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PHARM > Antidiabetics > Flashcards

Antidiabetics Flashcards

(69 cards)

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1
Q

Which medication is used with an unconscious hypoglycemic patient?

A

Glucagon (GlucaGen) IV

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2
Q

MOA of Glucagon?

A

stimulates hepatic production of glucose from glycogen stores (glycogenolysis)

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3
Q

Adverse effects of Glucagon?

A

N/V

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4
Q

Precautionary measures when giving Glucagon?

A

Position patient in a side lying position d/t potential V and have suction available

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5
Q

Can IV Glucagon be administered through a line containing D5W?

A

No

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6
Q

What should be the rate of administration of Glucagon?

A

not exceeding 1mg/min

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7
Q

Biguanides are oral agent that act on which organ?

A

liver to decrease glucose production

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8
Q

What is the 1st line Biguanide medication?

A

Metformin (Glucophage)

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9
Q

Therapeutic use of Metformin?

A

T2DM, pre-diabetes, gestational diabetes, and POS

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10
Q

MOA of Metformin?

A
  1. Decreases hepatic glucose production.
  2. Decreases intestinal glucose absorption.
  3. Increases sensitivity to insulin.
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11
Q

Adverse effects of Metformin?

A

GI: Abdominal bloating, N/V/D

unpleasant metallic taste, decreased vitamin B12 levels

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12
Q

What is the black box warning for Metformin?

A

risk of lactic acidosis (chills, diarrhea, ↓BP ↓ HR, dyspnea, weakness)

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13
Q

Interactions with Metformin?

A

acute/chronic alcohol ingestion or iodine contrast media, and cimetidine (Tagamet)

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14
Q

What is the interaction of iodine contrast media with Metformin?

A

increases risk of lactic acidosis

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15
Q

Dosing schedule for Metformin administration?

A

immediate release (BID) and extended release (QD) w/ meals d/t GI upset

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16
Q

High risk patients for Metformin use?

A

renal insufficiency, liver disease, severe infection, HF, hx of lactic acidosis, shock or other conditions that cause hypoxemia, ETOH use

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17
Q

What does it mean that Metformin is weight neutral?

A

It will not cause patient’s to gain weight. Weight may actually decrease

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18
Q

T/F. Metformin will not cause hypoglycemia when given alone?

A

True

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19
Q

What causes reduced vitamin B12 levels when taking Metformin?

A

altered absorption

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20
Q

How can severe lactic acidosis be treated?

A

hemodialysis

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21
Q

Sulfonylureas and Meglitinides act on which organ?

A

the pancreas to increase the secretion of insulin

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22
Q

What is the prototype for Sulfonylureas?

A

Glyburide (DiaBeta)

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23
Q

Therapeutic use of Glyburide?

A

blood sugar control in T2DM when diet therapy fails.

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24
Q

MOA of Glyburide?

A
  1. Lowers blood sugar by stimulating the release of insulin from the pancreas.
  2. Increasing the sensitivity to insulin at receptor sites.
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25
Adverse effects of Glyburide?
hypoglycemia, photosensitivity, and weight gain
26
Interactions with Glyburide?
beta blockers, NSAIDs, sulfonamide abx all which will increase hypoglycemia
27
T/F. Any drug that increases insulin secretion will cause increased weight gain.
True
28
Glyburide contraindications?
pregnancy and lactation
29
Why should you avoid alcohol use with Glyburide?
increase risk of disulfiram like reactions (abdominal cramps, N, flushing, HA, and hypoglycemia)
30
Should Glyburide be taken with or without food?
with food
31
T/F. Kidney and liver dysfunction are high risk patients with Glyburide use?
True
32
Prototype for Meglitinides "Glinides"?
Repaglinide (Prandin)
33
Therapeutic use of of Repaglinide (Prandin)?
T2DM with diet and exercise, may be used with Metformin, rosiglitazone, or pioglitazone
34
MOA of Repaglinide?
stimulates the release of insulin from the pancreatic beta cells by closing K channels, which results in the opening of Ca channels in the beta cells
35
Adverse effects of Repaglinide?
Hypoglycemia
36
Interactions with Repaglinide?
Gemfribrozil (Lopid), multiple interactions
37
Why should patients with liver impairment be cautious if taking Repaglinide?
May increase risk of hypoglycemia
38
Does Repaglinide need to be taken with a meal?
yes, 30 minutes or less before eating
39
What is the interaction of Gemfibrozil with Repaglinide?
slows metabolism of glinides → increasing levels → risk of hypoglycemia
40
Alpha-glucosidase inhibitors (AGI) act on which system?
The GI tract to decrease absorption of glucose
41
Prototype for AGIs?
Acarbose (Precose)
42
Therapeutic use of Acarbose ?
management of T2DM
43
MOA of Acarbose?
inhibits the enzyme alpha-glucosidase in the GI tract → delays and reduces glucose absorption
44
Adverse effects of Acarbose?
ABDOMINAL PAIN, diarrhea, flatulence, and liver dysfunction
45
Interactions with Acarbose?
Several
46
Acarbose contraindications?
hypersensitivity, DKA, and cirrhosis
47
Should Acarbose be taken with meals?
with 1st bite of each meal TID
48
Is Acarbose used in the US?
No d/t side effects
49
T/F. All oral agents are contraindicated in T1DM
True
50
Dipeptidyl Peptidase 4 (DPP-4) inhibitors act on which organ?
pancreas to prolong the action of incretin hormones
51
Prototype for DPP-4 inhibitors?
Sitagliptin (Januvia)
52
MOA of Sitagliptin?
prolong the action of incretin hormones → increases insulin release → decreases glucagon levels
53
Therapeutic use of Sitagliptin?
T2DM glycemic control. May be used as monotherapy or combination therapy.
54
Adverse effects of SitagliptiN?
HA, N, acute renal failure, URI, stuffy or runny nose, ST, drug induced pancreatitis. Serious hypersensitivity rxns (anaphylaxis, angioedema, Steven-Johnson syndrome).
55
Sitagliptin contraindications?
DKA and hypersensitivity
56
Does Sitagliptin need to be taken with food?
With or without food
57
Symptoms of pancreatitis?
severe and persistent abdominal pain w/ or w/o vomiting.
58
Interactions with Sitagliptin?
Glyburide, Glipizide, or Glimepiride → can increase risk of hypoglycemia
59
Prototype for Glucagon-like peptide 1 receptor Agonist (GLP-1RA)?
Exenatide (Byetaa)
60
Therapeutic use of Exenatide?
T2DM management as adjunct to diet and exercise
61
MOA of Exenatide?
mimics the action of incretin which promotes endogenous insulin secretion and promotes other mechanisms of glucose lowering
62
Adverse effects of ExeNatiDe?
N/V/D (most common), dyspepsia, weight loss, decreased appetite, hypoglycemia, acute renal failure, and pancreatitis
63
Interactions with Exenatide?
will slow absorption of oral medications like oral contraceptives and abx
64
What are benefits of Exenatide?
protective factors for atherosclerotic CVD, HF, and CKD. Will help minimize hypoglycemia or promote weight loss.
65
Exenatide contraindications?
severe renal impairment
66
Exenatide precautions?
kidney transplant recipients
67
Route and dosing schedule for Exenatide?
Route: subcut | 60 min before morning and evening meals, not PC
68
Can Exenatide be mixed with insulin?
No
69
Can patients still take oral contraceptives or abx with Exenatide?
yes but 1hr before Exenatide

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