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Endocrinology > Non-insulin agents > Flashcards

Non-insulin agents Flashcards

1
Q

metformin class

A

biguanide

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2
Q

metformin MOA

A

decrease hepatic glucose production, improve insulin sensitivity, decrease intestinal absorption of glucose

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3
Q

name the sulfonylureas

A

glipizide, glyburide, glimepiride

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4
Q

sulfonylurea MOA

A

stimulate pancreatic beta cells to secrete insulin

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5
Q

name the meglitinides

A

repaglinide, nateglinide

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6
Q

meglitinide MOA

A

stimulates pancreatic beta cells to secrete insulin

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7
Q

name the thiazolidinediones (TZDs)

A

pioglitazone, rosiglitazone

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8
Q

TZD MOA

A

insulin sensitizers: improve glucose uptake in muscle and fat, selective agonist for PPAR gamma, decrease hepatic glucose output, inhibit lipolysis, preserve beta cell function

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9
Q

name the GLP-1s

A

semaglutide, dulaglutide, exenatide, liraglutide, lixisenatide

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10
Q

GLP-1 MOA

A

increases glucose dependent insulin secretion, slows gastric emptying, promotes satiety, decreases glucagon secretion

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11
Q

name the DPP-4i

A

sitagliptin, saxagliptin, linagliptin, alogliptin

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12
Q

DPP-4i MOA

A

enhances levels of GLP-1 and other incretin hormones, stimulates glucose-dependent insulin synthesis and secretion and suppresses glucagon

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13
Q

name the SGLT-2is

A

canagliflozin, empagliflozin, dapagliflozin, ertigliflozin

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14
Q

SGLT-2i MOA

A

reduces urinary glucose reabsorption and increases urinary glucose excretion

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15
Q

name the alpha glucosidase inhibitors

A

acarbose, miglitol

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16
Q

alpha glucosidase inhibitor MOA

A

inhibits maltase, isomaltase, sucrase, and glucoamylase in the small intestine, delaying breakdown of starches and certain sugars, decreases post-prandial glucose peak

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17
Q

name the bile acid sequestrant

A

colesevelam

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18
Q

bile acid sequestrant MOA

A

binds bile acids in the intestines, MOA regarding glucose control not known

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19
Q

name the dopamine agonist

A

bromocriptine mesylate

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20
Q

dopamine agonist MOA

A

affects circadian rhythm and leads to increased insulin sensitivity and glucose disposal

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21
Q

name the amylin mimetic

A

pramlintide

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22
Q

amylin mimetic MOA

A

slows gastric emptying, suppresses glucagon, promotes satiety

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23
Q

metformin side effects

A

GI– diarrhea, abdominal discomfort, stomach upset
metallic taste
vitamin b12 deficiency
lactic acidosis

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24
Q

sulfonylurea side effects

A

hypoglycemia, weight gain

25
Q

meglitinides side effects

A

hypoglycemia, weight gain

26
Q

TZD side effects

A

weight gain (water weight), edema, new onset/worsening HF, increased fracture risk in upper/lower limbs of postmenopausal women, increased risk bladder cancer and macular edema

27
Q

GLP-1 side effects

A

n/v/d
decreased appetite
risk of thyroid c cell tumors
assoc with cases of acute pancreatitis
case reports of AKI or worsening renal function

28
Q

DPP-4 side effects

A

generally well tolerated, assoc. with cases of acute pancreatitis, increased hospitalization for heart failure, bullous pemphigoid requiring hospitalization, arthralgias

29
Q

SGLT-2i side effects

A

genital mycotic infections, UTIs, increased urination, increased risk of necrotizing fasciitis of the perineum (fournier’s gangrene), hypotension, dehydration (increased risk AKI, syncopem, falls), euglycemic DKA

canagliflozin– increased risk of bone fracture

30
Q

alpha glucosidase inhibitor side effects

A

flatulence, diarrhea, abdominal pain, bloating

31
Q

bile acid sequestrant side effects

A

constipation, dyspepsia, nausea

32
Q

dopamine agonist side effects

A

nausea, fatigue, headache, vomiting, hallucinations, somnolence (think CNS effects)

33
Q

amylin mimetic side effects

A

nausea, anorexia, vomiting, fatigue, abdominal pain, dizziness

34
Q

metformin counseling points

A

take with first bite of meal to prevent GI side effects, titration

35
Q

metformin dosing

A

IR 500-1000 mg BID titrate slowly to 1000 mg BID

XR 500-2000 mg once or twice daily

36
Q

metformin renal considerations

A

contraindicated when eGFR<30

do not start with eGFR 30-45
reduce dose if eGFR<45

37
Q

metformin advantages

A

minimal hypoglycemia risk, does not cause weight gain, may cause modest weight loss, decreases triglycerides & LDL, increases HDL, A1c reduction 1-2%

38
Q

the hypoglycemic action of sulfonylureas can be potentiated by what drugs

A

NSAIDs, clarithromycin, salicylates, sulfonamides, chloramphenicol, coumarins, probenecid, MAOi, beta blockers

39
Q

avoid what class/use with caution in older adults

A

sulfonylureas

40
Q

meglitinides counseling

A

take it when you are eating! if not eating, don’t take it

41
Q

meglitinides renal considerations

A

can be used in renal insufficiency

42
Q

coadministration of what drugs with meglitinides increases risk of hypoglycemia

A

clopidogrel, cyclosporine, gemfibrozil, ketoconazole

43
Q

TZD contraindications

A

NYHA Class III-IV HF

44
Q

do not use GLP-1 agonists with what class

A

DPP-4

45
Q

when to avoid GLP-1

A

family history of medullary thyroid carcinoma, gastroparesis, people on DPP-4

46
Q

counseling for SGLT-2

A

drink plenty of water, use good hygiene, stop 72 hours before surgery

47
Q

when to avoid alpha glucosidase inhibitors

A

SCr>2
CrCL<25

48
Q

counseling point for alpha glucosidase inhibitors

A

use glucose tabs or milk to treat hypoglycemia (sucrose not effective)

skip the dose if not eating

49
Q

when are alpha glucosidase inhibitors contraindicated

A

any type of bowel disease

50
Q

acarbose may increase ____ levels, which is dose related

A

liver transaminase

51
Q

who should not receive bile acid sequestrants

A

patients with history of bowel obstruction, serum triglyceride >500, history of pancreatitis

52
Q

counseling points for bile acid sequestrants

A

may decrease absorption of fat soluble vitamins and other drugs, administer other drugs at least 4 hours prior

53
Q

dopamine agonist counseling points

A

take within 2 hours after waking in the morning, with food

54
Q

do not use dopamine agonists in _____

A

patients with severe psychotic disorders

55
Q

dopamine agonist drug interactions

A

CYP3A4 inhibitors

56
Q

amylin mimetic should only be used in ____

A

patients using mealtime insulin

57
Q

avoid amylin mimetics in ____

A

people with hypoglycemic unawareness, gastroparesis

58
Q

amylin mimetics cause weight ____

A

gain

59
Q
A

Endocrinology (10 decks)

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