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Clin Mgt 2 DM & Psych > DM > Flashcards

DM Flashcards

(46 cards)

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1
Q

name 3 conditiond DM puts you at an INC risk for

A
  • 8X increased risk acute MI
  • 3X increased risk of CV death
  • 6.7X increased risk of stroke
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2
Q

T2DM first line

CI in what pt populaton?

A

Metformin

GFR <30

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3
Q

sulfonurea w/ Highest hypoglycemia

A

glyburide

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4
Q

adverse effect of Meglitinides

A

Hypoglycemia

Weight gain

repaglinide (Prandin)

nateglinide (Starlix)

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5
Q

what DM med Beneficial in the treatment of prediabetes ??

A

Alpha-glucosidase inhibitors—> acarbose

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6
Q

list Alpha-glucosidase inhibitors & adverse effct

A

Acarbose (Precose)

Miglitol (Glyset) (same dose)

(e.g., flatulence, diarrhea)

Low risk of hypoglycemia

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7
Q

what class of meds Slows progression of deterioration of B-cell function

A

Thiazolidinediones

Pioglitazone (Actos)

Rosiglitazone (Avandia) no inc CVD risk

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8
Q

what DM med:
may improve lipid profile (lowers triglycerides) &

CV benefit

A

Pioglitazone (Actos)

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9
Q

what class of med can cause New or worsening HF(

A

DPP-4 saxagliptin and alogliptin

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10
Q

what DPP -4 does not need to be renally dosed

A

Linagliptin (Tradjenta

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11
Q

name DPP4 inhibitos

A

Sitagliptin (Januvia)

Linagliptin (Tradjenta) ** - not renally dosed

Saxagliptin (Onglyza)

Alogliptin (Nesina)

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12
Q

name GLP-1 RAs

A

Exenatide (Byetta)

Liraglutide (Victoza)

Exenatide ER (Bydureon)

Dulaglutide (Trulicity)

Lixisenatide (Adlyxin)

Semaglutide (Ozempic) (Rybelsus

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13
Q

wnat class of meds is assoc w/ Yeast infections

A

SGLT-2 inhibitors

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14
Q

lsist SGL-2 i

A

Canagliflozin (Invokana)

Dapagliflozin (Farxiga)

Empagliflozi n (Jardiance)

Ertugliflozin (Steglatro)

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15
Q

DM med reccommended for CVD

A

SGLT-2is—- “liflozin”

  • empagliflozin
  • canagliflozin
  • dapagliflozin)

OR

GLP-1RAs – “glutid”

  • Liraglutid
  • semaglutid
  • dulaglutide
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16
Q

DM med recc for HF

first line

second line

A

FIRST LINE – SGLT2i – lifolzin

  • empagliflozin
  • dapagliflozin

If cannot take use GLP-1RAs w/ CV benefit “glutide”

  • Liraglutide
  • Semaglutide
  • dulaglutide
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17
Q

DM w/ CKD w/ albuminuria

A

SGLT2i w/ primary evidence in reducing CKD progression (Ertugliflozin)

  • AVOID - canagliflozin, dapagliflozin, empagliflozin)

SGLT2i w/ evidence in reducing CVD progression

  • empagliflozin
  • canagliflozin
  • dapagliflozin

IF SGLT2i not tolerated or CI:

GLP-1 RA w/ proven CVD benefit

  • Liraglutid
  • semaglutid
  • dulaglutide
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18
Q

DM w/ CKD w/o albuminuria

A

SGLT-2is

  • empagliflozin
  • canagliflozin
  • dapagliflozin

OR

GLP-1RAs

  • Liraglutid
  • semaglutid
  • dulaglutide
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19
Q

DM minimize hypoglycemia

Study These Flashcards
A

DPP-4i—–can add - SGLT2i OR TZD

  • NO DPP & GLP-1 RA!!!
  1. Degludec/glargine U300 <
  2. glargine U100/detemir <
  3. NPH insulin

GLP-1 RA — Add - SGLT2i OR TZD

SGLT2i —- Add - GLP-1 RA, DPP-4i, TZD

TZD —–Add –SGLT2i, DPP-4i, GLP-1 RA

20
Q

what class of DM med cause hypoglycemia

name meds in tbis class

Study These Flashcards
A

Sulfonylureas

  • glyburide
  • glimepiride
  • glipizide
21
Q

Minimize Weight Gain/ weight Loss

Study These Flashcards
A

GLP-1RAs – dulaglutide + Add SGLT2i

OR

SGLT2i —- Add GLP-1 PAs

  1. Semaglutide >
  2. liraglutide >
  3. dulaglutide* >
  4. exenatide >
  5. lixisenitid

Quad therapy or above not tolerated:

DPP-4i

Not tolerated or CI bc pt on GLP-1 RA —> + SU, TZD, basal insulin

22
Q

med to minimze cost

Study These Flashcards
A

SU – can add TZD

TZD can add SU

Choose later generation SU to lower risk of hypoglycemia.

Glimepiride has shown similar CV safety to DPP-4i6

Basal insulin

23
Q

list Thiazolidinediones

Study These Flashcards
A

Pioglitazone (Actos)

Rosiglitazone (Avandia) no inc CVD risk

24
Q

what 2 classes should you never combine

Study These Flashcards
A

NO DPP & GLP-1 RA!!!

25
# fill in Goal A1c - Goal FBG – Goal PP BS -
Goal A1c - \<7 Goal FBG – 80-130 Goal PP BS - \<130
26
what is first injectable consideed for T2DM
GLP-1RA
27
when is insulin considered in T2DM
•Consider insulin as first injectable if * catabolism * symptoms of hyperglycemia * A1C \> 10% o * BG are very high (\> 300) * suspect T1DM (EARLY INSULIN USE)
28
list rapid acting insulin
* Aspart (Novolog) * Glulisine (Apidra) * Lispro (Humalog) * Inhaled (Afrezza)
29
short acting insulin
* Humulin- R * Novolin – R
30
long acting insulin
* Glargine U100 (Lantus, Basaglar, Semglee) * Detemir (Levemir)
31
ultra long acting
* Deglutide (Tresiba) * Glargine U-300 (Toujeo)
32
premixed insulin
* Humulin 70/30 * Monolin 70/30
33
primary actions og insulin
­INC Glucose disposal DEC Gluconeogenesis INC Suppress ketogenesis
34
•Contraindicated in patients at risk of medullary thyroid cancer
GLP-1- receptors agonist (RAs) * •Exenatide\* (Byetta) * •Exenatide ER (Bydureon) * •Liraglutide\* (Victoza) * •Lixisensatide (Adlyxin) * •Dulaglutide (Trulicity) * •Semaglutide (Ozempic, Rybelsus)
35
­ INC insulin sensitivity in muscles & fat
Thiazolidinediones (Glitazones)
36
MOI SGLT-2 inhibitors
INC renal excretion of glucose (glucosuria) DEC plasma glucose level
37
MOI metformin
DEC gluconeogenesis INC insulin sensitivity in peripheral tissue DEC intestinal absorption of glucose
38
MOI GLP-RAs
INC exogenous GLP-1 INC ­ insulin secretion DEC glucagon secretion DEC gastric emptying INC­ satiety
39
wjat class causes hypoglycemia and weight gain
**Sulfonylureas** * Glyburide (Glynase) * Glipizide (Glucotrol) * Glimepiride (Amaryl)
40
what class causes you to loseweight and has CV benefit
**GLP-1- receptors agonist (RAs)** * Exenatide\* (Byetta) * Exenatide ER (Bydureon) * Liraglutide\* (Victoza) * Lixisensatide (Adlyxin) * Dulaglutide (Trulicity) * Semaglutide (Ozempic, Rybelsus)
41
•If A1C above goal
* Add GLP-1RA if not already taking (lower basal dose) or * Add prandial insulin; one dose with largest meal
42
•If above A1C target
* Stepwise approach (2 then 3 injections- meal time) * Go to full basal bolus * Consider NPH bid and rapid acting/sort acting with 2 meals * Consider Premixed insulin regimen
43
stepwise approach to staring insulin
1. start w/ GLP first --\>GLP CI then basal insulin 2. add basal anology or bedtime NPH 3. Add Prandial insulin or if on bedtime NPH then swicth to 2x a day dosing 4. Add prandial insulin 5. stepwise injectios of prandial insulin --\> full basal bolus regimine seld-mixed split insulin (NPH & short/rapid acting) 2x daily premixed insulin
44
what is important about basal insulin
Basal insulin - only duration is important – •want LONG duration of acting
45
differentiate b/w DM 1 & 2 basal/bolus basal only
Type 1: Basal / bolus (prandial) Type 2: Basal only
46
list MOI of ## Footnote * Repaglinide (Pandin) * Nateglinide (Starlix)
INC insulin secretion

Clin Mgt 2 DM & Psych (3 decks)

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