Treatment of Diabetes – Oral Agents Flashcards

1
Q

Intensive glucose control has been shown to reduce _________________.

A

microvascular disorders and all-cause mortality

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2
Q

Recombinant human insulin was first approved by the FDA in ________.

A

1982

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3
Q

What diabetes drug is an alpha glucosidase inhibitor?

A

Acarbose

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4
Q

For type 2 diabetes, the first therapy recommended –and the cornerstone of all therapies –is _________.

A

lifestyle modifications (weight loss; lower calorie intake; more complex carbohydrates)

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5
Q

True or false: biguanide increases the release of insulin.

A

False. Biguanide (brand name Metformin) enhances insulin’s ability to suppress hepatic glucose release.

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6
Q

Recently, guidelines have recommended that doctors assess ________ before prescribing Metformin to patients.

A

GFR

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7
Q

What are the pros and cons of Metformin use?

A

Pros:

  • it doesn’t cause weight gain
  • it can be used with other diabetes medications
  • it doesn’t carry a risk of hypoglycemia
  • it is inexpensive

Cons:

  • it can cause GI side effects
  • it carries a risk of lactic acidosis (particularly with concomitant imaging contrast, CHF, renal insufficiency, or liver disease)
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8
Q

After trying lifestyle modifications, give _________ to those with T2DM.

A

Metformin

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9
Q

Which two oral medications can lower A1c by the maximum amount?

A

Metformin and the sulfonylureas (both of which can lower A1c by 1-2%

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10
Q

GLP-1 is made by the _______________.

A

L cells in the distal ileum

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11
Q

GIP (gastric inhibitory peptide) is made by ____________.

A

the K cells in the duodenum

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12
Q

GLP-1 and GIP are secreted in response to ____________.

A

food intake

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13
Q

What is the incretin effect?

A

Consuming food by mouth leads to a greater release of endogenous insulin than does raising blood glucose levels to the same amount.

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14
Q

Those with __________ have a decreased incretin effect.

A

T2DM

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15
Q

In addition to stimulating insulin release, the incretins also ____________.

A

decrease glucagon release

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16
Q

GLP-1 decreases hepatic release of glucose via two mechanisms: ______________.

A

decreasing release of glucagon and increasing release of insulin (which also decreases gluconeogenesis by the liver)

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17
Q

True or false: the GLP-1 analogues can be given orally.

A

False. The DPP-4 inhibitors, however, are oral.

18
Q

What does SGLT-2 stand for?

A

Sodium-GLucose co-Transporter 2

19
Q

The -gliflozin drugs work by what mechanism?

A

They inhibit the SGLT-2 channels, thereby preventing glucose reuptake in the proximal convoluted tubules of the kidney.

20
Q

The maximum glucose concentration at which SGLT-2 can re-absorb in the PCT is __________; the -gliflozins bring this down to __________.

A

180 mg/dL; 90 mg/dL

21
Q

What side effects do the SGLT-2 inhibitors drugs cause?

A
  • Increased risk for UTIs (from the excess urinary glucose)
  • Risk for hypokalemia (be sure to correct this in the PDF/PP, because she said she accidentally wrote hyperkalemia)
  • Hypotension (because of osmotic diuresis)
22
Q

What side effects come with use of sulfonylureas?

A
  • Hypoglycemia
  • Weight gain
  • Loss of effectiveness due to increased insulin resistance
23
Q

Which two non-insulin drugs should you NEVER co-administer?

A

GLP-1 analogues and DPP-4 inhibitors

24
Q

Which three non-insulin drugs are best for patients with ASCVD?

A

Metformin
GLP-1 agonists
SGLT-2 inhibitors

25
Q

Go straight to insulin in type 2 diabetics with _____________.

A

impaired renal or hepatic function

26
Q

The shortest-acting sulfonylurea is ___________.

A

glipizide

27
Q

What are three contraindications for sulfonylurea?

A

Liver disease, renal failure, or G6PD deficiency

28
Q

The FDA now recommends obtaining ___________ prior to prescribing metformin.

A

the patient’s eGFR

29
Q

Use of ___________ has been associated with bladder cancer.

A

thiazolidinediones

30
Q

True or false: GLP-1 secretion by L cells in the distal ileum occurs roughly an hour after food has been ingested.

A

False. It occurs within minutes.

31
Q

Why is there no pharmacologic analogue of GIP?

A

Because those with type 2 diabetes are generally resistant to the effects of GIP

32
Q

The two main effects of using GLP-1 analogues are ____________.

A

lowered A1c and weight loss

33
Q

What is the main advantage of DPP-4 use over GLP-1 analogue use?

A

DPP-4 are oral!

34
Q

Pramlintide was developed because amylin ______________.

A

has a tendency to form amyloid deposits

35
Q

The main effects of pramlintide are _______________-.

A

delayed gastric emptying and decreased postprandial glucagon secretion

36
Q

You know that metformin and GLP-1RAs can help with weight loss, but there is another non-insulin diabetes medication that can, too. What is it?

A

SGLT-2

37
Q

The least potent drug (in terms of A1c lowering ability) is ____________.

A

DPP-4 inhibitors

38
Q

what two drugs lower cardiovascular events

A

SGLT2 inhibitors and GLp-1 agonists

39
Q

indications for SGLT2

A

reduce CV risks
prevent heart failure hospitalization
reduce BP
oral administration

40
Q

Indications for GLP-1 agonist

A

reduce CV risk
weight loss
once weekly subcutaneous dosing