2PD-Top200 Drugs-Spring2024-Anti Diabetic medications

insulin aspart brand name

Novolog, Fiasp

insulin FDA labeled indications

Diabetes mellitus, Types 1 and 2: Subcutaneous dosing is individualized to patient needs

Insulin MOA

romotes cellular uptake of glucose, fatty acids, and amino acids, and their conversion to glycogen, triglycerides, and proteins.

Insulin Common ADRs

Injection site reactions, weight gain

Insulin Key patient counseling points

Monitor blood glucose in frequent intervals (2-4 times/d);

if <70 mg/dL, eat non-sugar-free candy, glucose tablets, or drink a glass of juice and contact prescriber.

Store unopened vials in refrigerator.

Keep open vials at room temperature if it is painful to inject cold insulin.

Dispose needles in sharps container.

Do not share needles (risk of transmission of infectious diseases).

Rotate injection sites.

Insulin Aspart Brand Name

Fiasp, NovoLog

Insulin Aspart Onset of action

12-18 min

Insulin Aspart peak action

1-3 h

Insulin aspart duration of action

3-5 h

Insulin degludec brand name

Tresiba

Insulin degludec onset of action

60 min

Insulin degludec peak action

9 h

Insulin degludec duration of action

24 h

Insulin detemir Brand name

Levemir

Insulin detemir onset of action

3-4 h

Insulin detemir peak action

3-9 h

Insulin detemir duration of action

6-23 h (dose dependent)

Insulin glargine brand name

Lantus, Toujeo

Insulin glargine onset of action

3-4 h

Insulin glargine peak action

NO PEAK!!!

Insulin glargine Duration of action

>24 h

Insulin lispro brand name

Humalog, Admelog

Insulin lispro onset of action

15-30 min

Insulin lispro peak action

30-210 min

Insulin lispro duration of action

≤5 h

Dulaglutide brand name

Trulicity

Dulaglutide therapeutic class

Antidiabetic Agent, Glucagon-Like Peptide-1 Receptor Agonist

Dulaglutide FDA labeled indications

Diabetes mellitus, type 2: Adults, 0.75-1.5 mg every wk SUBQ

Dulaglutide MOA

is an agonist of human glucagon-like peptide-1 (GLP-1) receptor and augments glucose-dependent insulin secretion and slows gastric emptying.

Dulaglutide box warnings

Risk of thyroid cancers

Dulaglutide ADRs

Nausea, diarrhea, weight loss

Dulaglutide key counseling points

Inject SUBQ into the upper arm, thigh, or abdomen;

use a different injection site each week.

Administer once weekly on the same day each wk, without regard to meals or time of day.

Administration day can be changed as long as at least 3 d have passed.

If using concomitantly with insulin, administer as separate injections (do not mix); may inject in the same body region as insulin, but do not administer both agents directly adjacent to one another.

Keep refrigerated, but is stable at room temperature for 14 d. Be aware of symptoms of thyroid cancer (lump in neck, trouble breathing or swallowing) and kidney problems (decreased urination, blood in urine) and report to HCP.

Liraglutide brand name

Victoza, Saxenda

Liraglutide therapeutic class

Glucagon-Like Peptide-1-Receptor Agonist

Liraglutide FDA labeled indications

Diabetes mellitus type 2: 0.6 mg SUBQ once daily for 1 wk, then increase to 1.2 mg SUBQ once daily (max 1.8 mg SUBQ once daily)

Chronic weight management: 0.6 mg SUBQ once daily for 1 wk, then increase by 0.6 mg weekly to target of 3 mg SUBQ once daily (if patient cannot tolerate dose escalation, consider extending escalation period by 1 additional wk, but 3 mg dose cannot be tolerated, discontinue as effectiveness has not been established at doses <3 mg/d); discontinue if ≥4% of body weight loss not achieved after 16 wk of treatment

Liraglutide MOA

Analog of glucagon-like peptide-1, which increases glucose-dependent insulin secretion, decreases inappropriate glucagon secretion, slows gastric emptying, and increases satiety.

Liraglutide box warning

Increased risk of thyroid cancer

Liraglutide ADRS

Nausea, diarrhea, vomiting, hypoglycemia

Liraglutide patient key counseling points

Monitor blood glucose periodically (typically daily, more frequently if administered with sulfonylurea or insulin).

If <70 mg/dL, eat non-sugar-free candy, glucose tablets, or drink a glass of juice and contact prescriber. Administer in upper arm, thigh, or abdomen.

Change needle for each injection; do not share pens, even if needle is changed.

If also using insulin, administer with separate injection in a nonadjacent area. Can be injected without regard to meals.

Empagliflozin brand name

Jardiance

Empagliflozin FDA Labeled indications

Diabetes mellitus, type 2 as an adjunct to diet and exercise,

Chronic Kidney
Disease,

Heart Failure,

Reduction of Cardiovascular Mortality,

Reduction of Heart Failure
Hospitalizations, Type 2 Diabetes Mellitus

Empagliflozin MOA

Inhibits SGLT2 in the proximal renal tubules, which reduces reabsorption of filtered glucose from
the tubular lumen, increases urinary excretion of glucose and result in increased urinary volume.

Empagliflozin common ADRs

Hypoglycemia, diuresis

Empagloflozin patient key counseling points

Take this medication by mouth with water. Take it at the same time every day.

You may take it with or without food. Keep taking it unless your care team tells you to stop. Be aware
of symptoms of foot ulcers, pain or tenderness, or dehydration (dizziness, low BP, decreased urination),
and vaginal infections and report to HCP.

Empagloflozin therapeutic class

SGLT inhibitor

Glipizide brand name

Glucotrol

Glipizide therapeutic class

Second-Generation Sulfonylurea, Antidiabetic

Glipizide FDA-labeled indications

Diabetes mellitus: Immediate release, 5-10 mg po daily, may titrate to max 40 mg daily, divide bid if doses >15 mg; extended release, 5-10 mg po daily, may titrate to max 20 mg daily

Glipizide MOA

Sulfonylureas enhance insulin secretion from pancreatic β-cells and potentiate insulin action on several extrahepatic tissues. Long-term sulfonylureas increase peripheral utilization of glucose, suppress hepatic gluconeogenesis, and possibly increase the sensitivity and/or number of peripheral insulin receptors.

Glipizide common ADRs

Asthenia

Glipizide patient key counseling points

Monitor blood glucose in frequent intervals (2-4 times per d); if <70 mg/dL, eat candy or sugar and contact HCP.

Use a sunscreen and avoid sunlamps and tanning beds.

Do not drink alcohol; may cause a disulfiram reaction.

Take 30 min before morning meal.

Do not chew or crush extended-release formulation.

Glimiperide brand name

Amaryl

glimepiride therapeutic class

Second-Generation Sulfonylurea, Antidiabetic

Glimepiride FDA labeled indications

Diabetes mellitus, type 2: 1-2 mg po daily, may titrate by 1-2 mg every 1-2 wk to effect, max dose 8 mg po daily

Glimepiride MOA

Sulfonylureas enhance insulin secretion from pancreatic β-cells and potentiate insulin action on several extrahepatic tissues. Long-term sulfonylureas increase peripheral utilization of glucose, suppress hepatic gluconeogenesis, and possibly increase the sensitivity and/or number of peripheral insulin receptors.

Glimepiride common ADRs

None known

Glimepiride Key Counseling Points

Monitor blood glucose in frequent intervals (2-4 times per d); if <70 mg/dL, eat candy or sugar and contact HCP.

Take with food or milk in the morning.

Use a sunscreen and avoid sunlamps and tanning beds.

Do not drink alcohol; may cause a disulfiram reaction.

Metformin Hydrochloride brand name

Glucophage, Glumetza, Riomet

metformin therapeutic class

Biguanide, Hypoglycemic

Metformin: FDA Indication

Diabetes mellitus type 2: Adults, immediate release, 500-1000 mg po bid, may titrate to max dose 2250 mg/d; extended release, 500-2000 mg po daily, may titrate to max dose 2000 mg/d; Children ≥10 y of age, immediate release, 500-1000 mg po bid, may titrate to max dose 2000 mg/d

Metformin MOA

biguanide antihyperglycemic agent. It does not affect insulin secretion; rather, it reduces hepatic glucose production and enhances glucose utilization by muscle.

Metformin Boxed Warning

lactic acidosis

Metformin common ADRs

Diarrhea, malabsorption, nausea, asthenia, vomiting, flatulence

Metformin Key Counseling Points

Take with meals.

Drink plenty of liquids to improve elimination of metformin.

Avoid alcohol; this increases the risk of lactic acidosis.

Metformin Hydrochloride; Sitagliptin Phosphate brand name

Janumet

Sitagliptin Phosphate Brand name

Januvia

Sitagliptin therapeutic class

Dipeptidyl Peptidase-4 Inhibitor, Antidiabetic

Sitagliptin FDA Labeled Indications

Diabetes mellitus, Type 2: 100 mg po daily

Sitagliptin MOA

a DPP-4 enzyme inhibitor that inhibits the degradation of incretin hormones by DPP-4 and enhances the function of GLP-1 and GIP to increase insulin release and decrease glucagon levels in the circulation in a glucose-dependent manner.

Sitagliptin Common ADRs

Hypoglycemia

Sitagliptin Key Patient Counseling Points

Monitor blood glucose in frequent intervals (2-4 times/d). Take with morning meal if once-daily dosing. Take with morning and evening meal if twice-a-day dosing.

When used in combination with insulin or sulfonylureas, risk of hypoglycemia may be increased.

Pioglitazone brand name

Actos

Pioglitazone therapeutic class

Thiazolidinedione Antidiabetic

Pioglitazone FDA Indication

Diabetes mellitus type 2: 15-30 mg po daily; may titrate to max 45 mg po daily as monotherapy, or in combination with sulfonylurea or metformin

Pioglitazone MOA

a thiazolidinedione antihyperglycemic and a potent peroxisome proliferator-activated receptor-γ (PPAR-γ) agonist used to improve insulin sensitivity in patients with diabetes mellitus type

2. Insulin-dependent glucose disposal in skeletal muscle is improved and hepatic glucose production is decreased; both actions contribute to pioglitazone’s glucose-lowering effects.

Piolitazone Box warning

Heart failure risk

Pioglitazone common ADRs

Edema, weight gain

Pioglitazone - Key Patient Counseling Points

Monitor blood glucose in frequent intervals (2-4 times per d). May take without regard to food.

May require several weeks for maximum effect.

Seek care for bone pain, yellowing of skin or eyes, eye pain, or shortness of breath.