combination therapy for all well tolerate in the elderly Monitor FPG and Hb A1c

Combination therapy for all well tolerate in the

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combination therapy for all; well tolerate in the elderly, Monitor FPG and Hb A1c every 3 month Renal function baseline & annual; daily to weekly monitoring of FPG and postprandial BG and by monitoring Hb A1c every 3 months or monitoring fructosamine every 2 months Educatio n 0-30 min prior to each meal, omit if not eaten Once daily dosing in the morning, Selective Sodium Glucose Co- Transporter 2 Inhibitors (SGLT-2) Canagliflozin (Invokana), dapglifoxin (Farxiga), and empagliflozin (Jardiance) Amylin Agonists MOA Contra- indicatio n ADRs interacti on Clinical use
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Monitor Educatio n Glucagon-Like Peptide-1 Agonists (GLP-1 or incretin mimetics) Exenatide (Byetta), liraglutide, dulaglutide, albiglutide Glucagon MOA Binds w/ GLP-1 receptor on pancreatic beta cell, stimulating glucose- mediated insulin release Decrease hepatic glucose output & decrease insulin demand Slow gastric emptying, reduce appetite (weight loss) Contra- indicatio n Severe GI dz (ulcerative colitis, Crohn’s dz); cautious use in renal & hepatic impairment; Pregnancy C ADRs N/V, diarrhea; Pancreatitis; C cell thyroid tumors or hyperplasia (Black Box warning) Interacti on Warfarin increase INR; contraceptives, simvastatin; DGX Clinical use Add-on therapy (typically) for type 2 DM w/ metformin or TZD, sulfonylurea Monitor Renal, thyroid, pancreatitis assessment Educatio n SQ injection o rapid: 60 min before morning & evening meals, 6 hr apart, if misses, wait for next schedule) o ER form: weekly injection FHx of medullary thyroid tumor or endocrine neoplasia
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  • Spring '14
  • Henrikson,J
  • Hypoglycemia

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