Biguanides

Question 1

Biguanide example

Answer 1

Metformin

Question 2

Biguanide effect on hepatocytes

Answer 2

dec gluconeogenesis –> dec hep glucose produx

dec cholesterol, TG, and FA synth

Question 3

Biguanide effect on SKM

Answer 3

Inc GLUT4 translocation –> inc glucose uptake

Question 4

Biguanide AE

Answer 4

1. Gastrointestinal - very common
NVD
anorexia 
abd discomfort
metallic taste
dec vit B12 absorp

2. Lactic acidosis - very rare!

Question 5

Biguanide Considerations

Answer 5

1st line choice

Slowly titrate on w food

Question 6

Biguanide CI

Answer 6

-severe renal impairment (eGFR < 30 ml/min)
liver disease
ETOH abuse
HF
-hemodynamic instability due to infection or other
causes

Question 7

What parameters should be monitored with Biguanides?

Answer 7

GFR
HbA1c
BG

Question 8

Biguanide side note - other uses?

Answer 8

dec ovarian androgen produx –> adj therapy for PCOS

Question 9

Temporarily discontinue biguanide in pts with:

Answer 9

acute dehydration
sepsis
IV iodinated contrast material