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The following medications are important in the care of patients with diabetes. Medications listed in red are available at SHARING/GOODLIFE Clinics.

Aspirin

• General: Use for primary prevention of heart disease in males >50 and for prevention of stroke in females >60 who have at least one additional major risk factor. Also used for secondary prevention.
• Mechanism: Irreversibly inhibits cyclo-oxygenase in platelets thereby decreasing thromboxane and platelet aggregation.
• Dosing: 81mg daily to prevent heart attacks and ischemic stroke.
• Contraindications: Allergy, history of GI bleed.
• Major Side Effects: Bleeding risk, GI irritation, Reyes syndrome in children and teenagers.

Angiotensin Converting Enzyme Inhibitor (ACE)

• General: #1 choice of therapy to treat hypertension in diabeticpatients and #1 choice to treat heart failure in diabetic patientss. Also used to prevent nephropathy (kidney damage). The higher the dose the more protective effect seen.
• Mechanism: Inhibits the conversion of Angiotensin I to angiotensin II, a vasoconstrictor.
• Dosing: Depends on the medication.
• Contraindications: Pregnancy.
• Major Side Effects: Angioedema, ACE associated cough, dizziness, potassium changes.
• Common Medications: Lisinopril, Enalapril, etc.

Angiotensin Receptor Blocker (ARB)

• General: 2nd choice for hypertension/renal protective effect if patient can’t tolerate ACE cough.
• Mechanism: Blocks the receptor for angiotensin I and angiotensin II (a vasoconstrictor).
• Dosing: Depends on specific medication.
• Contraindication: Do not use if angioedema of tongue or mouth, pregnancy.
• Major Side Effects: Angioedema
• Common Meds: Losartan, Candesartan.

Statins

• General: LDL is primary target with a goal of <100. With cardiovascular disease goal is<70. HDL goal >40 for males and >50 for females.
• Mechanism: HMG CoA reductase inhibitor, blocks the rate limiting step in cholesterol synthesis thereby decreasing endogenous cholesterol production. Also upregulates HDL and LDL recepotrs thereby decreasing serum levels.
• Dosing: Depends on specific medication.
• Contraindications: Elevated LFTs, pregnancy, myopathy.
• Major Side Effects: Generalized muscle pain
• Common Medications: Simvastatin, Atorvastatin (Lipitor).