Endocrine Drugs 2
Terms
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- Glyburide, Glipizide, Glimepiride
- Sulfonylureas
- Glyburide
-
t1/2= 1-2hrs, but 24 hr action
Best for elderly due to the small half life.
Easy to use package. - Glipizide
- t1/2= 2-4 hrs
- Contraindications for Sulfonylurea Use
-
1.DKA
2.Diabetic coma - Caution when using Sulfonylureas
-
1.Renal/Hepatic Dz
2.HYPOGLYCEMIA
3.Metabolic Stress - BLACK BOX on Sulfonylureas
- May increase CV mortality (mainly 1st generations)
- When do pts take sulfonylureas?
- 30 mins b/f meals
- Meglitinide and Nateglinide
- Secretagogous (other than sulfonylureas)
- When should pts take Meglitinide and Nateglinide
- 15 mins bf meal... TID...short acting
- SE of 'other secretagogous'
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Hypoglycemia
GI disturbance
Arthralgia
Weight gain - Meglitinide
-
t1/2= <1hr...3hr action
*Work through Cyt P450 pathway, so competes with macrolides and antifungals for metabolism* - Meglitinide and Nateglinide Contraindication
-
T1DM
DKA - Nateglinide
-
t1/2= 1.5hrs
*Work through Cyt P450 pathway* - Metformin
- Can be used in 10yo and up. DOES NOT cause hypoglycemia. Works by decreasing gluconeogensis and absorption of glucose from GI. Increases glucose intake by skeletal muscle.
- Metformin T Max
- 4-8hrs
- SE of metformin
-
GI disturbance
Weight loss
Metallic taste in mouth - CI of metformin
-
Renal dysfnx
Abnormal CrCl
CHF requiring meds
Metabolic acidosis - Metformin Black Box
- Lactic Acidosis: Monitor creatinine and GFR. Initial presenting symptom is Abdominal Pain.