8: DM Meds

Question 1

Which med is contraindicated in treated CHF?

Answer 1

Metformin

Question 2

This incretin mimetic is administered orally and can be used as monotherapy or added to metformin, thiazolidendione, or sulfonylurea. It raises both endogenous incretins.

Answer 2

DPP-4 Inhibitors (-gliptins)

Question 3

Which drug class?

• Restores GLP-1 levels
• Promotes satiety
• Decreases glucagon release, stimulates insulin release
• Delays gastric emptying
• Used with caution in patients with impaired renal and hepatic function
• Major side effect is diarrhea

Answer 3

• DPP-4 Inhibitors:
  
  • Sitagliptin (Januvia)
  • Saxogliptin (Onglyza)

Question 4

Which drug class?

Incretins and incretin mimetics.

Answer 4

• DPP-4 Inhibitors (-gliptins like Januvia)
• GLP-1 receptor analogue (-natides and -glutides like Byetta, Victoza, Trulicity)

Question 5

Which drug class?

Contraindicated in class 3 and 4 CHF?

Answer 5

Thiazolidinediones (-glitazones)

Question 6

Which drug?

Injectible that increases satiety.

Answer 6

Amlin analogue: Pramlintide (Symlin)

Question 7

Which drug?

• Used to improve glycemic control in patients with type 2 DM taking oral agents
• Once daily dosing
• Not recommended in patients with end-stage renal disease, severe renal impairment or severe GI disease
• Nausea most common side effect
• Contraindicated in patients with gastroparesis

Answer 7

Exenatide (Byetta)

Question 8

T/F Monotherapy of DM is associated with hypoglycemia.

Answer 8

False. Not associated.

Question 9

Where does this oral med work?

Rosiglitazone

Answer 9

Muscle

Question 10

What are advantages and disadvantages to this treatment?

Lifestyle modifications

Answer 10

• Advantages:
  
  • Low cost
  • Additional health benefits
• Disadvantages:
  
  • Fails for most within a year

Question 11

Which drug class?

• Most effective
• No maximum dose
• Can be combined with oral agents in DMT2

Answer 11

Insulin

Question 12

What are advantages and disadvantages to this treatment?

Exenatide (Byetta)

Answer 12

• Advantages:
  
  • Weight loss
• Disadvantages:
  
  • Injections
  • GI side effects
  • Expensive

Question 13

What are advantages and disadvantages to this treatment?

Sulfonylureas

Answer 13

• Advantages:
  
  • Inexpensive
• Disadvantages:
  
  • Weight gain
  • Hypoglycemia

Question 14

What are advantages and disadvantages to this treatment?

Metformin

Answer 14

• Advantages:
  
  • Weight neutral
  • Inexpensive
• Disadvantages:
  
  • GI side effects
  • Lactic acidosis risk (rare)

Question 15

Which drug classes?

Slows absorption of glucose by the gut.

Answer 15

• Alpha glucosidase inhibitors (Miglitol and Acarbose)
• Pramlintide (Symlin)
• GLP-1 receptor analogs (-natides and -glutides like Byetta, Victoza, and Trulicity)

Question 16

What medication should be prescribed for all DM patients at risk of severe hypoglycemia?

Answer 16

Glucagon

Question 17

Which drug class?

Decrease glucagon levels.

Answer 17

• DPP-4 Inhibitors (-gliptins like Januvia)
• Pramlintide (Symlin)

Question 18

What 2 health conditions cause increased risk of hypoglycemia?

Answer 18

1. Active cardiac disease
2. Neurological disease

Question 19

Which med is contraindicated in binge alcohol drinking?

Answer 19

Metformin

Question 20

This incretin mimetic is administered subQ and can be added to metformin, thiazolidendione, and/or sulfonylurea (singly or in combination).

Answer 20

GLP-1 Receptor Analogues (-natides and -glutides like Byetta, Victoza, and Trulicity)

Question 21

What is the treatment for hypoglycemia?

Answer 21

• 15-20 g glucose
• Repeat if hypoglycemia remains
• Eat meal or snack after blood sugar returns to normal

Question 22

Which drug class?

Contraindicated if transaminase is 2.5x the upper normal limit at baseline.

Answer 22

Thiazolidinediones (-glitazones)

Question 23

Which drug?

Contraindicated in renal insufficiency.

Answer 23

Metformin

Question 24

Which drug classes?

Insulin sensitizers.

Answer 24

• Biguanides (Metformin)
• Thiazolididnediones (-glitazones)
• GLP-1 receptor analogues (-natides and -glutides such as Byetta, Victoza, and Trulicity)

Question 25

*Where does this oral med work?* Metformin

Answer 25

Liver

Question 26

*What are advantages and disadvantages to this treatment?* Insulin

Answer 26

* Advantages: * No dose limit * Inexpensive * Improved lipid profile * Disadvantages: * Injections * Monitoring * Hypoglycemia * Weight gain

Question 27

Which 4 drugs or classes specifically target postprandial hyperglycemia?

Answer 27

1. Meglitinides (Prandin/Repaglinide and Starlix/Nateglinide) 2. Acarbose (Alpha Glucosidase Inhibitor) 3. GLP-1 Analogs (-natides and -glutides such as Byetta, Victoza, and Trulicity) 4. DPP-4 Inhibitors (-gliptins such as Januvia)

Question 28

*Which drug?* * Once daily dosing * **Increased risk of pancreatitis** * **Contraindicated with medullary thyroid carcinoma**

Answer 28

Liraglutide (Victoza, a GLP-1 Analogue)

Question 29

What is the leading limiting factor in glycemic management of DM?

Answer 29

Hypoglycemia

Question 30

*What are advantages and disadvantages to this treatment?* Alpha Glucosidase Inhibitors (Acarbose/Precose and Miglitol/Glyset)

Answer 30

* Advantages: * Weight neutral * Disadvantages: * GI side effects * TID dosing * Expensive

Question 31

*What are advantages and disadvantages to this treatment?* TZDs (-glitazones)

Answer 31

* Advantages: * Improved lipid profile * Disadvantages: * Fluid retention * Weight gain * Expensive

Question 32

*Where does this oral med work?* Acarbose (Alpha Glucosidase Inhibitor)

Answer 32

Gut (carb metabolism)

Question 33

*Which drug class?* Contraindicated in **pancreatitis**?

Answer 33

GLP-1 Analogs (-natides and -glutides such as Byetta, Victoza, and Trulicity)

Question 34

*What are advantages and disadvantages to this treatment?* Glinides (Meglitinides such as Prandin/Repaglinide and Starlix/Nateglinide)

Answer 34

* Advantages: * Short duration * Disadvantages: * TID dosing * Expensive

Question 35

*Where does this oral med work?* Pioglitazone

Answer 35

Muscle

Question 36

*Where does this oral med work?* Repaglinide

Answer 36

Pancreas

Question 37

Which 3 drug classes cause weight gain?

Answer 37

1. Sulfonylureas (Glimepiride, Glipizide, Glyburide) 2. Thiazolidinediones (-glitazones) 3. Insulin

Question 38

*Which drug class?* Contraindicated in active liver disease.

Answer 38

Thiazolidinediones (-glitazones)

Question 39

*Which drug class?* Contraindicated in gastroparesis.

Answer 39

GLP-1 Analogs (-natides and -glutides such as Byetta, Victoza, and Trulicity)

Question 40

*Where does this oral med work?* Miglitol (Alpha Glucosidase Inhibitor)

Answer 40

Gut (carb metabolism)

Question 41

*What are advantages and disadvantages to this treatment?* Pramlintide (Symlin)

Answer 41

* Advantages: * Weight loss * Disadvantages: * Injections * TID dosing * GI side effects * Expensive

Question 42

*Where does this oral med work?* Sulfonylureas (Glimepiride, Glipizide, and Glyburide)

Answer 42

Pancreas

Question 43

*Where does this oral med work?* Nateglinide (-glinides)

Answer 43

Pancreas

Question 44

*Which drug class?* Increase insulin secretion.

Answer 44

* Secretagogues * Sulfonylureas: Glimepiride, Glipizide, Glyburide. * Meglitinides: Repaglinide, Nateglinide.