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FA17 Endocrine > Diabetes Pharm > Flashcards

Diabetes Pharm Flashcards

(48 cards)

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1
Q

Drugs with little/no risk of HYPOGLYCEMIA (5)

A

Metformin

GLP-1 RA

SGLT2-I

DPP4-I

TZD

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2
Q

Drugs with HIGH risk of HYPOGLYCEMIA

A

Sulfonuryea

Insulin

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3
Q

Drugs causing weight gain?

A

Sulfunayrea

Insulin

TZD

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4
Q

Drugs causing weight loss

A

Metformin i

GLP-1 RA

SGLT2-I

DPP4-I

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5
Q

Metformin (glucophage)

MOA

A

Limits haptic production of glucophage

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6
Q

Metformin (Glucophage)

Indications + off label

A

Treatment of T2DM

Off-label: Pre diabetes prevention, PCOS

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7
Q

Metformin (Glucophage)

Effectiveness/Advantages

A

reduces A1C by 1.5-2%

Modest weight loss or weight stabilization

Low risk of hypoglycemia

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8
Q

Metformin (Glucophage)

S.E.

A

GI most common (allergies)

Diarrhea, N/V
Metallic taste
Minimized by gradual dose titration or XR formulations

Also can be done used in IV contrast (hold 48hrs before to 48hrs later)

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9
Q

Metformin

BBW

A

Elevated lactate and anion acidosis

Increased risk in renal impairment
Hypoperfusion
Hypoxia

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10
Q

Glucophage CI

A

Metformin

CKD 
Heart Failure
ALcohol use
Surgery 
Significant chronic liver disease

Can cause b12 deficiency

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11
Q

Sulfonylureas

MOA

A

Stimulate pancreatic beta cells to secrete more insulin REGARDLESS of glucose levels

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12
Q

Sulfonylureas

Drug list

A

glyburide (Micronase, Diabeta)

Glipizide (Glucotrol)

Glimepiride (Amaryl)

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13
Q

Sulfonylureas

SE/Adverse outcomes

A

Can cause weight gain

Can cause hypoglycemia

Increase in all cause mortality (may even increase CVD)

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14
Q

Sulfonylurea

Effectiveness

A

Reduces A1c by 1-2%

Effectiveness decreases over time as b-cell mass declines

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15
Q

Sulfonylurea

C/i

A

Sulfa allergic patients (avoid in those with SJS/TEN rxns)

G6PD def.

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16
Q

Sulfonylurea indications

A

Used often 2nd line therapy for T2DM

Falling out of favor

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17
Q

GLP-1 analogs

MOA + possible benefit

A

Stimulating glucose dependent insulin release from pancreatic islets

Slows gastric emptying, inhibits inappropriate post meal glucagon release and reduce food intake

MAY Also stimulate beta cell recovery

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18
Q

Drug list

GLP-1 analogs

A

Exenetide (Byetta, Bydureon) - daily, weekly

Liraglutide (Victoza) - daily

Albiglutide (Tanzeum) - weekly

Dulaglutide (Trulicity) -weekly

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19
Q

GLP-1 RA

Indications

A

Used 1st Lin in pts with T2DM

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20
Q

GLP-1 Analogs

Effectiveness

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A

Lower A1c by 1%

21
Q

GLP-1 Analogs

ADRs

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A

GI effects (cause nausea, v/d)

pancreatitis

Injection site reactions

Thyroid C cell tumors

22
Q

CI of GLP-1 Analogs

Study These Flashcards
A

Stage V CKD

Also use caution in CKD stage IV

23
Q

DPP-IV inhibitors

MOA

Study These Flashcards
A

Inhibits the breakdown and prolongs action of endogenous incretin hormones

24
Q

Drug list DPP-IV inhibitors

Study These Flashcards
A

Stigalipitin (Januvia)

Sazeglipitin (Onglyza)

Linagliptin (Tradjenta)

Alogliptin (Nesina)

25
Linagliptin Special note
Tradjenta No need to dose adjust for liver or kidney disease
26
DPP-IV inhibitors Benefits
Weight neutral
27
DPP-IV inhibitors ADRs/
Less effective than GLP -1 Pancreatitis Alterations in immunity HA, dizziness Hepatic inflammation Skin lesions MSK Increase HF
28
DPP-IV inhibitors Place in therapy
Can be first line, or more often used as add on Lower A1c by 0.6-0.8%
29
SGLT2 - Inhibitors MOA
Blocks reabsorption of glucose in the kidney and causes glucose removal in the urine Limited by amnt of glucose filtered and osmotic diuresis
30
SGLT2 - Inhibitors Benefits
Should not cause hypoglycemia Promotes weight loss and lower blood pressure
31
SGLT2 - Inhibitors Effectiveness
First line monotherapy Lowers A1c by 0.5-0.7% (moderately effective)
32
SGLT2 - Inhibitors Drug list
Canagliflozin (Invokana) Dapagliflozin (Farxiga) Empaglifozin (Jardiance)
33
SGLT2 - Inhibitors ADRs
Increased risk of infection + delays recognition of DKA (this is a problem bc infxn can cause DKA) Can contribute to orthostatic hypotension + bone loss (will fall often, and break a hip) May cause AKI, has to be dose adjusted in CKD Increased risk of lower extremity amputation (canagliflozin)
34
SGLT2 - Inhibitors Special benefit of Empagliflozin
Lowers CV mortality !!
35
TZD/Glitazones Drug choices
Pioglitazone (Actos) Rosiglitazone (Avandia)
36
TZD/Glitazones Effectiveness
Lower A1C by 0.5-1.4%
37
TZD/Glitazones SE (many!)
Believed to be causing MI at one time (associated with higher risk of HF) Lipid effects (Ros- increase LDL) Piog- increased risk of HF causes weight gain Can cause bladder cancer Increase risk of osteoporosis
38
TZD/Glitazones C/I
Patients w/NYHA class III or IV heart failure
39
Drugs in Meglitinides class
Repaglinide (Prandin) Nateglinide (Starlix)
40
Meglitinides Place in therapy
Diabetic patients who have allergies to sulfonylureas Considerably more expensive with no real added benefit so really not used
41
Meglitinides SE
May lead to CV events Caution in liver dz Risk of weight gain CI in CKD
42
Alpha-glucosidase Inhibitors MOA
Inhibits upper GI enzymes, so ingested polysaccharides are not converted to monosaccharides so decreased absorption in small intestine Limits postprandial glucose excursions
43
Alpha-glucosidase Inhibitors Drug lists
Acarbose (Precose) Miglitol (Glyset)
44
Why are Alpha-glucosidase Inhibitors not used often
Can cause flatulence and diarrhea Reduced efficacy (0.5-0.9%), high expense, and poor tolerance
45
Rapid acting insulin
Absorbed more quickly than regular following injection Onset of action is 5-10 min, peak 45-75 min, duration 2-4 hrs Carbs should be ingested first, take 20 min before meal
46
Types of rapid acting insulin brand + generic
Insulin lispro (Humalog) Insulin aspart (Novolog) Insulin glulisine (Apidra)
47
Regular insulin - short acting Pharmacokinetics
Onset of 30 minutes Peaks at 2.5-5 hrs Duration is 4-12 hrs
48
Regular insulin - short acting Therapy use
Can be given as basal bonus for mealtime coverage (being replaced) Main use is IV tx of DKA

FA17 Endocrine (10 decks)

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