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Diabetes Mellitus > DM Pharmacology Part II > Flashcards

DM Pharmacology Part II Flashcards

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1
Q

Patients with liver/renal disease, age over 65, hypoxic states and use excessive EtOH who take metformin should be monitored for?

A

lactic acidosis

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2
Q

medications that predispose you to hypoglycemia

A 
combinind antidiabetics 
aspirin
beta blockers
fluoroquinolones
fenugreek
MAO inhibitors 
psyllium 
ACE inhibitors
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3
Q

Effect of metformin in PCOS

A

can help with conception

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4
Q

why do you have to frequently dose glinides?

A

short half life

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5
Q

Two types of Thiazolidinedione drugs

A

pioglitazone → MC

rosiglitazone

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6
Q

black box warning for GLP1 agonist

A

thyroid cancer in rat studies

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7
Q

what drug do you want to avoid interacting with acarbose?

A

digoxin

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8
Q

this receptor regulated gene transcription associated with proteins which interact in carb and lipid metabolism

A

peroxisome proliferator-activated receptor gamma (PPAR-y)

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9
Q

if the patient has ASCVD or needs weight loss you should consider

A

GLP1 agonist

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10
Q

MOA for thiazolidinediones

A

increases insulin sensitivity by stimulating PPAR-y

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11
Q

MOA of a-glucosidase inhibitors

A

decreases prostprandial hyperglycemia with delayed intestinal carbohydrate absorption

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12
Q

pro of nateglinide

A

doesn’t need renal dosing → good for patient with renal insufficiency

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13
Q

what drug can you prescribe to a prediabetic patient?

A

a-glucosidase

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14
Q

what is the incretin effect?

A

INtestinal seCRETion of INsulin→ oral glucose ingestion results in greater insuline response in comparion to IV glucose administration

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15
Q

two types of insulin secretagogues

A

sulfonylurea (SUR) and meglitindes

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16
Q

effects of GLP1 on the pancease

A

increases insulin release

decrease glucagon release

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17
Q

adverse effects for SGLT2 inhibitors

A 
potential for DKA 
potential for leg and foot amputations 
yeast infections 
increased fracture risk
hypotension
hyperkalemia 
bladder cancer
UTIs
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18
Q

T2DM with HF or CKD → first line? Second line?

A

metformin

metformin + GLP1RA or SGLT2i

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19
Q

T2DM with established ASCVD → first line

A

metformin

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20
Q

GLP1 agonist that is the best at lowering glucose and has benefit of weight loss

A

semaglutide

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21
Q

Adverse effects in GLP1 agonists

A

GI → D/N
gallbladder disease
hypoglycemia

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22
Q

Patient is on GLP1 agonist and experiences severe abdominal pain that radiates to the back, they also are experiencing nausea and vomiting → work them up for?

A

pancreatitis

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23
Q

4 types of DPP-4 inhibitors

A

alogliptin
linagliptin
saxagliptin
sitagliptin

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24
Q

MOA of SUR

A

block ATP sensitive potassium channels in pancreatic B cell membrane → increase insulin secretion

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25
which DPP-4 would you give to a patient with renal failure since there are no adjustments required?
linagliptin
26
Besides decreasing glucose levels how else is SGLT2 benefitial?
decreases SBP decreases body weight decreases urinary albumin excretion
27
you should avoid DPP-4 inhibitor in patient already on
GLP1 agonist
28
Black box warning for TZD
congestive heart failure
29
adverse effect to be on the lookout for with exenatide
injection site reactions
30
If the eGFR falls below 45 in a patient who just started Metformin, what is the next step you should take?
consider risk/benefit for treatment
31
Actions of GLP1
``` neuroprotective appetite suppression decreased gastric emptying increased insulin secretion decreased glucagon secretion increased B cell proliferation increased glucose uptake/storage in muscle and adipose decreased glucose production by liver cardioprotective ```
32
T2dM with established ASCVD → second line
metformin + GLP 1RA or SGLT2i
33
what heart failure signs do you want to monitor for in starting and increase TZD dose?
excessive rapid weight gain dyspnea edema
34
According to ADA, the recommended glycemic management for T2DM with establish ASCVD is
SGLT2 inhibitor or GLP1 agonist
35
If a patient has eGFR between 30-45, can they take metformin?
not recommended
36
Patient on metformin should stop their meds before receiving contrast media if their eGFR is between
30-60
37
What do you do with a patient on metformin whose eGFR falls below 30?
discontinue therapy
38
4 types of SGLT2 inhibitors
canagliflozin dapagliflozin empagliflozin etrugliflozin
39
3 pros of metformin
highly efficacious low risk of hypoglycemia weight neutral
40
this transporters main role is glucose/galactose reabsorption in the small intestines
SGLT1
41
Where do SGLT1 mainly act? | Where do SGLT2 mainly act?
SGLT1 → gut | SGLT2 → renal
42
How should a patient take Nateglinide?
with food → more effective
43
Pregnancy category for a-glucosidase inhibitors
B
44
What do you want dose adjust SGLT2 inhibitors for?
renal impairment
45
when prescribing metformin, you can go ahead and inititate the required dose for the patient?
no → must titrate up
46
Adverse effects in meglitinides
hypoglycemia weight gain diarrhea
47
MOA of dipeptidyl peptidase enzyme inhibitor
protects GLP1 from inactivation → increases glucose depended insulin secretion decreases glucagon secretion
48
biggest adverse effect for SUR and some others
weight gain | nausea and vomiting, hypoglycemia, CV events, hyponatremia
49
metformin is pregnancy category __
B
50
biggest side effect with Metformin
diarrhea → seen less with XR
51
MOA of SGLT2 inhibitors
increases urinary glucose excretion
52
Three 2nd generation SUR that are most often used
glyburide glipizide glimipride
53
two types of Meglitinides (nonsulfonylurea secretagogues)
nateglinide | repaglinide
54
MOA of Meglitinides
similar to SUR → block ATP Na/K channels on pancreatic B cells → enhances insulin secretion
55
examples of GLP1 agonists
dulaglutide exanatide liraglutide lixisenatide
56
Adverse effects of TZD
``` fluid retention → edema and HF increased risk of MI bone fracture risk bladder cancer hepatotoxicity ```
57
pro of second generation SUR
low cost and highly effective
58
this enzyme converts complex startes (oligosaccharides, disaccharides) to simple start (monosaccharides)
alpha-glucosidase
59
T2DM without ASCVD or CKD: what do you add on if you need to manage weight loss?
GLP 1 RA | SGLT2 i
60
GLP1 agonist with best cardiovascular benefit
liraglutide
61
incretin hormones are responsible for ___% of postprandial insulin release
60%
62
adverse effects of DPP-4 inhibitors (gliptins)
``` angioedema heart failure hepatic failure joint pain renal impairment acute pancreatitis hyperlipidemia ```
63
first line in treating T2DM
metformin
64
what gylcemic lowering drug should be avoided in a patient with heart failure?
TZD
65
When you should start to consider dose adjusting for renal function for SUR?
CrCl < 50
66
metformin is at risk for lowering what level?
B12
67
Pro of using meglitinide over SUR
patients with sulfa allergy
68
this transporter facilitates renal glucose reabsorption
SGLT2
69
2 incretin hormones
gastric inhibitory peptide (GIP) | glucagon-like peptide (GLP1)
70
while Beta Blockers can decrease signs of hypoglycemia, they will not decrease what?
sweating
71
Is SUR effective in T1DM?
no → need functioning pancreatic B cells
72
Who are TZD contraindicated in?
heart failure patients
73
side effects of SGLT1 inhibitors
diarrhea and dehydration
74
3 MOA of GLP1 agonists
increases glucose dependent insulin secretion decreases glucagon secretion slows gastric emptying
75
Con of linagliptin that may cause lots of DDI
long half life → > 100 hours
76
T2DM without ASCVD or CKD: add on if cost is concern for patient?
SU | TZD
77
biggest adverse effects of a-glucosidase inhibitors
flatulence → MC diarrhea abdominal pain
78
what levels do you check before prescribing TZD?
LFTs
79
effects of GLP1 on the hypthalamus
decreases appetite
80
MOA for TZD at the liver, muscle, and adipose tissue
decreases hepatic glucose production | increases glucose uptake in muscles
81
T2DM without ASCVD or CKD: what do you add on if you need to address hypoglycemia?
DPP-4 I GLP 1 RA SGLT2i TZD
82
2 MOA of Metformin
decreases hepatic glucose production | increases glucose uptake in muscles
83
effects of GLP1 on the stomach
delays gastric emptying
84
Black box warning for canagliflozin
increased risk of lower limb amputation in patients with T2DM and established CVD
85
two types of a-glucosidase inhibitors used
acarbose | miglitol

Diabetes Mellitus (4 decks)

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