Extra Oral Diabetes

Question 1

what diabetic pt will primarily get oral agents?

Answer 1

type 2

Question 2

why is glipizide the preferred agent of 2nd gen sulfonylureas?

Answer 2

metabolized into an inactive metabolite, dec risk for hypoglycemia, and wont have an effect on pt with renal dysfunction

Question 3

which meglitinide drug is better for renal failure patients?

Answer 3

repaglinide: bc only 10% is excreted in urine compared to 90% of nateglinide

Question 4

what frequently should be monitored for a renal disease pt on metformin?

Answer 4

initial GFR check; not recommended therapy for pts under 45 ml/min but if ok, then dosages need to be closely monitored

Question 5

what is MOA of thiazolidinediones?

Answer 5

help stimulate PPARy receptor and recognize insulin

Question 6

how long are max effects of metformin seen?

Answer 6

up to 2 weeks

Question 7

which thiazolidinedione can be used with insulin?

Answer 7

actos (pioglitazone)

Question 8

what is the black box warning for thiazolidinediones? what is the other major ADR

Answer 8

black box: risk of heart failure

hepatotoxicity- check LFTs before starting pt on

Question 9

how often do alpha-glucosidase inhibitors need to be taken?

Answer 9

with each meal in order to affect glucose concentration

Question 10

what rule only pertains to the DPP-4 inhibitor linagliptin/tradjenta?

Answer 10

no dosage adjustment for renal impairment is necessary (but ALL the rest are)

Question 11

how often do you take GLP-1 receptor agonists?

Answer 11

1-2 times daily or once weekly

Question 12

what are three ADRs of GLP-1 receptor agonists?

Answer 12

GI upset- titrating the dose can help
Hypoglycemia if used with sulfonylurea
acute pancreatitis

Question 13

what needs to be monitored in a pt taking a GLP-1 receptor agonist?

Answer 13

kidney function

Question 14

what SGLT2 has an impact on CVD?

Answer 14

empagliflozin- reduces risk of CV death in adults with type 2 diabetes and CVD

Question 15

what is black box warning for canagliflozin?

Answer 15

bone fractures

Question 16

what number do we want a patient’s A1C under?

Answer 16

7

Question 17

what type of agents are Colesevelam (welchol) and bromocriptine (cycloset)?

Answer 17

4th line for type 2

Question 18

what should you check when a pt is on metformin?

Answer 18

B12 levels (once a year)

Question 19

what are the 9 categories of oral diabetic agents?

Answer 19

sulfonylureas, meglitinides, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, DPP-4 inhibitors, GLP-1 receptor agonist, SGLT2, amylin agonist

Question 20

clinical use of amylin agonists?

Answer 20

type 1 and 2 patients who use mealtime insulin and have failed to achieved desired glycemic control