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Pharm Practice 4 > Diabetes > Flashcards

Diabetes Flashcards

(67 cards)

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1
Q

Type 1 DM

A

absolute deficiency of insulin production
onset is usually during childhood
most autoimmune in nature

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2
Q

Type 2 DM

A

relative deficiency of insulin production associated with tissue insulin resistance
usually occurs during adulthood
mostly due to genetics/lifestyle
MOST COMMON

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3
Q

HYPOglycemia symptoms

A

tremors, tachycardia, diaphoresis, dizziness, anxiousness, increased appetite, impaired vision, weakness, headache, irritability

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4
Q

HYPERglycemia symptoms

A

polyuria, polydipsia, sweet/fruity breath, somnolence, increased appetite, blurred vision, nausea, vomiting

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5
Q

Non-DM drugs that cause HYPERglycemia

A

systemic corticosteroids, protease inhibitors (ritonavir), oral contraceptives (estrogens), diuretics (furosemide, HCTZ), atypical antipsychotics (olanzapine, clozapine), beta-agonists

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6
Q

Non-DM drugs that cause HYPOglycemia

A

alcohol, pentamidine, fluoroquinolones, beta blockers

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7
Q

DM treatment guidelines

A

American Diabetes Association - Standards of Medical Care in Diabetes
AMerican Association of Clinical Endocrinologists - AACE/ACE Comprehensive Type 2 DM Management

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8
Q

Metformin

A

Glucophage/Glucophage XR/Glumetza
decreases hepatic glucose production and intestinal glucose absorption
Improves insulin sensitivity by increasing glucose uptake and utilization in skeletal muscle and adipose tissue

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9
Q

Metformin AEs, Precautions, Contraindications

A

AEs: diarrhea, GI upset, vitamin B-12 deficiency, lactic acidosis
Precautions: hepatic impairment, CV disease, renal impairment (eGFR 30-45), black box warning: lactic acidosis
Contraindications: eGFR<30, acute/chronic metabolic acidosis

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10
Q

Metformin Pearls

A

take w/ food
shell of ER form may remain intact and visible in stool
drug-drug interactions: ranolazine (increases serum conc. of metformin), alcohol (increase risk of hypoglycemia)
weight neutral
d/c before contrast dye

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11
Q

Sulfonureas MOA and AEs

A

MOA: Directly stimulates insulin secretion from functioning beta cells in the pancreas
Increases insulin sensitivity and lowers hepatic glucose production
AEs: hypoglycemia, weight gain

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12
Q

Sulfonureas Precautions, contraindications and Counseling points

A

Precautions: renal/hepatic impairment, sulfa allergy, G6PD deficiency, don’t use w/ meglitinides
CIs: ketoacidosis, type 1 DM
Counseling: maintain consistent diet - take w/ breakfast, s/s of hypoglycemia, weight gain (esp. glyburide), decreased efficacy over time

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13
Q

Glipizide

A

Glucotrol/Glucotrol XL
5-20mg once/day or BID
Take 30 mins before meals

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14
Q

Glyburide

A

Diabeta/Micronase
2.5-5mg once or BID
Take w/ breakfast/1st meal of the day
Not recommended in CKD or concomitant use of bosentan

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15
Q

Glimepiride

A

Amaryl
1-4mg QD
Take w/ breakfast/1st main meal

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16
Q

Meglitinides MOA, AEs, Precautions

A

MOA: lowers glucose levels by stimulating release of insulin - interacts w/ ATP sensitive K+ channel on beta cells in pancreas
AEs: hypoglycemia, weight gain
Precautions: don’t use w/ sulfonureas, caution in renal/hepatic impairment

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17
Q

Meglitinides - benefits over sulfonureas

A

effects primarily postprandial glucose level, variable meal schedule (skipped meal = skip a dose), shorter duration of action, reduced incidence of hypoglycemia throughout the day

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18
Q

Repaglinide

A

Prandin
0.5mg TID w/ meals
Skip a meal = skip a dose, Take 30mins or less before a meal
CI w/ concurrent gemfibrozil

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19
Q

Nateglinide

A

Starlix
60-120mg TID w/ meals
Skip a meal = skip a dose, Take 30mins or less before a meal

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20
Q

Alpha-glucosidase inhibitors MOA, AEs

A

MOA: lowers postprandial glucose by competitive reversible inhibition of pancreatic alpha-amylase and membrane bound intestinal alpha-glucoside hydrolysis - inhibits hydrolysis of complex starches decreasing glucose absorption
DOESN’T ENHANCE INSULIN SECRETION
AEs: GI side effects (flatulence, diarrhea, abdominal pain), elevated AST/ALT

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21
Q

Alpha-glucosidase inhibitors Precautions and Contraindications

A

Precautions: not recommended if SCr >2mg/dl or CrCl <25
CI: ketoacidosis, inflammatory bowel disease, bowel obstruction, colonic ulceration or other chronic intestinal disorder

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22
Q

Acarbose

A

Precose
25mg TID
Take w/ 1st bite of food

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23
Q

Miglitol

A

Glyset
25mg TID
Take w/ 1st bite of food
CI in cirrhosis

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24
Q

GLP-1 mimetics MOA

A

increase insulin in presence of elevated glucose conc. (stimulates B-cells in pancreas)
decreases glucagon secretion in glucose-dependent manner (inhibits a-cells in pancreas)
delays gastric emptying
regulates appetite

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25
GLP-1 mimetics AEs, Precautions, Counseling points
AEs: n/v/d, headache, pancreatitis Precautions: pancreatitis, boxed warning: thyroid cancer Counseling: injection technique, weightloss
26
Liraglutide
Victoza 1.8mg SQ QD less GI side effects
27
Exenatide
``` Byetta/Bydureon Byetta: 5-10mcg SQ QD can increase INR, CI: CrCl <30 Bydureon: 2mg SQ qweek needs to be assembled ```
28
Albiglutide
Tanzeum 30-50mg SQ qweek must dissolve first
29
Dulaglutide
Trulicity | SQ qweek
30
DPP-4 inhibitors MOA
inhibits degradation of incretiin hormones (GLP-1) by DPP-4 - GLP-1 is an incretin hormone released in response to food intake to maintain glucose homeostasis enhances function of GLP-1 to increase release and decrease glucagon levels in circulation in a glucose dependent manner
31
DPP-4 Inhibitors AEs, Precautions, Counseling Points
AEs: nasopharyngitis, pancreatitis, arthralgia, angioedema, urticaria Precautions: renal insufficiency, use w/ agents that cause hypoglycemia Counseling: take w/ or w/o food, weight neutral
32
SitaGLIPTIN
Januvia 100mg QD renal adjustment may increase digoxin levels
33
LinaGLIPTIN
Tradjenta 5mg QD CYP3A4 interactions
34
SaxaGLIPTIN
Onglyza 2.5-5mg QD renal adjustment, CYP3A4 interactions Avoid in new/worsening HF
35
AloGLIPTIN
Mesina 25mg QD renal adjustment Avoid in new/worsening HF
36
SGLT-2 Inhibitors MOA
highly selective for SGLT-2 in S1 segment of proximal renal tubules - reduces renal threshold reduces glucose reabsorption increases loss of glucose in urine reduces plasma glucose levels
37
SGLT-2 Inhibitors AEs, Precautions, Counseling
AEs: UTI/fungal infections, increased urination, increased LDL, dizziness Precautions: ketoacidosis, hypotension, fractures, hyperkalemia, renal impairment - CI w/ CrCL <30 Counseling: weightloss, s/s of decreased BP
38
CangliFLOZIN
``` Invokana 100mg QD Take w/ 1st meal of the day CYP3A4 substrate 300mg dose can be used if eGFR >60 **increased risk of leg/foot amputations ```
39
DapagliFLOZIN
Farxiga | 5mg QD
40
EmpagliFLOZIN
Jardiance 10mg QD **Decrease CV mortality and hospitalization due to HF in T2DM w/ CVD** Dose adjust w/ eGFR <45
41
Thiazolidinediones (TZDs) MOA
Skeletal muscle: increase glucose uptake Adipose tissue: increase fatty acid uptake/lipogenesis/glucose uptake (= adipogenesis) Liver: decrease gluconeogenesis --> decreases plasma free fatty acids and hyperglycemia
42
TZD AEs, Precautions, and Contraindications
AEs: edema, macular degeneration, weight gain, muscle pain, headache Precautions: edema/macular edema, bladder cancer, fractures, drug-drug interactions CI: HF
43
PioGLITAZONE
Actos 15mg QD decreased TG may reduce CVD
44
RosiGLITAZONE
Avandia 4mg QD increased LDL **Do not initiate in patients w/ stable IHD
45
Glucovance
glyburide-metformin
46
Janumet/Janumet XR
sitagliptan-metformin
47
Jentadueto/Jentadueto XR
linagliptan-metformin
48
Kombiglyze/Kombiglyze XR
saxagliptan-metformin
49
Invokamet
canagliflozin-metformin
50
Glyxambi
empagliflozin-linagliptin
51
Duetact
pioglitazole-glimepiride
52
Insulin Indication, AEs, Precautions
Type 1 & 2 DM AEs: hypoglycemia, injection site rxn, weight gain Precautions: hypoglycemia
53
Rapid acting insulins
Aspart - Novolog (flexpen) Lispro - Humalog (kwikpen) Glulisine - Apidra (Solostar)
54
Novolog/Flexpen
``` Onset: 10-20mins Peak: 40-50mins Duration: 3-5hrs expires 28 days after opening give 5-10 mins before meal ```
55
Humalog/Kwikpen
``` Onset: 15-30mins Peak: 30mins -2.5hrs Duration: 3-5hrs expires 28 days after opening give 15 mins before or w/in 20mins after starting a meal ```
56
Apidra/Solostar
``` Onset: 25mins Peak: 45-50mins Duration: 4-5hrs expires 28 days after opening give 15 mins before or w/in 20mins after starting a meal ```
57
Short/Intermediate Acting Insulins
Regular - Humulin R, Novolin R | NPH - Humulin N, Novolin N
58
Humulin R
``` Onset: 30-60mins Peak: 1-5hrs Duration: 4-12hrs OTC give 30 mins before a meal Expires 28 days after opening ```
59
Novolin R
``` Onset: 30mins Peak: 2.5-5hrs Duration: 8 hrs OTC give 30 mins before a meal Expires 42 days after opening ```
60
Humulin N
``` Onset: 1-2hrs Peak: 6-14hrs Duration: up to 24hrs OTC Should be cloudy vials expire 28 days after puncturing pens expire 14 days after 1st use ```
61
Novolin N
``` Onset: 90mins Peak: 4-12hrs Duration: up to 24hrs OTC Should be cloudy expires 42 days after opening ```
62
Basal Insulins
Degludec - Tresiba Flextouch Detemir - Levemir/Flextouch Glargine - Lantus/Solostar, Toujeo Solostar
63
Tresiba Flextouch
``` Onset: 30-90mins Peak: none Duration: 24+ hrs Once daily dosing expires 56 days after opening ```
64
Levemir/Flextouch
``` Onset: 1-2hrs Peak: none Duration: up to 24hrs can be once or twice daily Expires 42 days after opening ```
65
Lantus/Solostar | Toujeo Solostar
``` Onset: 1-2hrs Peak: none Duration: up to 24hrs acidic pH cloudy appearance Toujeo is more concentrated than Lantus Expires 28 days after opening ```
66
Insulin Dosing: Type 2 DM
start w/ basal insulin: 0.2 units/kg (min 10units) at bedtime, check FBG daily, increase 2-4 units every 3 days until FBG target is met If very high FBG (>250) initial dose can be higher and titration can be more aggressive Bolus, if needed: 4-6 units w/ meals - increase by 2-3 units every 3 days until postprandial glucose target is met
67
Insulin Dosing: Type 1 DM
Basal-bolus dosing: 0.5units/kg body weight 50% bolus dosing 50% basil dose

Pharm Practice 4 (8 decks)

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