceridemia- liquid circulation -constipation induced pancreatitis -no dose adjustments because not T2DM- mechanism is not -nausea -phenytoin (lowers absorbed well understood -dyspepsia phenytoin level  lowers -give this four hours before other -abdominal pain seizure threshold) drugs -inability to swallow -warfarin (dec INR) -may cause increases in TRG levels -esophageal obstruction -inc TSH -pancreatitis -hemorrhoid exacerbation -bowel obstruction -fecal impaction Diabetes Drug Grid

Bromocriptine daily -inc dopamine (dopamine -hypotension, especially -A1c: dec a little -dopamine agonists -titrate weekly Mesylate D2 receptor agonists) to orthostatic -FBG: none -inc in fu -take within 2 hrs after waking in (Cycloset) dec insulin resistance -exacerbate psychotic disorders -PPG: dec a little -dopamine antagonists the morning with food -oral -somnolence -recues PPBG (clozapine, olanzapine, antihyperglycemic -fatigue ziprasidone) diminishes -dizziness effects of both -n/v -ergot-related drugs -headache (when treating migraines) -diarrhea causes dec in -constipation effectiveness of ergot and -hypoglycemia n/v and fatigue - -potent inhibitors or inducers of CYP3A -caution in azole anitmycotics and HIV protease inhibitors -sympathomimetic drugs (phenyl propanolamine and isotheptene) in postpartum women causes HTN and tachycardia -5-HT1B agonists (sumatriptan) -CI: hypersensitivity to ergot-related drugs; syncopial migraines (inc hypotension); inhibits lactation

Diabetes Drug Grid

GLP-1 Analogs -(Byetta)-smallest -inc incretin concentration -N/V/D exenatide DI- delays gastric Weight loss -longer acting -non-insulin homogeneity; renal dosing; to supraphysiologic -exenatide: hypoglycemia A1C: 0.4-0.8% emptying, may impact -causes satiety, weight loss often injectable incretin BID, within 60min food; concentration  inc or -: URI FBG: 8-10mg/dl absorption of occurs, delays gastric emptying mimetics mostly dec PPG; discard prolong hormone actions -pancreatitis concomitant oral meds after 30 days; ore n/v; less -same effects as DPP4 inh inj pruritus. BID but also dec food intake (in A1C: 0.8-1.1% -exenatide: oral meds -exenatide ER(Bydureon): CNS it promotes satiety and FBG: 15- requiring rapid QW; microspheres; long dec appetite) and dec 26mg/dl absorption, if drugs are t1/2; discard after 4 weeks; glucose absorption (delays administered with food— less n/v; more inj pruritus; gastric emptying) patients should take when full effect in 4-6weeks; ss -decrease glucose A1C: 0.75% exenatide isn’t 10 weeks. Weekly production FBG: 14 mg/dl administered. -liraglutide(Victoza): more -decrease glucose Acute pancreatitis, renal homology (less absorption impairment, GI disease immunogenicity); QD; -increased beta cell A1C: 1.06-1.22% resistance to DPP-IV function FBG: 26.5- -liraglutide, albiglutide, degredation; can change 34.75mg/dl dulaglutide: CI- personal site and time without dose or family history of adjusting. daily Short acting- medullary thyroid -dulaglutide(Trulicty): reduces PPBG carcinoma, multiple approved for use with basal Long acting- endocrine neoplasia or prandial insulin; QW; reduces FBG + syndrome. needle hidden in pen. PPBG Weekly. -lixisenatide(Adlyxin): QD; within 60 minutes of food; discard after 14 days; least effective daily

Diabetes Drug Grid

Insulin - Humulin R, - basal utilize -hypoglycemia -basal insulin -T1DM Bolus insulin allows for faster onset Novolin R: onset of action subcutaneous depot -weight gain (less with levemir) reduces FBG -T2DM - indicated for adult 30-60min, peak effect 2-4 and peds >6 years with T1DM, hours, duration of action 6- -bolus insulin administered at any time of day 10 hours. Requires admin reduces PPBG 30-45 min prior to meal. Long DOA increases risk of hypoglycemia

Boluslispro/aspart/glulisine (Humalog, Novolog,Apidra): onset 5-15min, peak 1-2 hours, DOA 3-5 hours

Basal, NPH (Humulin N, Novolin N): onset 1-2 hours, peak 4-8 hours, DOA 10- 20hours—does not last 24 hours, does not match basal insulin

Basal, glargine (Lantus): onset 2-4hours, no peak, DOA 24 hours Toujeo: onset 6 hours, no peak, DOA 24 hours (28-36 hours)

Basal, detemir (Levemir): onset 2-4 hours, no peak, DOA 18-24 hours

Basal, degludec (Tresiba): onset 1-2 hours, no peak, DOA 42+ hours

* , , Admelog, Fiasp, Basaglar