Diabetes medications: Difference between revisions
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###Signs of lactic acidosis: nausea/vomiting, abd pain, tachypnia, lethargy | ###Signs of lactic acidosis: nausea/vomiting, abd pain, tachypnia, lethargy | ||
##Nausea, diarrhea, crampy abdominal pain | ##Nausea, diarrhea, crampy abdominal pain | ||
#Almost never causes hypoglycemia when taken alone, but can exacerbate hypoglycemia when taken in combination with hypoglycemic agents | |||
==Sulfonylureas== | ==Sulfonylureas== |
Revision as of 04:53, 13 March 2015
Background
- Hypoglycemics
- Sulfonylureas
- Benzoic acid derivatives
- Antihyperglycemics
- Biguanides
- Alpha glucosidase inhibitors
- Thiazolidinediones
Insulin
Biguanides (Metformin)
- Suppresses liver glucose production
- 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 pts with renal failure
- Signs of lactic acidosis: nausea/vomiting, abd pain, tachypnia, lethargy
- Nausea, diarrhea, crampy abdominal pain
- Lactic acidosis (due to increased lactate production)
- Almost never causes hypoglycemia when taken alone, but can exacerbate hypoglycemia when taken in combination with hypoglycemic agents
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
Source
Tintinalli