L30- Antidiabetic Drugs II (drug guidelines)

Question 1

_____ is the initial drug 1st line therapy for type II DM

Answer 1

Metformin (inhibits gluconeogenesis, inc liver/muscle glucose utilization)

Question 2

Monotherapy with non-insulin antidiabetic can by itself reduce HbA1c by (1)

Dual therapy in newly diagnosed type II DM patients is considered if (2)

Answer 2

1- ~1%

2- HbA1c is >1.5% above glycemic target

Question 3

Monotherapy, = (1), is advanced to dual combination therapy if (2) is not achieved. (3) or (4) are the additional 2nd drug.

Answer 3

1- metformin

2- HbA1c goal is reached in ~3 mos

3- GLP-1 agonist (incretiin analog: exentide)
4- basal insulin

Question 4

Dual therapy, = (1), is advanced to triple therapy if (2) persists, then (3) will be added.

Answer 4

1- metformin, GLP-1 agonist (exentide)

2- HbA1c >8.5%

3- insulin (basal, then mealtime)

Question 5

describe why GLP-1 receptor agonist or insulin therapy is preferred

Answer 5

*GLP-1 receptor agonist (incretin analog: exentide)

Pros: (to minimize hypoglycemia or weight gain)

• similar efficacy
• lower hypoglycemic risk
• dec weight

Cons:

• greater GI side-effects, lower tolerability
• high cost

Question 6

Insulin is indicated as initial diabetic therapy if……

Answer 6

(for DM II)

• ongoing catabolism (weight loss)
• significant hyperglycemic Sxs
• ketonuria
• HbA1c >10%
• random glucose >300

Question 7

describe the management of diabetes in pregnancy

Answer 7

(pre-existing DM I or II, and gestational DM)

insulin (doesn’t cross placenta)

Question 8

DM managment in pregnancy:

• (1) is typical insulin regimen choice
• (2) is then usually added if needed

Answer 8

1- NPH (intemediate acting), single dose at bedtime

2- postprandial control: lispro, aspart (rapid-acting)

Question 9

list the main diabetic complications

Answer 9

CVS: HTN, dyslipidemia, anti-platelet therapy

Nephropathy

Neuropathy: neuropathic pain, gastroparesis, ED

Question 10

________ is the major cause of death in diabetics

Answer 10

cardiovascular disease

Question 11

list the drugs of choice for HTN in DM

Answer 11

1) ACEI / ARB (especially to reduce albuminuria if present –> dec risk of CRF)
2) thiazide
3) dihydropyridine CCB

Question 12

describe management of dyslipidemia in DM

Answer 12

Statins regardless of lipid levels for patients with:

• overt CVD
• <40 y/o w/ CVD risk factors
• > 40 y/o w/ or w/o CVD risk factors

Question 13

_____ therapy (OTC) is considered as a primary prevention strategy in patients with DM I or II

Answer 13

ASA- anti-platelet agent

Question 14

(T/F) neuropathic pain is simply treated with traditional pain therapies (NSAIDs, opiods, etc)

Answer 14

F- does not respond well to traditional pain therapies

Question 15

(1) and (2) are common ANS neuropathic symptoms, include Tx

Answer 15

1- Gastroparesis (delayed gastric emptying Sxs) –> Prokinetic Agents: metoclopramide, erythromycin

2- ED –> phosphodiesterase type 5 inibitors (sidenafil)

Question 16

list the clinical uses of Glucagon

Answer 16

Severe Hypoglycemia, especially in diabetic Pts
β-blocker poisoning / overdose

Bowel Radiology –> relaxes bowel
Glucagon C-peptide Test (tests residual β-cell function in diabetics)