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Pharmacology PaxFlan > DiaBETES > Flashcards

DiaBETES Flashcards

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1
Q

Biguanes

A

metformin

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2
Q

metformin MOA

A

decrease hepatic glucose production

and increase GLP-1

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3
Q

indications for metformin

A

prediabetes
1st line for an oral diabetes (non-insulin) med - *every DMII should be on it!
PCOS

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4
Q

what is prediabetes

A

fpg 100-125 or A1C 5.7-6.4%

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5
Q

steps in treating a PCOS patient

A

1: diet/exercise/metformin
2: ocp > spironolactone to decrease testosterone
3: HRT for fertility

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6
Q

dosing of metformin at start

A

250-500 mg/day

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7
Q

titration of metformin

A

250-500 mg q1-2 weeks

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8
Q

what is the usual effective dose of metformin

A

2g

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9
Q

weight implications + hypoglycemic effects of metformin

A

weight lowering/neutral

rarely causes hypoglycemia

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10
Q

other benefits of metformin

A

decrease micro/macro-vasc complications

decreases TG, decrease in LDL, increase in HDL (modest)

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11
Q

monitoring for metformin

A

H&H, RBC indices (monitor B12)

eGFR

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12
Q

what else to prescribe with metformin + why

A

multivitamin for vitamin B12 deficiency

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13
Q

who should not get metformin + why

A

HF exacerbation –> LA
renal dysfunction –> LA
hepatic dysfunction

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14
Q

renal function and metformin

A

do not start if eGFR <30!!!

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15
Q

specific interaction of metformin

A

d/c prior to and for 48 hours after procedure involving IV administration of iodinated contrast –> can cause AKI

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16
Q

ADR of metformin

A

metallic taste
N/V/D, anorexia, abdominal discomfort
macrocytic anemia, peripheral neuropathy
lactic acidosis

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17
Q

should you stop metformin if pt has a B12 deficiency?

A

no - benefit outweighs risk

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18
Q

what drug classes should you measure LFTs in

A

GLP-1
DDP-4
TZD (glitazones)

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19
Q

interactions with all diabetes meds

A

concomitant hypoglycemia meds

hyperglycemia-inducing agents (steroids)

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20
Q

sulfonylureas

A

glipizide
glyburide
glimepiride

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21
Q

what sulfonylurea should you avoid in elderly

A

glimepiride

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22
Q

what sulfonylurea is not recommended in anyone + why

A

glyburide d/t disulfram-like rxn

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23
Q

what is the best option sulfonylurea

A

glipizide

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24
Q

MOA of sulfonylurea

A

stimulation of insulin secretion via ATP-dependent K+ channels in pancreatic B-cells

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25
renal function and glyburide
do not give if eGFR < 50
26
when should pts take sulfonylureas
in AM before breakfast
27
weight implications + hypoglycemic effects of sulfonylureas
weight gain and hypoglycemia | glyburide > glimepiride > glipizide
28
precaution for sulfonylureas
pts with sulfonamide allergies
29
in what patients is drug-induced hypoglycemia more common in
``` ETOH ingestion a lot of exercise low calorie intake 1 or more glucose lowering drug (Paxton on a plane) ```
30
reactions of glyburide
"disulfiram-like" rxn with ETOH ingestion
31
meglitinides
nateglinide repaglinide (MEG- REPents NATE)
32
meglitinides MOA
increase insulin secretion via ATP-dependent K+ channels in pancreatic B-cells (same as sulfonylureas)
33
when should meglintinides be taken + what should you tell pts about meals and taking the drug
in AM prior to meal | skip a meal - skip the drug!!
34
weight implications + hypoglycemic effects of meglitinides
weight neutral and hypoglycemia
35
interactions of meglitinides
substrate of 2C9 & 3A4
36
Thiazolidinediones
pioglitazone | rosiglitazone
37
TZD MOA
increase insulin sensitivity in muscle, adipose, liver --> increase glucose utilization and decrease glucose production via PPAR-y agonism (genes)
38
indications for TZD
DMII (when you MUST) | PCOS (use metformin 1st)
39
how long should it take TZD to take full effect and why
6-14 weeks because it is influencing genes!
40
lipid effects with TZDs
pioglitazone has favorable lipid effect
41
contraindications/warnings for TZD
bladder cancer! (pioglitazone) NYHA III or IV HF patients MI patients
42
ADRs of TZDs
weight gain fluid retention --> edema decreased bone density = increased fracture risk hepatotoxicity
43
Alpha-glucosidase inhibitors
acarbose | miglitol
44
alpha-glucosidase MOA
inhibits a-glucosidase enzymes that line brush border of SI = delayed absorption of glucose & other monosaccharides
45
weight implications for alpha-glucosidase inhibitors
weight neural
46
contraindications for alpha-glucosidase inhibitors
pts with intestinal or bowel disease, or intestinal obstruction
47
ADR of alpha-glucosidase inhibitors
abdominal pain, diarrhea, flatulence (d/c often because of this)
48
what are the 2 incretins
glucose-dependent insulinotropic peptide (GIP) | glucagon-like peptide (GLP-1)
49
GLP-1 incretin MOA
stimulates insulin secretion | inhibits glucagon secretion, hepatic glucose production, gastric emptying, appetite
50
when are incretins normally released
throughout the day in response to a meal
51
how does DPP-IV impact insulin levels
by increasing active levels of incretin hormones
52
GLP-1 agonists
``` (tides and glutides) exenatide semaglutide liraglutide lixisenatide dulaglutide ```
53
what is the most potent GLP-1 drug for lowering A1C
semaglutide
54
what are the 3 GLP-1 agonists that are "pushed" by cardiologists due to its + CV effects
sema, lira, dula | she loves dogs
55
what is an indication for liraglutide aside from DMII
weight loss aid (pts w BMI > 30 or >27 with weight-related condition)
56
weight implications + hypoglycemic effects of GLP-1
weight loss, rare hypoglycemia
57
storage for GLP-1
store in fridge
58
contraindications/warnings for GLP-1s
gastroparesis (b/c it slows gastric emptying) CKD patients thyroid nodule patients
59
interactions for GLP-1 and why
OCPs taken 1 hr before or 11 hrs after IR products because GLP-1s delay gastric emptying
60
ADRs of GLP-1s
GI intolerance (nausea) thyroid c-cell carcinoma acute pancreatitis biliary/gallbladder dz
61
DPP-IV inhibitors
``` (gliptins) sitagliptin saxagliptin linagliptin alogliptin ```
62
DPP-IV inhibitors and postprandial blood glucose
more effective at reducing postprandial blood glucose than it is at reducing fasting blood glucose
63
DPP-IVs ADRs
acute pancreatitis/cancer (as with GLP-1s) hypersensitivity rxn severe joint pain
64
SGLT-2 inhibitors
(gliFLOZINs) canagliflozin dapagliflozin empagliflozin
65
SGLT-2 of choice
empagliflozin
66
SGLT-2 MOA
transports filtered glucose from proximal renal tubule into tubular epithelial cells decreased glucose/Na reabsorption, increased urinary glucose/Na excretion, decrease blood [glucose]/BP *basically - sugar and sodium diuretic!!
67
when should pts take SGLT-2s
before 1st meal of day
68
weight implications + hypoglycemic effects of SGLT-2
weight loss, no hypoglycemia
69
monitoring for SGLT-2s
renal function (like in ACE/ARB)
70
contraindications for SGLT-2s
not for CKD patietns
71
do not give SGLT-2s with what other drugs
ACE/ARB/NSAID (can = AKI)
72
SGLT-2 ADRs
genital myocotic infections, UTI, Fournier's gangrene volume depletion/hypotension AKI (dehydration, poor renal function, NSAID/diuretic/ACE/ARB >>) increased fracture risk euglycemic DKA (DKA with normal BS!)
73
dapagliflozin ADR
small increase risk in bladder cancer
74
canagliflozin ADR
small risk of toe & mid-foot amputations
75
prandial insulins
regular = fast acting | lispro, aspart, glulisine = faster acting
76
basal insulins
NPH = intermediate-acting | glargine, detemir, degludec = long-acting
77
with what patients should you decrease the dose of insulin
CKD patients (because insulin is broken down in kidney)
78
onset + duration of regular insulin
onset 30-60 min, duration 5-8 hrs
79
when to take regular insulin
30 min prior to meal
80
advantages of regular insulin
cheap, good for DM gastroparesis
81
general onset + duration of faster acting prandial insulins
onset 10-30 min, duration 3-5 hrs
82
when to take faster acting insulins
right before 1st bite
83
advantages to faster acting insulins
reduction in postprandial hyperglycemia | hypoglycemia less than regular
84
onset + duration of NPH insulin
onset 1-2 hrs, duration 12-24 hrs
85
when to take NPH insulin
15 min before meals when mixed with rapid-acting | 30 min before if mixed with regular
86
advantages of NPH insulin
cheap
87
onset + duration for long-acting insulins
onset 60-90 min, duration 24-42 hrs
88
how often to take glargine, detemir, degludec
qday because of long duration of action
89
can long-acting insulins be combined with other insulins
nah
90
what can you try if pt refuses to take 2 injections/day
biphasic insulin (70% NPH, 3% regular)
91
what to start with when initiating insulin
longer-acting, "basal" insulin once daily (10 units NPH or long-acting)
92
what else to add after longer-acting insulin is started
1: GLP-1 agonist 2: prandial insulin (aspart) at largest meal 3: switch to premixed insulin (70/30) BID
93
what non-insulin drugs can be combined with insulin
GLP-1, DDP-IV, gliflozins (SGLT-2)
94
Metformin category in pregnancy
B
95
what types of insulin have most data in pregnancy
NPH, regular | insulin is gold standard for pregnant DMII pts

Pharmacology PaxFlan (12 decks)

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