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Pharmacotherapeutics II > Diabetes > Flashcards

Diabetes Flashcards

1
Q

A1c reduction for DPP-4 inhibitor added to SU

A

0.3-0.6

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2
Q

A1c reduction for GLP analog added to Metformin

A

0.8

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2
Q

A1c reduction for GLP analog added to SU + Metformin

A

0.7-1.3

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2
Q

A1c reduction for DPP-4 inhibitor added to SU + Metformin

A

0.6

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3
Q

A1c reduction for SU added to Metformin or Metformin added to SU

A

0.7-1.4

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4
Q

A1c reduction for TZD added to Metformin

A

0.8-1.2

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5
Q

A1c reduction for TZD added to SU

A

1.1-1.4

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5
Q

A1c reduction for GLP analog added to SU

A

0.9

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5
Q

A1c reduction for TZD added to SU +Metformin

A

1.0-1.5

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6
Q

A1c reduction for DPP-4 inhibitor added to Metformin

A

0.5-0.7

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7
Q

Available products for α-glucosidase inhibitors

A

Acarbose & Miglitol

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8
Q

Available products for SGLT-2 inhibitors

A

-aglifozin

Canaglifozin

Dapaglifozin

Emaglifozin

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9
Q

Biguanide (Metformin) A1c reduction

A

1.5-2.0

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9
Q

Biguanide (Metformin) MOA

A

Enhances insulin sensitivity of both hepatic and peripheral (muscle) tissues. This allows for increased uptake of glucose into these insulin-sensitive tissues.

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9
Q

Dipeptidyl Peptidase 4 inhibitors adverse effects

A

Weight neutral

Dose related reduction in absolute lymphocyte count

Low risk of hypoglycemia when used as monotherapy

Increases risk of peripheral edema of TZDs

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10
Q

DPP-4 inhibitor that dose not recquire dose adjustment for renal dysfunction

A

Linagliptin (Tradjenta)

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11
Q

DPP-4 Inhibitors (-agliptins) MOA

A

Dipeptidyl peptidase-IV inhibitors prolong the half-life of an endogenously produced glucagon-like peptide-1. These agents partially reduce the inappropriately elevated glucagon post-prandially and stimulate glucose-dependent insulin secretion.

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13
Q

DPP-4 Inhibitors (-agliptins) A1c reduction

A

0.3-0.5

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13
Q

DPP-4 Inhibitors CV effects

A

Weight neutral/some weight loss

Positive effects on lipids and BP

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14
Q

Glipdizide brand name and dose

A

Glucotrol

IR: 5-10 mg PO daily; Max; 40 mg daily

Divide BID if dose is >15 mg

XL: 5-10 mg PO QD; Max: 20 mg QD

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14
Q

DPP-4 Inhibitors Monitoring Parameters

A

Renal function every 6-12 months (if dose adjustment is required!)
SMBG more frequently when starting these agents

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14
Q

Exenatide brand name and dose

A

Byetta

SubQ: Initial: 5 mcg BID within 60 minutes prior to a meal; after 1 month, may be increased to 10 mcg BID (based on response)

CrCl ≥50 mL/min: No adjustment necessary

CrCl 30-50 mL/min: Use caution when initiating or escalating doses

CrCl

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15
Q

GLP-1 analog that does not need dose adjustment for renal dysfunction

A

Liraglutide (Victoza)

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16
Q

GLP-1 analogs A1c reduction

A

0.5-1

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16
Q

GLP-1 analogs Adverse Effects

A

Weight loss

Low risk of hypoglyceia when used as monotherapy

Nausea/vomiting

Pancreatitis

17
Q

GLP-1 analogs CV effects

A

Weight loss

Positive effects on lipids and BP

19
Q

GLP-1 analogs MOA

A

Stimulates insulin secretion

20
Q

GLP-1 analogs Monitoring Parameters

A

Renal function: Q6-12 months (if dose adjustment is required for renal dysfunction)

SMBG: monitor more frequently upon starting these agents

At start of therapy at least QD or more often to determine effectiveness and ensure no hypoglycemia (if added to a secretagogue)

22
Q

Majority of effect is seen with 1/2 max dose with

A

Sulfonylureas

23
Q

Meglitinides (-glinides) A1c reduction

A

0.5-1.0

25
Q

Meglitinides (-glinides) MOA

A

Stimulates insulin release from the pancreatic beta cells to reduce postprandial hyperglycemia; amount of insulin release is dependent upon existing glucose levels

26
Q

Meglitinides (Repaglinide & Nateglinide) Adverse Effects

A

Hypoglycemia (less than SUs)

Weight gain (less than SUs)

27
Q

Meglitinides (Repaglinide & Nateglinide) Monitoring Parameters

A

SMBG
A1c stable: 3-4 days/weel

Meglitinide Dose being titrated: Daily
If dose is being titrated, may recommend patient monitor BG levels once daily

Hypoglycmia - ask about frequency of hypoglycemia at every medical visit that is scheduled to address diabetes care

Weight at every medical visit

29
Q

Metformin Adverse Effects

A

Most common: diarrhea/loose stools, dyspepsia, N/V

Reduced absorption of B12, metallic taste

Rare: Lactic acidosis (do not screen for it)

31
Q

Metformin Instant Release brand name and dose

A

Glucophage

500 mg PO BID or 850 mg PO QD

In 5-7 days:

500 mg PO BID –> 1,000 mg PO BID

850 mg PO QD –> 850 mg PO TID

FDA approved max: 2,550 mg/day

Max effective: 2,00 mg/day

80% of effectiveness: 1,500 mg/day

32
Q

Metformin manufaturer contraindications

A

SCr ≥1.5 for men
SCr ≥1.4 for women

ADA: not contraindicated, increase monitoring based on eGFR

HF precaution (not contrainidication –> monitor carefully)

33
Q

Metformin Monitoring Parameters

A

Renal function - SCr, creatinine clearance
At least annually
Q3-6 months in patents at risk for renal dysfunction or pts with renal dysfunction (older pts)

SMBG
Stable A1c: 3-4 days/week

Metformin being titrated: Daily

34
Q

Pioglitazone brand name and dose

A

Actos

15-30 mg QD to start

Can titrate to 45 mg QD max

Maximum 15 mg QD in NYHA class I and II HF

35
Q

Pioglitazone contraindications

A

NYHA Class III and IV HF

36
Q

SGLT-2 inhibitors Adverse Effects

A

Genital fungal infections in men and women

Volume depletion (dehydration)

37
Q

SGLT-2 inhibitors effecton lipids, weight and hypoglycemia risk

A

Slight increases in LDL

Weight loss

Low risk of hypoglycemia when used as monotherapy

(Ineffective in patients with renal impairment)

38
Q

Glimperide brand name and dose

A

Amaryl

1-4 mg PO daily; Max 8 mg PO daily

Divide BID if dose >10mg

39
Q

SGLT2 Inhibitors (-aglifozin) A1c reduction

A

0.7-1.0

41
Q

SGLT2 Inhibitors (-aglifozin) MOA

A

SLGT2 inhibition → reduced reabsorption of glucose filtered from tubular lumen → increased excretion of glucose in urine → reduced plasma glucose

42
Q

Sitagliptin brand name and dose

A

Januvia

100 mg QD

CrCl 30-50 mL/min: 50 mg QD

CrCl

ESRD on hemodialysis: 25 mg QD

43
Q

Start insulin immediately in a Type II if:

A
  1. FPG >250 mg/dL
  2. Random PG consistently >300 mg/dL
  3. A1c >10%
  4. Ketonuria
  5. Significant weight loss, polyuria, polydipsia
44
Q

Starting dose of insulin for Type I or Type II monotherapy

A

0.5-0.6 units/kg

45
Q

Starting dose of insulin for Type II with other medications

A

0.1-0.3 units/kg or a set dose 10 units

(usually a long acting before dinner or at bedtime)

47
Q

Sulfonylureas A1c reduction

A

1.5-2.0

49
Q

Sulfonylureas Adverse Effects

A

Hypoglycemia

Weight Gain

Hemolytic anemia potential in people with G6PD deficiency

51
Q

Sulfonylureas MOA

A

Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites

52
Q

Sulfonylureas Monitoring Parameters

A

Renal function

SCr, creatinine clearance (especially with active metabolites that recquire renal elimination)

SMBG

A1c controlled: 3-4 days/week

SU Dose being titrated: Daily

Hypoglycemia - ask about frequency of hypoglycemia at every medical visit that is scheduled to address diabetes care

Weight at every medical visit

53
Q

Takes up to 4-6 weeks to see effect and up to 12 weeks to see full effect

A

Thiazolidinediones (Pioglitazsone & Rosiglitazone)

54
Q

Thiazolidinediones (-glitazones) A1c reduction

A

0.5-1.5

55
Q

Thiazolidinediones (-glitazones) MOA

A

These agents activate PPAR-γ, a nuclear transcription factor important in fat cell differentiation and fatty acid metabolism. PPAR-γ agonists enhance insulin sensitivity in muscle, liver, and fat tissues indirectly. Insulin must be present in significant quantities for these actions to occur.

56
Q

Thiazolidinediones (Pioglitazone & Rosiglitazone) Adverse Effects

A

Weight gain/fluid retention
HF exacerbations
Increased risk for bladder cancer
Increased fracture risk in post-menopausal women
Liver injury (more of a risk with predecessor TZD: troglitazone)
Small reduction in hgb/hct of 2-4%

Thought to be due to increased plasma volume
Tends to occur when starting of therapy

Low risk for hypoglycemia when given as monotherapy

57
Q

Thiazolidinediones (Pioglitazone & Rosiglitazone) Monitoring Parameters

A

Liver function: AST/ALT at baseline then “periodically”

SMBG
Stable A1c: 3-4 times/week TZD Dost titrated: Daily

Weight at every medical visit

Sign/symptoms of HF exacerbation (in pts with HF or RFs for HF)

Rapid weight gain (>5 lbs in 1 week)
Edema
Increasing dyspnea

Do NOT need to routinely monitor CBCs (but be aware that small reductions in hgb/hct may be due to TZD)

Bone health screening – based on patient’s risk factors

58
Q

TZDs effects on lipids

A

Pioglitazone: decrease TG, increase LDL, increase HDL

Rosiglitazone: increase all 3

59
Q

α-glucosidase (acarbose and miglitol) inhibitors MOA

A

These agents prevent the breakdown of sucrose and complex carbohydrates in the small intestine, thereby prolonging the absorption of carbohydrates.

60
Q

α-glucosidase (acarbose & miglitole) inhibitors A1c reduction

A

0.3-1

61
Q

α-glucosidase inhibitors (Acarbose & Miglitol) Adverse Effects

A

Mostly GI: flatulence, gas/abdominal bloating

Low risk for hypoglycemia when given as monotherapy

62
Q

α-glucosidase inhibitors (Acarbose & Miglitol) Contraindications

A

Hypersensitivity, DKA, Inflammatory Bowl Disease, Colonic ulceration

Acarbose: SCr >2.0

Pharmacotherapeutics II (3 decks)

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