drug table

Question 1

Metformin

effect

Answer 1

• Lowers A1C 1-2%

* Lowers fasting glucose primarily

Question 2

metformin

AE

Answer 2

• Malabsorption of B12
• GI distress: Diarrhea, abdominal cramping (ER formulation better tolerated)
• Lactic acidosis [Boxed warning]

Question 3

metformin contradiction

Answer 3

• eGFR <30
• eGFR 30-45 no new starts, use half maximal dose
• severe hepatic, pulmonary, cardiac disease (avoid in unstable or hospitalized HF)

Question 4

metformin comments

Answer 4

• Improved CV outcomes (UKPDS)
• No hypoglycemia
• Weight neutral
• Max:2550mg/day
• Unlabeled use: PCOS
• May be used to reduce insulin requirements in Type 1

Question 5

Sulfonylurea

Answer 5

1st gen-
tolbutamide, acetohexamide, chlorpropamide,
2nd gen-
glyburide, glipizide, glimepiride

Question 6

Sulfonylurea

effects

Answer 6

• Lowers A1C 1-2%

* Lowers both fasting and postprandial glucose

Question 7

Sulfonylurea

AE

Answer 7

• Hypoglycemia

* Weight gain

Question 8

Sulfonylurea

contradiction

Answer 8

• Lactating women
• Type 1 DM
• Hypoglycemic unawareness

Question 9

Sulfonylurea

comments

Answer 9

• Glyburide- active metabolite secreted renally (avoid in renal dysfxn)
• Associated with high treatment failure (beta cell destruction)
• Reduces microvascular complications (UKPDS)
• Avoid in basal/bolus insulin therapy

Question 10

Thiazolidinediones

Answer 10

• Rosiglitazone

* Pioglitazone

Question 11

Thiazolidinediones

effects

Answer 11

• Lowers A1C 0.8-1.5%

* Primarily lowers fasting blood glucose

Question 12

Thiazolidinediones

AE

Answer 12

• Does not cause hypoglycemia- generally well tolerated
• Wt gain
• CHF exacerbation
• Hepatotoxicity
• Fractures
• ? MI (rosiglitazone)
• ? bladder cancer (pioglitazone)

Question 13

Thiazolidinediones

contradiction

Answer 13

• CV- ? MI in predisposed individuals (duration of exposure related, rosiglitazone
• Do not use in CHF III, IV
• ALT >2.5x ULN

Question 14

Thiazolidinediones

comment

Answer 14

• Long lag before max effect (8-12 weeks)
• Bladder cancer risk increases in males, tobacco users and PMH/FH of bladder cancer
• Increase in HDL and decrease in TRG (pioglitazone) (IMPORTANT)
• Can induce ovulation in PCOS

Question 15

Alpha-glucosidase inhibitors

Answer 15

• Acarbose

* Miglitol

Question 16

Alpha-glucosidase inhibitors

Effect

Answer 16

• Lowers A1C 0.5-1%

* Lowers postprandial glucose levels

Question 17

Alpha-glucosidase inhibitors

AE

Answer 17

• GI: flatulence, diarrhea
• Weight neutral
• No hypoglycemia

Question 18

Alpha-glucosidase inhibitors

contradiction

Answer 18

• Do not use in IBD, intestinal obstruction, cirrhosis, sCr >2mg/dl, CrCl <25 ml/min

Question 19

Alpha-glucosidase inhibitors

comments

Answer 19

• physical drug-drug interactions
• Nonsystemic
• ? reduction in CVD events (STOP-NIDDM)

Question 20

Metformin MOA

Answer 20

Decreased liver gluconeogenesis and increased insulin sensitivity in muscle tissues

Question 21

sulfonylurea MOA

Answer 21

Close the ATP dependent K+ channel to cause the depolarization of the beta cell and release of insulin in a glucose independent manner

Question 22

Thiazolidinediones MOA

Answer 22

Increase target tissue sensitivity to insulin by activating genes (PPAR-gamma) involved in carb and lipid metabolism, increased glucose uptake in muscle, and reduced liver gluconeogenesis

Question 23

alpha-glucosidase inhibitors MOA

Answer 23

Inhibits a-glucosidase enzyme in the GI tract that hydrolyzes complex carbs into glucose, thus reducing circulating postprandial glucose levels

Question 24

DPP-IV inhibitors

Answer 24

• • sitagliptin
• vildagliptin
• saxagliptin
• linagliptin
• Alogliptan

Question 25

DPP-IV inhibitors MOA

Answer 25

* Reversible inhibition of DPP-IV protease activity * Glucose dependent; affects post-prandial levels * Increase insulin secretion and lowers glucagon secretion

Question 26

DPP-IV inhibitors effects

Answer 26

* Lowers A1C 0.6-0.8% | * Lowers postprandial sugars

Question 27

DPP-IV inhibitors AE

Answer 27

* URI, HA, UTI | * Generally well tolerated

Question 28

DPP-IV inhibitors | contradiction

Answer 28

* Hx of pancreatitis * DKA * DM type 1

Question 29

DPP-IV inhibitors | comments

Answer 29

* Avoid in basal/bolus insulin therapy | * Dose adjustments with impaired renal function (all except linagliptin)

Question 30

SGLT 2

Answer 30

* Canagliflozin * Dapagliflozin * Empagliflozin * Ertugliflozin

Question 31

SGLT 2 MOA

Answer 31

* lowers renal threshold for glucose | * increases urinary glucose excretion

Question 32

SGLT 2 effect

Answer 32

* lowers A1C by 1 % | * Mixed effect

Question 33

SGLT 2 AE

Answer 33

* polyuria * UTI * Mycotic infection * No hypoglycemia * Decreased weight and blood pressure

Question 34

SGLT 2 contradiction

Answer 34

* Recurrent UTI and mycotic infections * Fournier’s Gangrene (necrotizing fasciitis of the perineum) serious but rare * BOXED WARNING: Increased risk of foot/toe amputations (Canagliflozin) * Risk of DKA while euglycemic or only slightly elevated DKA

Question 35

SGLT 2 comments

Answer 35

* No hypoglycemia * Effective at all stages of Type 2 * Can increase LDL levels * Adjust dose if crcl <60 ml/min (see table below) * Empagliflozin, dapagliflozin, canagliflozin have demonstrated benefit (reduce HF, CKD)***IMPORTANT

Question 36

GLP-mimetic injectable

Answer 36

* Exenatide * Liraglutide * Dulaglutide * Semaglutide (Ozempic Subcut, NEW Rybelsus Only current Oral GLP)

Question 37

GLP-mimetic injectable MOA

Answer 37

* Glucagon like peptide-1 (GLP-1) mimetic reduces food intake and results in weight loss * Increase endogenous incretin levels and decrease glucagon secretion (glucose dependent) * Increases satiety through delayed gastric emptying

Question 38

GLP-mimetic injectable | Effect

Answer 38

* Lowers A1C 0.6-1.0% * Lowers postprandial (exenatide) * Lowers more fasting glucose (liraglutide) * Mixed Effect: exanetide ER (Bydureon) and semaglutide

Question 39

GLP-mimetic injectable | AE

Answer 39

* N/V, diarrhea, dizziness, HA, dyspepsia | * Weight loss

Question 40

GLP-mimetic injectable | contradiction

Answer 40

* Avoid in CrCl <30ml/min (exenatide) * Gastroparesis * Pancreatitis * Thyroid carcinoma

Question 41

GLP-mimetic injectable | comments

Answer 41

• Injectable • Thyroid tumors in animal studies • Reduce insulin dose by up to 20% when starting this drug class, in most cases will reduce insulin burden • Exenatide 1 hour before meals, titrate monthly • Liraglutide: w/o regard to meals, titrate weekly • Liraglutide> semaglutide> exenatide er CV benefits

Question 42

insulin | rapid acting

Answer 42

• Rapid acting- | Lispro, aspart, glulisine

Question 43

insulin | short acting

Answer 43

Human regular

Question 44

insulin intermediate acting

Answer 44

NPH

Question 45

insulin long acting

Answer 45

detemir, glargine, degludec