Please enable JavaScript.

Coggle requires JavaScript to display documents.

DM Tx (Not Insulin Rx (SGLT-2 Inhibitors (Mechanisms (↓ glucose…

- - - - Mechanism
        
        ↓ intestinal absorption of glucose
        
        90% in the urine
        10% feces
        
        ↑ insulin sensitivity in peripheral tissues
        
        ↓ hepatic gluconeogenesis
      - PEARLS
        
        decrease LDL
        
        take with meals 2 weeks endure or try lower dose hydrate don't use with IV dye
      - Side Effects
        
        Increase
        
        2 weeks:Diarrhea, Nausea, Anorexia try lower
        
        Kidney Stress
        
        Creatinine annually
        
        No radio dye!
  - - - Sissy version of Sulfonurea
      - Take before meals
      - -glinide
        
        Nateglinide (Starlix®)
        
        Repaglinide (Prandin®)
      - Mechanism
        
        Stimulates islet 𝞫 cells to release insulin, weaker than sulfonylureas
        Excretion
        90% feces
      - Side Effects
        
        URI (10%)
        Hypoglycemia (3%)
        HA
        Arthralgia
        Diarrhea
        Back pain
        Nausea
    - - Glyburide/DiaBeta
      - Glipizide/Glucotrol
      - Glimepiride/Amaryl
    - - Hypoglyemia dizzy overwhelm B cells, creatinine careful w/ insulin dark urine
  - - - Mechanism
        
        Bind amylase to slow carb digestion
      - Monitor/Risk
        
        GI
        
        Flatulence, Diarrhea
        
        Liver Fx Test AST/ALT q 3 mox 1 yr
        
        Creatinine #
        
        Not w/ sulfonurea
      - PEARLS
        
        Don't use w/ sulfonylureas treat hypoglycemia w/ glucose not sucrose Eat w/ meals
  - - - rosiglitizone maleate/avandia
      - pioglitozone/actos
    - - Stimulate fat, muscle, & liver cells to ↑ insulin receptors
      - Excretion
        15-64% urine, 23% feces
      - ↑ storage in fat & muscle
        ↓ glucose production
    - - ovulation, weight gain
    - - Fluid retention, edema, URI Not w/ CHF May stimulate ovulation-give conrtaceptive option, not for smokers-may be connected to bladder cancer
      - Weight gain
  - - - Delays gastric emptying
        ↑ satiety
        
        #
      - Excretion: mostly urine
      - ↓ liver gluconeogenesis
      - ↓ Glucagon secretion
      - ↑ Insulin secretion
    - - Nausea (28-39%)
        Vomiting (11-15%)
        Constipation (10-19%)
        Diarrhea
        HA
        Dyspepsia
        e #
      - Weight loss #
      - Hypoglycemia (monotherapy, 10-23%; combo therapy, 4-43%) #
      - Watch creatinine #
    - - Avoid dehydration
        Report S/S of a thyroid tumor, cholelithiasis, or pancreatitis
        Monitor for hypoglycemia & report glycemic control
  - - - Sitagliptin (Januvia®)
      - Alogliptin (Nesina®)
      - Linagliptin (Tradjenta®)
      - Saxagliptin (Onglyza®)
    - - DPP-4 enzyme brakes down GLP-1 naturally,
        allow GLP-1 to work longer
        Slows incretin metabolism
        
        #
        
        ↑ insulin synthesis & release
        
        ↓ glucagon levels
      - Excretion
        75% urine, 22% feces
    - - URI (5%)
        HA (1-6%)
        Hypoglycemia (.5-12%)
        UTI
        Vomiting
        Abdominal pain
        Gastroenteritis
        Watch Creatinine #
      - Creatinine levels #
    - - Report severe abdominal pain & discontinue
        Report severe joint pain
        Report stress, such as fever, trauma, infection, or surgery, that may require medication dosage adjustments
  - - - ↑ Satiety (↓ appetite)
        ↓ gastric emptying
      - ↓ glucagon secretion
      - Excretion
        Most all in the urine
    - - Nausea (28-48% )
        Anorexia (9-17%)
        HA (13%)
        Vomiting (8-11% )
        Abdominal pain
        Fatigue
        Arthralgias
        #
      - Drug should be at room temperature to prevent injection site reactions
      - Weight loss
      - Drowzy
    - - Give any oral drugs requiring rapid GI absorption 1 hr before injection or 2 hrs after meal
  - - - ↓ glucose reabsorption in the kidney
      - Excretion
        33% urine, 60% feces
      - ↑ insulin sensitivit
      - ↑ insulin release from 𝞫 cells
      - ↓ gluconeogenesis in the liver
    - - Genital mycotic infection (4-11%, > in females)
        UTI (5%)
        ↑ urination frequency (5%)
        Hyperkalemia
        ↑ cholesterol
        ↑Magnesium
      - Baseline GFR, BP, Lipid panel, K+
      - Not for acidosis or DM1
      - Weight Loss #
      - Hypoglycemia #
    - - Report S/S of: hypotension or acute renal failure
        of ketoacidosis or hyperkalemia
        a UTI or genital mycotic infection
        a fracture
        Take before 1st meal of the day
  - - - Who cooks?
    - - 150 min/week moderate
    - - Obstructive Sleep Apnea
- - - - aspart (NovoLog®)
      - glulisine (Apidra®)
      - lispro (Humalog®)
    - - (more those needing >200 units/day)
  - - - Humalin R
      - Novalin R
  - - - NPH protamine hagedorn
      - NPH Humulin N
      - NPH Novalin N
  - - - U-300
        Glargine (Toujeo®)
      - U-100, 200
        Degludec (Tresiba®)