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Diabetes Flashcards

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1
Q

Metformin contraindications

A

Kidney disease (GFR <30)
Liver disease or failure (hepatitis, chronic ETOH)
Heart failure

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2
Q

First line therapy for Type 2 DM

A

Metformin

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3
Q

Side effects of metformin

A 
GI effects (diarrhea, gas)
B12 deficiency
Lactic acidosis (especially with liver disease)
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4
Q

Sulfonylureas meds end in?

A

M/R/Z -ide (tolbutaMide, glybuRide, glipiZide)

DO NOT CONFUSE WITH “TIDE” the GLP-1 analogs

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5
Q

What medication class/drug requires functioning beta cells

A

Sulfonylureas “M/R/Z -ide”

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6
Q

What two types of medications classes/drugs does NOT require functioning beta cells

A

Biguanide - metformin

Thiazolidinediones - “zone” Pioglitazone

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7
Q

T/F metformin has ASCVD benefit

A

TRUE! Pre-diabetic and diabetic pts benefit from a prevention of CVD with this medication

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8
Q

Side effects of sulfonylureas (M/R/Z-ide); tolbitamide, chlorpropamide, glyburide, glimepride, glipizide

A

Hypoglycemia! Weight gain!

C-peptide

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9
Q

What is the black box warning for “TZDs” thiazolidinediones (Pioglitazone)

A

Signs of heart failure! increases CHF risk

Other side effects:
Edema, SOB, rapid weight gain
Osteopenia/fractures
Liver toxicity

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10
Q

What oral drug class MUST be taken with food?

A

Alpha-glucosidase inhibitors - Acarbose and Miglitol

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11
Q

What are common side effects of alpha-glucosidase inhibitors (Acarbose, Miglitol). What lab should be monitored?

A

GI issues! Abdominal pain, diarrhea, flatulence

Elevated liver enzymes

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12
Q

Black box warning of GLP-1 Receptors Agonists (Exenatide, Liraglutide, Albiglutide, “-TIDE”)

A

Thyroid cancer

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13
Q

What side effects are most common of the GLP-1 receptor agonists (-TIDE). What is an increased risk due to this drug class?

A

Nausea, vomiting, diarrhea

Increase risk of pancreatitis seek immediate care with severe abdominal pain

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14
Q

Any diabetic patient with a GFR 40 or less is at increased risk for?

A

Hypoglycemia

Medication dose must be decreased. Patient may need recurrent labs or referred

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15
Q

What two drug classes increase the risk of CHF?

A

Thiazolidinediones “TZDs” -glitazone

DPP4-Inhibitors -gliptins

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16
Q

What drug classes (2) are associated with weight loss as a potential beneficial side effect?

A

GLP-1 Receptor Agonists “-TIDE” (exenaTIDE, liragliTIDE, etc)

SGLT-2 Inhibitors “-gliflozin” (canagliflozin, empagliflozin, dapagliflozin)

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17
Q

What drug classes (2) are associated with weight gain as a potential side effect?

A

Sulfonylureas “M/R/Z -ide”

Thiazolidinediones “-glitazones”

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18
Q

What drug class may cause UTIs, candidiasis infections, renal failure, hyperkalemia, dehydration, or hypotension?

A

SGLT-2 inhibitors “-gliflozin”

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19
Q

What drugs have a ASCVD benefit? (6 types of drugs, 4 different classes)

Which two drugs specifically have a CHF benefit? (Same class)

A

Metformin - Biguanide
PioglitaZONE - Thiazolidinediones “TZDs”
ExenaTIDE and LiragluTIDE - GLP-1 Receptor
CanagliFLOZIN and EmpagliFLOZIN - SGLT-2

CHF benefits: GLP-1 Receptor Agonists “TIDE”

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20
Q

What is the black box warning of SGLT-2 Inhibitors? “gliflozin”

A

Amputation! (Canagliflozin)

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21
Q

What two drug classes may cause pancreatitis?

A

GLP-1 Receptor Agonists -TIDE

DPP4-Inhibitors -gliptins

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22
Q

What drug needs periodic measurement of B12 lab with therapy?

A

Metformin

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23
Q

What drug class increases LDL?

A

SGLT-2 Inhibitors -gliflozin

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24
Q

Side effects of hypoglycemia and weight gain are commonly caused by what drug class?

Study These Flashcards
A

Sulfonylureas M/R/Z ide

25
What drug class causes weight loss due to slowed gastric emptying? (Incretin)
GLP-1 Receptor Agonists "TIDE"
26
What drug class is considered weight neutral?
DPP4-Inhibitors -gliptans
27
Side effects of nasopharyngitis/URI, joint pain, GI distress and pancreatitis are commonly caused by what drug class?
DPP4-Inhibitors -gliptans
28
What 2 drug classes may cause osteopenia or increase the risk of bone fractures? (Similar ending drug names)
Thiazolidinediones -glitazone | SGLT-2 Inhibitors -glifozin
29
An A1C >9 will require what kind of therapy?
Dual therapy as initial treatment
30
An A1C 10-12 will require what kind of therapy?
Insulin until the patient is not glycemix toxic
31
A blood glucose level >300 will require what therapy?
Insulin, until the pt is no longer glycemic toxic
32
What drug classes (2) are considered low cost?
Biguanide - Metformin | Sulfonylureas - M/R/Z ide
33
According to ADA, what is the ONLY noninsulin medication approved for type 1 DM?
PramlinTIDE (GLP-1 Receptor Agonist) MOA: decreases A1C and body weight when added to insulin
34
What is essential to treatment of type 1 DM?
Insulin, analog - the beta cell function is absent or near-absent AUTOIMMUNE DESTRUCTION
35
A drug ending in -TIDE is a what?
``` GLP-1 Receptor Agonists ExenaTIDE LiragliTIDE AlbuigluTIDE DulagluTIDE ```
36
A drug ending in "-gliflozin" is a what?
SGLT-2 Inhibitor Canagliflozin - BBwarning, bone fractures Empagliflozin Dapagliflozin
37
A drug ending in -MIDE, RIDE, ZIDE is a what?
Sulfonylureas (1st and 2nd generation) Known for weight gain and hypoglycemia, but low in cost. Be weary of giving to older adults. Tolbutamide Glyburide Glimepiride Glipizide
38
A drug ending in -gliptin is a what?
DPP4-Inhibitors Weight neutral, no hypoglycemia, $$$, URI and pancreatitis Sitagliptin, Saxagliptin, Linagliptin
39
A drug ending in -glitaZONE is a what?
Thiazolidinediones "TZD" Doesn't require beta cells to function Will cause weight gian and NO HEART FAILURE (BBwarning) Monitor for fractures and osteopenia Can help with ASCVD Pioglitazone
40
Drug class that increases renal glucose excretion?
SGLT-2 Inhibitors | -gliflozin
41
Beside allergy to sulfa drugs, who should NOT receive sulfonylureas?
Obese (due to weight gain) Elderly (hypoglycemia and increase in falls) Pregnancy, avoid this med!
42
This drug class increases insulin secretion from beta cells of the pancreas
Sulfonylureas M/R/Z ide
43
This drug class increases insulin secretion, decreases glucagon secretion, delays gastric emptying and improves post-prandial hyperglycemia
GLP-1 Receptor Agonists -TIDE
44
Why will GLP-1 Receptor Agonists reduce the risk of hypoglycemic effects?
Route of administration - subcutaneous injection!
45
This drug class increases insulin sensitivity thus decreasing insulin resistance (insulin sensitizers)
ThiaZOlidinediones -glitaZONEs
46
This drug class inhibits hepatic glucose production (gluconeogenesis) and insulin resistance
Biguanides - Metformin
47
What is the initial dose of metformin?
500 mg daily until tolerating/minimal side effects 2. 500 mg BID 3. 1000 mg daily 4. 1000 mg BID Max dose is 2000 mg a day
48
When should meglitinides be taken?
Before meals! Never take if meal is missed!!
49
What drug class decreases glucose absorption by slowing the absorption of carbs into proximal gut blood after meals?
Alpha-glucosidase Inhibitors (aCARBose, Miglitol)
50
Medication that can be used with both type 1 and type 2 DM
PramaliTIDE - injection medication, amylin analog
51
Increases risk of myocardial infarction (think heart failure black box warning medications)
Thiazolidinediones -GLITAZONES Rosiglitazone
52
Initial dose of basal insulin (long acting: Detemir [levemir], Glargine [lantus]). How much should the PCP titrate if the initial dose does not achieve A1C goal set? What if the patient becomes hypoglycemic, how should you titrate insulin?
10 units once a day or 0.1-0.2 units/kg Increase by 1 unit/day or 3 units/3 days until Fasting Blood Glucose is within goal (80-135) Hypoglycemia = decrease by 4 units until FBG within range
53
What is the insulin unit to carbohydrate ratio? ICR
1:15 | 1 unit to 15 carbs
54
What should indicate a need to titrate insulin dosage? (Long acting or basal)
The morning fasting blood glucose! Long acting is given at the same time, everyday (even without eating) alone or with a short-acting Titration is only based on AM fasting blood glucose (80-135 is normal)
55
What is the most common side effect of insulin
Hypoglycemia
56
Patient with ASCVD and high risk of heart failure or has heart failure, should be treated with what diabetic drug class?
SGLT-2 Inhibitors -gliflozin
57
Patient with type 2 DM and an established ASCVD (risk score >15%), should be considered for treatment with what TWO diabetic medication classes? (not a dual therapy, both classes treat DM and ASCVD)
SGLT-2 Inhibitors -gliflozin or GLP-1 Receptor Agonists -TIDES
58
Patient with DM type 2 and chronic kidney disease may be treated with either TWO diabetic medication classes?
SGLT-2 Inhibitors -gliflozin | GLP-1 Receptor Agonists -TIDES

Diabetic Medications (1 decks)

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