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Year 1: Patho/Pharm > Diabetes PHARM > Flashcards

Diabetes PHARM Flashcards

(48 cards)

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1
Q

Metformin
Indications

A

Type 2 DM (non-insulin dependent) A1C > 6.5%

Safe in pregnancy and childhood (A1C > 9%)

PCOS to increase fertility
(insulin insensitivity, increases insulin = increase androgens = decrease fertility)

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1
Q

Metformin
MOA

A
  1. GI: Decrease GI absorption of glucose
  2. Muscle/Fat: Increase insulin sensitivity in periphery
  3. Liver: Prevents liver from synthesizing glucose (gluconeogenesis, glycogenolysis)
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2
Q

Metformin
SE/AE

A
  1. GI: N/V/D/anorexia
    - start low, go slow
  2. Macrocytic anemia (absorption vitamin B12 and folic acid inhibited)
    - pre-disposed to anemia
  3. Lactic acidosis
    - prevent mitochondria from oxidizing lactic acid
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3
Q

Metformin
Pros/Cons

A

Pros
- Cardioprotective: decrease MI
- Weight neutral
- Low risk hypoglycemia

Cons
- Toxicity (not metabolized, excreted by kidney)
- liver disease
- lactic acidosis

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4
Q

Metformin
Contraindications

A
  1. Kidney disease and nephrotoxic medications
    - high risk toxicity
    - D/C contrast dyes
  2. Liver disease
    - high risk toxicity and lactic acidosis
  3. Risk or history of lactic acidosis
    - Liver disease
    - alcoholism
    - hypoxia
    - sepsis
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5
Q

PRN medications
Metformin

A
  • Vitamin B12
  • Folic Acid
  • drink water to flush out
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6
Q

Patient Education
Metformin

A
  1. Take PRNs
    - vitamin B12
    - Folic acid
    - monitor S&S anemia
  2. Inform MD before contrast dyes
  3. Monitor for S&S lactic acidosis
    - hyperventilation
    - malaise
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7
Q

Metformin
Drug class

A

Biguanide

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8
Q

Sulfonylureas
Examples

A

Glyburide
Glimepiride
Glipizide

Insulin secretagogue

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9
Q

Sulfonylureas
Indication

A

Type 2 DM
non-insulin dependent

*Insulin secretagogues

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10
Q

Sulfonylureas
MOA

A
  1. increase insulin secretion
    - Blocks K ATPase islet cell
    - Depolarization
    - influx of calcium
    - release of insulin

*Insulin secretagogue

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11
Q

Sulfonylureas
SE/AE

A
  1. Hypoglycemia
    - increases release of insulin regardless of BG
    - *Glyburide >
  2. Hypoglycemic shock
  3. Weight gain
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12
Q

Sulfonylureas
Con

A

Weight gain
- increases insulin release
- anabolic hormone

Hypoglycemia
* do not combine with meglitinides or insulin

Cardio- neutral

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13
Q

Sulfonylureas
Contraindications

A

Liver or kidney disease
- accumulation drug to toxic levels

Hypoglycemia

Pregnancy and breast feeding

Insulin

Rx. Meglitinides (same mechanism, hypoglycemia)

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14
Q

Meglitinide
Examples

A

RepaGLINIDE
NateGLINIDE

Insulin secretagogues

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15
Q

Meglitinide
Indication

A

Lower post-prandial glucose
Taken TID with meals

Type 2 DM (non insulin dependent)

*insulin secretagogue

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16
Q

Meglitinide
MOA

A

*Same as sulfonylureases (faster acting, must be taken with meals)

  1. Increase insulin secretion
    - Block K ATPase
    - depolarization
    - influx calcium
    - release insulin
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17
Q

Meglitinide
SE/AE

A

Hypoglycemia and hypoglycemic shock
- must be dosed with meals

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18
Q

Meglitinide
Pros/Cons

A

Cons
- weight gain
- hypoglycemia
- cardio neutral

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19
Q

Meglitinide
Contraindications

Study These Flashcards
A
  1. liver and kidney disease
    - accumulate to toxic levels
  2. pregnancy and breast feeding
  3. Rx. Sulfonylureas (glyburide, glimepiride, glipizide) = hypoglycemia
    * or insulin
  4. Empty stomach
  5. insulin dependence (will not work)
20
Q

Thiazolidinediones
Indicaiton

Study These Flashcards
A

Type 2 DM (non-insulin dependent)

21
Q

Thiazolidinediones
Examples

Study These Flashcards
A

RosiGLITAZONE

PioGLITAZONE

22
Q

Thiazolidinediones
SE/AE

Study These Flashcards
A

Rosiglitazide - causes MI

Pioglitazide - Causes congestive heart failure (edema), and fractures

hypoglycemia

liver disease (monitor LFTs 3-6m)

bladder cancer

ovulation and unwanted pregnancies (PRN contraception)

macular degeneration

fractures (PRN vitamin D, calcium, excercise)

Dyslipidemia (high LDL, high HDL, low TG)

23
Q

Thiazolidinediones
Contraindications and Patient educaiton

Study These Flashcards
A
  • liver disease and kidney disease
  • Monitor S&S liver failure, LFT monitoring
  • bladder cancer (personal or family history)
  • dyslipidemia
  • osteoporosis
  • PRN Calcium, vitamin D, exercise
  • macular degeneration (personal, family history)
  • history MI or heart failure
  • monitor S&S FVO
  • insulin
24
thiazolidinediones MOA
Activation peroxisome proliferator activated receptor gamma (PPAR gamma) --> transcription insulin responsive genes 1. increase insulin sensitivity MSK/fat 2. decrease liver production of glucose
25
Acarbose Indication
Type 2 DM Adjunct medication
26
Acarbose MOA
Delays carbohydrate digestion and prevents post-prandial glucose spike - inhibits alpha glucosidase - cannot break down disaccharides into monosaccharides for absorption
27
Acarbose SE
GI: Fermentation of disaccharides Abdominal distention, bloating, gas, cramping, diarrhea Anemia - prevents absorption of iron Liver damage - LFT monitoring required Inhibits treatments of hypoglycemia - do not use disaccharide (use monosaccharide)
28
Acarbose Contraindications
Irritable bowel symdrome (IBS) Irritable bowel disease (IBD) Liver disease Anemia
29
Patient Education Acarbose
Monitor for S&S anemia - iron supplement Monitor for S&S liver disease - LFT blood monitoring Q3months
30
Dipeptidyl peptidase 4 Inhibitors (DPP4) Indication
Type 2 DM Second line combined with metformin therapy Adjunct - metformin - sulfonylureas (glyburide, glimepiride, glipizide) - thiazolidinediones (rosiglitazone, pioglitazone)
31
Dipeptidyl peptidase 4 inhibitors Examples
SaxaGLIPTIN AloGLIPTIN linaGIPTIN sitaGLIPTIN *incretin mimetics
32
Dipeptidyl Peptidase 4 (DPP4) inhibitor MOA
Block dipeptidyl peptidase 4 (DPP4), blocks degredation of incretin Incretin stimulates 1. Insulin release 2. inhibits glucagon release 3. slows gastric emptying 4. inhibits appetite
33
Dipeptidyl peptidase 4 (DPP4) inhibitor SE/AE
Saxagliptin - heart failure weight gain Upper respiratory tract infections - nasopharyngitis Pancreatitis Hypersensitivity reactions - angioedema, anaphylaxis, SJS
34
Dipeptidyl peptidase inhibitor (DPP4) contraindications
Personal or family history Pancreatitis Patient Education - Monitor S&S URT infection - Monitor S&S pancreatitis Heart failure - saxagliptin
35
Glucagon Like Peptide 1 Agonist (GLP1 agonist) Indications
Type 2 DM (non insulin dependent)
36
Glucagon like peptide 1 receptor agonist (GLP1 receptor agonist) MOA
Incretin mimetic *same MOA as DPP4 inhibitors Increase activity of GLP1 1. increase insulin secretion 2. inhibit glucagon secretion 3. slow gastric emptying 4. decrease hunger
37
GLP 1 receptor agonist SE/AE
hypoglycemia (combination) N/V/D Antibodies against drug decrease action Hypersensitivity - angioedema, anaphylaxis Thyroid cancer, multiple endocrine neoplasia syndrome (MENS2) Pancreatitis Kidney failure Retinopathy with large drop in A1C Teratogenic
38
GLP1 receptor agonists Pros/Cons
Pros - cardioprotective - Reduce MACE in individuals with ASCVD and > 60 years - weight loss Cons - subcutaneous injection - antibodies against drug - hypersensitivities - renal failure - retinopathy - thyroid / endocrine cancer - pancreatitis - teratogenic
39
Glucagon like peptide 1 receptor agonist (GLP 1) Examples
LiraGLUTIDE SEmaGLUTIDE DulaGLUTIDE ExenaTIDE TirzepaTIDE (GIP and GLP1 receptor agonist)
40
Contraindications GLP-1 receptor agonists
Dehydration - increase renal failure Personal or family history - thyroid cancer - pancreatitis - kidney disease - retinopathy Teratogenic - pregnancy and breastfeeding Hypersensitivity reactions
41
Sodium Glucose Co-Transporter 2 (SGLT2) inhibitor Indication
1. HTN 2. T2DM
42
Sodium Glucose Co-transporter 2 (SGLT2) inhibitor MOA
blocks sodium/glucose re-absorption by the kidney tubules (90%)
43
Sodium Glucose Co-Transporter 2 (SGLT2) inhibitor SE/AE
1. osmotic diuresis - dehydration - polyuria - polydipsia - orthostatic hypotension (fall risk) 2. Hyponatremia 3. Glucosuria = UTI - infections 4. Bladder cancer (Dapagliflozin)
44
Sodium Glucose Co-Transporter 2 inhibitor Contraindications
Kidney failure (GFR < 30mL/min) Bladder cancer UTI infections
45
Benefits SGLT2 inhibitors
Reduced MACE, HF, nephropathy in patients with ASCVD weight loss
46
Sodium Glucose Co-Transporter 2 Inhibitors (SGLT2) Examples
CanaGLIFLOZIN DapaGLIFLOZIN EmpaGLIFLOZIN
47
Cardioprotective Anti-hyperglycemics
Metformin - prevents MI GLP1 receptor agonists (semaglutide, liraglutide) - prevent MACE in > 60 years with ASCVD SGLT2 antagonists - prevent HF - prevent MACE - nephroprotective

Year 1: Patho/Pharm (45 decks)

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