Diabetes Flashcards
(68 cards)
1
Q
Diabetes Medications
A
- Biguanides
- Sulfonylureas
- Meglitinide derivatives
- Alpha-glucosidase inhibitors
- thiazolidinediones (TZDs)
- Glucagonlike peptide-1 (GLP-1) agonists
- dipeptidyl peptidase IV (DPP-4) inhibitors
- Selective sodium-glucose transporter-2 (SGLT-2)
- insulins
2
Q
example of biguanides
A
metformin (glucophage)
3
Q
metformin indication
A
type 2 DM
PCOS
pre-diabetes
4
Q
metformin CI
A
- metabolic acidosis
2. moderate to severe CKD
5
Q
metformin MOA
A
- decrease hepatic glucose production
- decreases intestinal absorption of glucose
- improves insulin sensitivity by increases peripheral glucose uptake
6
Q
metformin monotherapy or combo?
A
both
7
Q
how much does metformin lower HbA1c
A
1-2%
8
Q
metformin SE
A
- GI - abdominal pain, nausea, diarrhea
- reduced absorption of Vit B12 and folate
- mild weight loss
- hypoglycemia (but not really)
- lactic acidosis
9
Q
Sulfonylurea examples
A
- glyburide / glynase
- glipizide / glucotrol
- glimerpiride / amaryl
10
Q
Sulfonylurea MOA
A
- stimulate insulin secretion from beta cells of pancreas
2. reduce serum glucagon levels
11
Q
how much do sulfonylureas lower HbA1c
A
1-2%
12
Q
Sulfonylurea indications
A
- DM type 2
13
Q
Sulfonylurea CI
A
- Type I DM
2. pregnancy
14
Q
monotherapy or combo?
A
both
15
Q
Sulfonylurea SE
A
- hypoglycemia
- flushing (w/ alcohol)
- weight gain
- tolerance - less effective over time
- anemia/thrombocytopenia
16
Q
who are Sulfonylureas not the best for
A
diabetic who is not good at scheduling meals or who like to drink alcohol
17
Q
Meglitinides examples
A
- Repaglinide / Prandin
18
Q
Meglitinides indications
A
- DM type 2
2. postprandial hyperglycemia
19
Q
Meglitinides CI
A
concomitant gemfibrozil (cholesterol med) and repaglinide/Prandin sulfonylureas
20
Q
Meglitinides MOA
A
short acting, stimulate release of insulin from beta cells
21
Q
who are Meglitinides good for
A
significantly elevated blood sugar post meals
irregular meals!
22
Q
Meglitinides SE
A
- hypoglycemia
2. weight gain
23
Q
special consideration for Meglitinides
A
dose adjust if liver impairment
check LFTs, urine microalbumin at lease once a year
24
Q
alpha glucosidase inhibitors (AGIs) example
A
- acarbose / precose
not really seen
25
alpha glucosidase inhibitors (AGIs) indications
1. DM type 2
2. predominantly postprandial hyperglycemia
3. new onset diabetes w/ mild HTN
26
alpha glucosidase inhibitors (AGIs) CI
1. IBS
| 2. IBD
27
alpha glucosidase inhibitors (AGIs) monotherapy or combo?
both - combo w/ sulfonylureas
28
alpha glucosidase inhibitors (AGIs) MOA
inhibit breakdown of carbohydrates to glucose n the gut - act locally in the gut
29
alpha glucosidase inhibitors (AGIs) SE
1. flatulence
2. bloating
3. abdominal discomfort
4. diarrhea
5. increased liver enzymes
30
Thiazolidinedoiones examples
1. rosiglitazone / Avandia
| 2. Pioglitazone / Actos
31
TZD Indications
DM type 2
32
TZD CIs
1. heat failure
2. pregnancy
3. breastfeeding/lactation
33
how much do TZDs lower HbA1c
1-2%
34
when to use TZDs
1. if someone doesn't tolerate metformin
| 2. use w/ metformin if unable to tolerate high levels of meformin
35
TZDs SE
1. weight gain
2. edema
3. cardiovascular
4. fractures
5. raise HDL
36
if you have a diabetic patient who also tends to be a fluid retaining hypertensive, what medication class should you avoid
TZDs b/c can cause edema
37
What does GLP-1 agonists stand for?
glucagonlike peptide-1 agonist
38
examples of long-acting GLP-1 analogs
Liraglutide (Victoza)
39
examples of prolonged-acting GLP-1 analogs
1. dulaglutide (Trulicity)
| 2. semglutide (Ozempic)
40
difference between long-acting and prolonged acting GLP-1 agonists
long-acting taken daily vs. prolonged-acting taken weekly
41
GLP-1 agonists monotherapy or combo?
only add-in therapy (combo) - patients who have not achieved glycemic goals using metformin, a sulfonylurea or both, in combo with TZD +/- metformin
42
GLP-1 agonist MOA
1. mimic endogenous incretin GLP-1
2. stimulate glucose-dependent insulin release
3. reduce glucagon
4. slow gastric emptying
5. may prevent beta-cell apoptosis
43
GLP-1 agonist SE
1. weight loss
2. thyroid c-cell tumors / medullary thyroid cancer
3. Steven-Johnson syndrome
4. angioedema
5. upset stomach
6. pancreatitis
7. cholelithiasis
8. change in vision (semiglutide/ozempic)
44
GLP-1 agonist CI
1. personal or family history of medullary thyroid cancer
| 2. exenatide in end stage renal disease
45
what does DPP-IV inhibitor stand for?
Dipeptidyl-peptidase IV inhibitors
46
DPP-IV inhibitor examples
1. Linagliptin (Tradjenta)
| 2. Sitagliptin (Januvia)
47
DPP-IV inhibitor monotherapy or combo?
both, combo w/ metformin or TZD
48
DPP-IV inhibitor MOA
1. block degradation of endogenous incretins, GLP-1 and GIP
2. inhibit glucagon release
3. increases insulin secretion
49
benefits of DPP-IV inhibitor
1. no hypoglycemia
2. well tolerated
* weight neutral
50
how much do DPP-IV inhibitors lower HbA1c
0.6%
51
warnings/risks with DPP-IV inhibitors
1. pancreatitis
2. joint pain
3. saxagliptin can worse HF
52
what does SGLT-2 inhibitor stand for
1. Sodium glucose CoTransporter inhibitors
53
SGLT-2 inhibitor examples
1. Canagliflozin / Invokana
| 2. empagliflozin / jardiance
54
SGLT-2 inhibitor MOA
block resorption of glucose in kidneys
55
limitation of SGLT-2 inhibitors
not effective if eGRF <45
56
benefits of SGLT-2 inhibitors
1. some weight loss
2. may reduce BP
3. no hypoglycemia
57
who are SGLT-2 inhibitors good for
add on therapy for patients who have greater risk of stroke and heart attack
58
SGLT-2 inhibitors SE
1. UTI, yeast infections, increased urination
2. increased LDL
3. fractures
4. possible ketoacidosis
5. amputations (invokana)
6. hypotension
7. bladder cancer? (farxiga)
59
insulin indications
DM type 1 and 2
| gestational diabetes
60
insulin examples
1. short acting insulin - insulin R
2. intermediate acting insulin - NPH insulin, lente
3. long acting insulin - insulin ultralente
61
long acting insulin features
1. 25 hour half life
2. up to 42 hour glucose lowering effect
3. relatively peakless
4. anytime dosing
62
insulin MOA
1. promotes uptake of glucose by cells
2. increased glycogen deposition in liver and muscle
3. liver: inhibits synthesis of glucose
4. muscle: facilitates uptake of amino acids in --> protein synthesis
5. adipose: promotes synthesis of triglycerides and inhibits lipolysis
63
insulin SE
1. hypoglycemia
2. lipodystrophy
3. edema
64
Presentation of hypoglycemia
1. sweating
2. tachycardia
3. tremor
4. weakness
5. hunger
6. blurred vision
7. confusion
8. convulsions
9. coma
65
Glucagon indications
1. refractory hypoglycemia (after PO or IV glucose)
2. hyperinsulin states - insulin overdose, insulinoma
3. drug overdoses - beta blockers, ca channel blockers
4. intestinal relaxation
66
Glucagon CIs
1. pheochromocytoma
67
Glucagon SE
1. nausea/vomiting
2. hyperglycemia
3. hypokalemia
68
Combination drugs
1. invokamet = canagliflozin + metformin
2. synjardy = empagliflozin + metformin
3. glyxambi = empagliflozin + linagliptin
