E1 Flashcards
(351 cards)
1
Q
What BG is considered hyperglycemia?
A
BG > 250mg/dl
2
Q
What are the S/Sx of hypoglycemia?
A
sweaty, tachycardia, pallor, hangry
3
Q
How to tx hypoglycemia?
A
Tx with Rule of 15:
- check BG
- 15g carb load of OJ/soda/candy
- wait 15min, then recheck BG
- substantial snack w protein, carb, fat
4
Q
How do you treat severe hypoglycemia?
A
impaired mentation –> paramedics + recombinant glucagon
5
Q
What are the S/Sx of hyperglycemia?
A
visual changes, polyuria, nocturia, long-term weight loss
6
Q
How do you tx hyperglycemia?
A
Home mgmt: monitor BG, insulin, rest, water, exercise
7
Q
What is severe hyperglycemia?
A
DKA –> T1DM, hrs-days
HHS –> T2DM, days-weeks, higher mortality
8
Q
What are microvascular complications?
A
retinopathy, nephropathy, neuropathy
9
Q
What are macrovascular complications?
A
cerebrovascular disease, heart disease (CAD leading cause of death), Peripheral vascular disease
10
Q
What are the ADA guidelines to treat HTN?
A
no preference unless albuminuria –> ACEi/ARB
11
Q
What are the AAE guidelines to treat HTN?
A
prefer ACEi/ARB
12
Q
What are the ACC/AHA guidelines to treat HTN?
A
no preference unless:
- CKD –> ACE
- HF –> avoid nonDHP CCBs
- African American –> Thiazides or CCB if monotherapy
13
Q
What are the ADA guidelines to tx cholesterol?
A
under 40y/o:
- ASCVD > 10% –> high intensity statin (+/- ezetimibe, PCSK9i)
over 40y/o:
- ASCVD < 20% –> mod. statin
- ASCVD > 20% –> high intensity statin (+/- ezetimibe, PCSK9i)
14
Q
What are the ACC/AHA guidelines to tx cholesterol?
A
all DM its should have mod. intensity statin
15
Q
What do the ADA guidelines say about ASA in primary prevention?
A
may in pt with high CVD risk (50+, smoker, HTN, LDL > 100, CKD)
16
Q
What do the AACE guidelines say about ASA in primary prevention?
A
when ASCVD > 10%
17
Q
How do you treat obesity in DM pts?
A
- diet, exercise, behavioral therapy to 5% weight loss
- BMI >= 27 –> consider weight loss meds/therapy
- BMI >= 35 –> consider bariatric surgery
18
Q
How do the guidelines address smoking cessation?
A
AVOID tobacco products, even e-cigs
19
Q
What do the guidelines say about immunizations?
A
- influenza annually
- HepB
- Pneumococcus: 19-64y/o: PPSV23, 65+: PCV13 then PPSV23 booster 1yr later
20
Q
What do the guidelines say to treat retinopathy?
A
- optimize BG, BP, lipid control to dec. risk and slow progression
- annual eye exams –> T1DM within 5yrs post-DM onset, T2DM at the time of diagnosis
21
Q
What do the guidelines say about nephropathy?
A
- risk factors: BG, HTN, proteinuria (ACE/ARB), dyslipidemia (statins)
- annually asses urinary albumin (proteinuria) and eGFR
22
Q
What do the guidelines say about neuropathy?
A
- tx options for Sx but not progression (Lyrica, duloxetine)
- annual comprehensive foot exams
23
Q
How do you tx microvascular complications?
A
by controlling blood sugars
24
Q
What does DCCT trial show?
A
T1DM; largest study ever conducted
- intensive insulin therapy reduces A1C and T1DM microvascular complications –> EDIC
- relative risk of microvascular complication is highly affected by A1C
- CV benefit won’t be realized until ~10yrs from when you started intensive therapy
25
What does UKPDS trial show?
T2DM; trial we talk about when we consider metformin CV benefit
- intensive therapy (+metformin, SU) reduced microvascular events --> 10yr follow up: need for meticulous glucose control to improve microvasc. complications & long-term macrovasc. comps., necessary to control BG, A1C & BP
26
what does ACCORD trial show?
T2DM; study that makes us want to individualize goals for pts
- super intensive therapy (AIC< 6%) led to higher risk of death & MI, esp. if A1C >= 8.5, hx of neuropathy, hx of ASA use
27
What does ADVANCE trial show?
T2DM
- corroborated with UKPDS 10yr follow up with a dec. in micro and macrovascular complications with intensive therapy
28
What does VADT trial show?
T2DM (white, older men)
- lower threshold to start insulin therapy dec. major microvascular complications; severe hypoglycemia in last 90 days is strong predictor of mortality
29
What class of drugs don't have CVD mortality benefits?
DPP4i
only SGLT2 and GLP-1 do
30
What guidelines (outpt) would you use for someone <65 y/o without clinical ASCVD event?
Strict Guidelines: AACE
- AIC <= 6.5%
- FBG < 110mg/dl
- PPG < 140mg/dl
- want to prevent long-term complications
31
What guidelines (outpt) would you use for someone >= 65y/o OR any age with a clinical ASCVD event?
Loose Guidelines: ADA
- AIC < 7.5%
- FBG 80-130mg/dL
- PPG < 180mg/dl
- want to avoid hypoglycemia
32
What are the guidelines to treat a pediatric pt with T1DM?
- BP: tx if consistently > 130/80mmHg
- cholesterol: tx if LDL consistently > 130mg/dl
- microvascular monitoring once >= 10y/o OR had DM for 5yrs
- 60min aerobic exercise with strength training at least 3x/week
33
What are the guidelines to treat a pediatric pt with T2DM?
- screening once >= 10y/o AND BMI >= 85th percentile
- aim for 7-10% weight loss
- 30-60mins of mod-vigorous physical activity 5x/week with strength training for 3
- goal AIC < 7% (6.5% reasonable if you can avoid hypoglycemia)
34
What are the guidelines to treat a geriatric pt with DM?
- functional, cognitively intact older adults can use goals developed for younger adults. otherwise...
- A1C goals more lenient < 7.5%
- AVOID HYPOGLYCEMIA
- routinely consider de-escalating regimens
35
What do you do for sick day mgmt?
Sick day = infection, injury, surgery, trauma, invasive procedure, major life stress
- continue long-acting (basal) insulin as normal
- use rapid-acting (bolus) insulin only If eating
- continue PO meds EXCEPT metformin, SGLT2i, GLP-1 --> d/t all PO meds if N/V/D
- check OTC meds (sugar content)
36
What are some counseling points for sick day mgmt?
test BG Q2H
- T1DM: check urine/blood ketones Q4H
- monitor temp. and hydration status
- tract Sx: N/V/D, thirst, urination
37
What is MNT?
medical nutrition therapy
- MNT for all DM pts
- portion control and healthy food choices: low carb, low processed foods
- plate method
- weight loss > 5%
- individualized meal plans
alcohol consumption inc. hypoglycemia
- no more than 1drink/day for females
- no more than 2 drinks/day for males
- preferably drinking with food
38
What are the target BG values for hypoglycemia and hyperglycemia for inpatient?
- hyperglycemia: > 140mg/dl
- hypoglycemia: < 70mg/dl
- severe hypoglycemia: < 40mg/dl
39
What are the target BG value for FBG and PPG for inpatient?
- FBG: < 140mg/dl
- PPG: < 180mg/dl
- if BG goes < 100mg/dl we should modify the pts regimen
40
What factors could affect a pts glucose control in the inpatient setting?
- stress hyperglycemia: pts without DM (AIC < 6.5%) can experience inc. BG readings when ill
- inpatient and pt specific risk factors for Hypo and Hyperglycemia
- drug-induced alterations in BG
41
What are patient specific factors for hypoglycemia?
- advanced age
- dec. oral intake
- chronic renal failure
- liver disease
- hx of frequent or severe hypoglycemia
42
What are inpatient factor for hypoglycemia?
- Change in diet
- medication use (BBs)
- failure to adjust regimen based on BG patterns
- poor coordination between testing and timing of insulin delivery
43
What are inpatient factors for hyperglycemia?
- prolonged use of correctional insulin as monotherapy
- TPN or enteral feeds
- medication use
- failure to adjust regimen based on BG patterns
- poor coordination between testing and timing of insulin delivery
44
What drugs increase the risk of hypoglycemia?
- BBs
- fluoroquinolone ABX (-oxacin)
- alcohol
- pentamidine
45
What drugs increase the risk of hyperglycemia?
- corticosteroids (-sone)
- atypical antipsychotics (-zapine)
- Fluoroquinolone ABX (-oxacin)
- calcineurin inhibitors (cyclosporine, Tacrolimus)
- protease inhibitors (-vir)
- thiazide diuretics
46
What do you do if a pt comes in and they have a hx of T1DM or T2DM and A1C >= 6.5%?
treat them as diabetic (regular POC BG monitoring). no further tests needed
47
What do you do if a pt comes in with no hx of diabetes but BG > 140mg/dL?
send for A1C and begin POC BG testing while we wait (24-48hrs). Can't confirm DM status without A1C, further tests needed.
48
What do you do if a pt comes in with no indication that they have been diagnosed with DM, but have a BG > 140mg/dL & A1C in the last 3 months is >= 6.5%?
treat them as diabetic (regular POC BG monitoring). no further tests needed.
49
What are the names of long-acting (basal) insulins?
- Glargine (Lantus, toujeo, basaglar)
| - determir (Levemir)
50
What are the names of rapid-acting (bolus) insulins?
- aspart (novolog)
| - lispro (Humalog, Admelog)
51
What insulin dosage do you use for an inpatient with T1DM?
TDD = 0.2-0.4U/kg/day
- 50-60% basal, 40-50% nutritional
52
What insulin dosage do you use for an inpatient with T2DM but who has never had insulin?
TDD: 0.3-0.5U/kg/day
- 50% basal, 50% nutritional
53
What insulin dosage do you use for an inpatient with T2DM who was on insulin before they came in?
reduce outpatient dose by 20-25%
54
If FBG > 140mg/dL how do we adjust insulin dosage?
inc. dose of basal insulin by 20%
55
If BG < 70mg/dl how do we adjust insulin dosage?
reduce basal dose by 20%
56
What is a counseling point for Linagliptan (tradjenta)?
URTI
57
What 2 classes of meds can you never use together?
DPP4i and GLP-1
58
What DPP4i does not require renal dose adjustments?
Linagliptan (Tradjenta)
59
What sulfonylurea is not on the BEERs list?
Glipizide
60
What medication has a DDI with radiopaque contrast dye?
metformin --> D/t 24h before, 48hr after imaging
61
Glyburide
SU: Diabeta, Micronase, Glynase
62
Glipizide
SU: Glucotrol, Glucotrol XL
63
glimepiride
SU: Amaryl
64
Is glyburide on BEERs list?
yes
65
Is glipizide on BEERs list?
no
66
Is glimepiride on BEERs list?
yes
67
Repaglinide
Meglitinide: Prandin
68
Nateglinide
Meglitinide: Starlix
69
metformin
biguanide
70
rosiglitazone
TZD: avandia
71
pioglitazone
TZD: actos
72
acarbose
alpha-glucosidase inhibitor: precose
73
miglitol
alpha-glucosidase inhibitor: glyset
74
sitagliptin
DPP4i: Januvia
75
linagliptin
DPP4i: tradjenta
76
Saxagliptin
DPP4i: Onglyza
77
Alogliptin
DPP4i: nesina
78
canagliflozin
SGLT2i: invokana
79
dapagliflozin
SGLT2i: farixiga
80
empagliflozin
SGLT2i: jardiance
81
ertugliflozin
SGLT2i: steglatro
82
exenatide
GLP-1: bydureon
83
liraglutide
GLP-1: victoza
84
dulaglutide
GLP-1: trulicity
85
lixisenatide
GLP-1: adlyxin
86
semaglutide
GLP-1: ozempic
Rybelsus = semaglutide oral
87
What is basal secretion rate?
0.5-1 unit/hr
88
Is insulin a hormone?
yes
89
Where is insulin produced?
in the beta cells of the islets of langerhans in the pancreas
90
What is insulin formed from?
proinsulin (cleaved by beta cella peptidases to insulin)
91
insulin aspart
Novolog, Fiasp
Rapid-Acting Insulin
92
insulin lispro
Humalog, admelog
Rapid-Acting Insulin
93
Insulin Glusine
Apidra
rapid acting insulin
94
insulin degludec
Tresiba
long acting insulin
95
insulin determir
Levemir
Long-Acting Insulin
96
insulin glargine
Lantus, Toujeo, basaglar, semglee
long acting insulin
97
Insulin Aspart can be administered IV?
no
98
Can insulin aspart be mixed with NPH?
yes
99
Can insulin lispro be administered IV?
no
100
Can insulin lispro be mixed with NPH?
yes
101
What are the ultra-rapid acting insulins?
insulin aspart and insulin lispro
102
What are the rapid acting insulins?
insulin lispro, aspart, glulisine
103
When should you eat after administering a rapid acting insulin?
eat within 15mins of injection
104
Can a rapid acting insulin be mixed with NPH?
yes
105
Can a rapid acting insulin be administered IV?
no
106
What is a short acting insulin?
Regular insulin (Humulin R, Novolin R)
107
What color is regular insulin?
clear, colorless
108
Can regular insulin be given IV?
yes (it is the only insulin that can be administered IV)
- DKA Tx, TPN
109
What is an intermediate acting insulin?
NPH (humulin NPH , Novolin NPH)
110
What can NPH insulin be mixed with?
regular insulin, aspart, lispro, glulisine
111
What color should NPH insulin be?
should be cloudy bc its a suspension but not frosty --> DONT SHAKE WILL DENATURE INSULIN INSIDE
frosting = loss of potency
112
What are long-acting insulins?
glargine, detemir, degludec
113
Can you dilute long acting insulins?
no
114
Can you mix long acting insulin?
no
115
insulin glargine MOA
forms a precipitate right under the skin
116
insulin detemir MOA
has neutral pH of 7.4
117
Insulin degludec MOA
injected as a multi-hexamer --> long time to get broken down to monomer then attaches to albumin
3-5 day SS, no other insulin has this!!!
118
Inhaled regular insulin
Afrezza --> bolus insulin
BBW: acute bronchospasm
approved for 18y/o+
119
What dosage is blue afrezza?
4 units
120
what dosage is green afrezza?
8 units
121
what dosage is gold afrezza?
12 units
122
Insulin ADES
HYPOGLYCEMIA
- allergy extremely rare
- injection site
- lipohypertrophy
- cough (Afrezza only)
123
Using AACE guidelines, what insulin dosage should someone with an A1C < 8% get?
TDD: 0.1-0.2U/kg
124
Using AACE guidelines, what insulin dosage should someone with an A1C > 8% get?
TDD: 0.2-0.3U/kg
125
Using AACE guidelines, pt is on basal insulin and you want to add bolus insulin, how do you do this?
start 1 bolus shot/day
start: 10% of basal dose
126
Using AACE guidelines, you want to start basal and bolus insulin , how do you do this?
- start bolus before each meal
- if not on basal: 0.3-0.5U/kg/day
- if on basal: 50% of basal dose divided by 3 for each meal
127
Using ADA guidelines, you want to start bolus insulin in a patient already on basal insulin, how do you do this?
10% of basal dose injected once a day at largest meal of day
128
Using ADA guidelines, you want to start basal insulin in a patient, how much do they get?
0.1-0.2U/kg/day
129
insulin drug interactions
- TZDs
- ACEi, MAOi
- thiazide diuretics
- hormones (estrogens/androgens/thyroid)
- beta blockers
- alpha-glucosidase inhibitors
130
insulin monitoring
- FBG/PPG
- hypoglycemia
- weight gain
- injection site rxns
- cough (afrezza only)
131
Whats the MDD for insulin?
there is none
132
does insulin cause weight gain or loss?
weight gain
133
Whats absorbed faster, injectable or nasal insulin?
injectable
134
What SQ injection site has fastest absorption?
abdomen > arms > thighs > buttocks
135
What SQ injection depth has fastest absorption?
IV > IM > SQ
136
Regional blood flow is affected by?
- exercise
- skin temp.
- hydration status
- local heat
137
Insulin glargine + Lixisenatide
(Soliqua)
- MDD: 60units/20mcg
- admin. 1hr before breakfast
- no thyroid C-cell tumor BBW
138
insulin degludec + liraglutide
xultophy
- MDD: 50U/1.8mg
- pen delivers doses between 10-50U
- admin. anytime once daily without regard to food
139
Are sulfonylureas PO or SQ?
PO
140
What drugs are SUs?
(-ide)
Glyburide, Glipizide, Glimepiride
141
How often are SUs dosed?
QD-BID
142
What is the MDD for glyburide?
20mg
143
what is the MDD for glipizide?
IR: 40mg
ER: 20mg
144
What is the MDD for glimepiride?
8mg
145
what is the MOA for SUs?
stimulate insulin release from beta cells
- "insulin secretagogues"
146
What is the SOA for SUs?
beta cells in the pancreas
147
What are CIs of SUs?
hypersensitivity
T1DM
DKA
148
When is glyburide CI?
CrCl < 50
149
When is glipizide CI?
CrCl < 10
150
when is glimepiride CI?
CrCl < 15
151
What SUs are CI if pregnancy-near term?
Glyburide and Glipizide
152
What are ADEs of SUs?
hypoglycemia
N/V
weight gain
153
What SUs are on the BEERs list?
glyburide and glimepiride
154
When should you take SUs?
Take with breakfast or first meal of the day
Exception: Glipizide should be taken 30 min before a meal
155
What should you ask about at every refill for SUs?
hypoglycemia and weight gain
156
What efficacy is SUs?
high efficacy
157
What cost is SUs?
low cost
158
What durability are SUs?
low durability --> become less efficacious over time
159
SUs may blunt ___?
may blunt myocardial ischemia preconditioning
160
What is the ASCVD risk of SUs?
neutral
161
What is the HF risk of SUs?
neutral
162
What is the CKD risk of SUs?
neutral
163
Do SUs cause weight gain or loss?
weight gain
164
What do you monitor in SUs?
Hypoglycemia
FBG
A1C
allergic rxns, sun sensitivity
165
How long until SUs reach peak effect?
4-6 weeks
166
What drugs are meglitinides?
(-glinide)
Repaglinide
Nateglinide
167
Are meglitinides PO or SQ?
PO
168
What is the MDD for Nateglinide when A1C < 8%?
4mg
169
What is the MDD for Nateglinide when A1C > 8%?
16mg
170
What is the MOA for meglitinides?
- stimulate insulin release from beta cells
| - insulin secretagogues
171
What is the SOA for meglitinides?
beta cells in pancreas
172
What are DDI with Repaglinide?
NPH insulin --> inc. risk of MI
Gemfibrozil --> inc. Repaglinide levels
173
What are DDI with Nateglinide?
Mifepristone (abortificant): do not use within 14 days
Pazopanib (cancer agent) --> inc. nateglinide levels
174
What are meglitnides CI in?
hypersensitivity
T1DM
DKA
175
What are precautions with meglitnides?
severe renal disease
impaired liver fx
use with insulin
176
What are ADEs of meglitinides?
hypoglycemia (less common than SUs)
GI disturbances
weight gain
headache
177
When do you administer meglitinides?
before meals
- skip meal, skip dose
178
When do you take repaglinide?
15-30mins before meals
179
When do you take nateglinide?
1-30min before meals
180
Meglitinides are the short acting form of?
SUs
181
What should you ask about at every Meglitinide refill?
hypoglycemia and weight gain
182
What efficacy are meglitnides?
low efficacy
183
What cost are meglitnides?
intermediate cost
184
What is the ASCVD risk of meglitnides?
neutral
185
What is the HF risk of meglitnides?
neutral
186
What is the CKD risk of meglitnides?
neutral
187
Do meglitnides require renal dosing?
no
188
Meglitnides work specifically on?
PPG, so if pt with high PPG these might be good meds
189
What do you monitor for Meglitnides?
PPG
hypoglycemia
A1C
weight gain
190
How long until meglitnides reach peak effect?
4-6 weeks
191
Do meglitnides cause weight gain or loss?
weight gain
192
What drugs are biguanides?
metformin
193
Are biguanides PO or SQ?
PO
194
How is IR Metformin dosed?
850-1000mg BID
195
How is ER metformin dosed?
1000-2000mg QD
196
What is minimal effective dose for metformin?
500mg
197
What is the primary MOA of biguanides?
dec. glucose output from liver
198
what is the secondary MOA of biguanides?
inc. peripheral muscle glucose sensitivity
199
What is the SOA of biguanides?
liver and peripheral muscle
200
When are biguanides CI?
eGFR < 30
Acute Renal Failure
201
When should you dec. biguanides dose?
eGFR 30-45 = 1/2 dose
202
What are DDIs with biguanides?
radiopaque contrast dyes!!!
d/t 24hrs prior and 48hrs after admin.
203
What are ADEs of biguanides?
GI
weight loss
lactic acidosis
cardio protection
vit. B12 deficiency
204
What is a rule of biguanides?
titrate SLOWLY to avoid GI ADEs
205
How should you take biguanides?
take with food to dec. GI effects
start low, go slow
206
What should you ask about for every biguanide refill?
GI upset, weight loss, S/Sx of lactic acidosis (SOB, muscle cramping, tachycardia)
207
What efficacy are biguanides?
high
208
Do biguanides cause hypoglycemia?
no
209
What cost are biguanides?
low cost
210
What ASCVD risk do biguanides have?
potential benefit
211
What HF risk do biguanides have?
neutral
212
What CKD risk do biguanides have?
neutral
213
What do you monitor for biguanides?
- renal fx (eGFR) --> check 6 weeks after initiation, then annually, most providers do Q3-6months
- GI intolerance
FBG/PPG
- A1C --> Q3months
- B12 levels
- weight loss
- s/sx of lactic acidosis
214
When do biguanides reach peak effect?
6-8 weeks
215
Do biguanides cause weight gain or loss?
weight loss
216
What drugs are Thiazolidinediones?
(-glitazone)
Rosiglitazone
Pioglitazone
217
Are TZDs PO or SQ?
PO
218
How often are TZDs dosed?
QD
219
What is the MDD of Rosiglitazone?
8mg
220
What is the MDD of pioglitazone?
45mg
221
What is the primary MOA of TZDs?
inc. peripheral muscle glucose sensitivity
222
What is the secondary MOA of TZDs?
dec. glucose output from the liver
223
What is the SOA of TZDs?
liver and peripheral muscle
224
What DDI does Rosiglitazone have?
insulin, nitrates
225
What DDI does Pioglitazone have?
oral contraceptives, progestins, pazopanib
226
What are CI of TZDs?
hypersensitivity
T1DM
DKA
ALT > 2.5xULN
NYHA Class 3-4
Symptomatic CHF
ACS
227
What is a CI of pioglitazone?
active bladder cancer
228
What are precautions for TZDs?
NYHA class 1-2
edema
impaired liver fx
insulin/SU use
bladder cancer hx
fracture risk
MI --> rosiglitazone has higher risk
females --> can induce ovulation
229
What is the BBW for TZDs?
CHF
230
What is the BBW specific to Rosiglitazone?
MI
231
What are ADEs of TZDs?
edema --> may worsen CHF
weight gain
hepatotoxicity
fractures
232
What is an ADE specific to Pioglitazone?
Bladder cancer
233
How are TZDs dosed?
QD; same time each day
report weight gain &/or swelling of legs immediately
234
What should you ask about for every refill of TZDs?
edema and weight gain
235
What efficacy are TZDs?
high
236
Do TZDs cause hypoglycemia?
no
237
what cost are TZDs?
low cost
238
What ASCVD risk do TZDs have?
potential benefit with pioglitazone
239
What HF risk do TZDs have?
inc. risk
240
What CKD risk do TZDs have?
neutral
241
Do TZDs require renal dose adjustment?
no
242
What do you monitor in TZDs?
LFTs
edema
weight gain
cholesterol panel
FBG/PPG
A1C
243
How long until TZDs reach peak effect?
6-8 weeks
244
What drugs are alpha-glucosidase inhibitors (AGIs)?
acarbose
miglitol
245
Are AGIs PO or SQ?
PO
246
How are AGIs dosed?
TID; dosed with every meal --> take with first bite of each meal
skip meal, skip dose
start low, go slow
they have a v short half life
247
What is the MDD of Acarbose?
50mg
248
What is the MDD of Miglitol?
100mg
249
What is the MOA of AGIs?
dec. breakdown of sucrose and complex carbs in the brush border of the SI
250
What is the SOA of AGIs?
gut
251
What are the CIs of AGIs?
hypersensitivity
T1DM
DKA
IBS
Crohn's disease
colonic ulceration
intestinal obstruction
SCr > 2.0
252
What are precautions of AGIs?
impaired renal fx
253
What are ADEs of AGIs?
GI: abdominal pain, diarrhea, flatulence, bloating --> ADEs more intense than metformin
254
When on AGI, when should you contact a MD?
if severe diarrhea or vomiting occur
255
What should you ask about for every refill of a AGI?
GI upset and meal timing
256
What efficacy are AGIs?
high
257
Do AGIs cause hypoglycemia?
no
258
What are the cost of AGIs?
intermediate cost
259
What ASCVD risk are AGIs?
neutral
260
What HF risk are AGIs?
neutral
261
What CKD risk are AGIs?
neutral
262
What ASCVD risk are AGIs?
no
263
Do AGIs cause weight gain or weight loss?
no weight change
264
What do you monitor in AGIs?
PPG, A1C
GI intolerance
265
How long until AGIs reach peak effect?
4-6 weeks
266
What drugs are Gliptins/DPP4is?
(-gliptin)
Sitagliptin
Linagliptin
Saxagliptin
Alogliptin
267
Are DPP4s PO or SQ?
PO
268
What is the dose of Sitagliptin?
100mg daily
269
What is the dose of Linagliptin?
5mg daily
270
What is the dose of saxagliptin?
5mg daily
271
What is the dose of Alogliptin?
25mg daily
272
What is the MOA of DPP4s?
potentiate the effects of incretin hormones (which are involved in the physiologic regulation of glucose homeostasis)
273
What is the SOA of DPP4s?
suppresses glucagon secretion
slows gastric emptying
dec. food intake
promotes beta cell proliferation
274
What DPP4 inhibitor is does not have a renal dose adjustment?
linagliptin
275
What is a DDI with Saxagliptin?
conivaptan
276
What is a DDI with Linagliptin?
carbamazepine
Efavirenz
phenytoin
rifampin
St. John's Wort
277
What is a DDI with Sitagliptin?
none
278
What is a DDI with Alogliptin?
none
279
What are CIs are DPP4s?
hypersensitivity
T1DM
DKA
280
What is a precaution of DPP4s?
impaired renal & hepatic fx
281
What is a precaution specific to Saxagliptin and Alogliptin?
HF --> FDA warning
282
What drug class should you never use with DPP4 inhibitors?
GLP-1 RA
283
What are ADEs of DPP4s?
nasopharyngitis
URI
abdominal pain
N/V/D
headache
edema
hepatotoxicity
284
How should you take DPP4s?
take QD; same time each day
can be taken with or without food
285
What should you ask about at every refill for a DPP4?
nasopharyngitis and URI
286
What efficacy are DPP4s?
intermediate
287
Do DPP4s cause hypoglycemia?
no
288
What cost are DPP4s?
high cost
289
What ASCVD risk do DPP4s have?
neutral
290
What HF risk do DPP4s have?
potential risk with saxagliptin and alogliptin
291
What CKD risk do DPP4s have?
neutral
292
Do DPP4s require renal dosing?
Yes except Linagliptin!!!
293
What should you monitor for DPP4s?
FBG, PPG
A1C
URI Sx
GI intolerance
294
What drugs are SGLT2 inhibitors?
(-flozin)
Canagliflozin
Dapagliflozin
Empagliflozin
Ertugliflozin
295
Are SGLT2s PO or SQ?
PO
296
How are SGLT2 inhibitors dosed?
QD; same time each day
297
What is the MOA of SGLT2s?
by inhibiting SGLT2, reabsorption of filtered glucose is dec. and the renal threshold for glucose (glucose reabsorption) is lowered, thereby inc. urinary glucose excretion
298
How long until DPP4s reach peak effect?
6-8 weeks
299
Do DPP4s cause weight gain or loss?
no weight change
300
What is the SOA of SGLT2i?
proximal renal tubules
301
What are CIs of SGLT2s?
eGFR < 30 (renal failure)
dialysis
ESRD
302
What are DDIs with SGLT2s?
UGT enzyme inducers
Rifampin
Ritonavir
Phenytoin
Phenobarbital
watch for hypotension if pt on: ACE/ARB/diuretic
may alter digoxin levels
303
What are precautions of SGLT2s?
hypotension
genital mycotic infections
UTIs
AKD
ketoacidosis
hyperkalemia
bladder cancer
amputations
304
What are ADEs of SGLT2s?
genital mycotic infections
UTIS
inc. urination
hypotension
weight loss
ketoacidosis: stay hydrated
Fournier's Gangrene
305
What ADEs are specific to Canagliflozin?
lower limb amputations
bone fractures
hyperkalemia
306
What ADEs are specific to Dapagliflozin?
bladder cancer
307
What should you discuss in women who are taking an SGLT2i?
yeast infections/UTIs
308
What should you discuss in men who are taking na SGLT2i?
circumcision status
UTIs
penile discharge
309
What efficacy are SGLT2s?
high
310
Do SGLT2s cause hypoglycemia?
no
311
What cost are SGLT2s?
high cost
312
What ASCVD risk do SGLT2s have?
benefit with Canagliflozin, dapagliflozin, empagliflozin
313
What HF risk do SGLT2s have?
benefit with Canagliflozin, dapagliflozin, empagliflozin
314
What CKDrisk do SGLT2s have?
benefit with Canagliflozin, dapagliflozin, empagliflozin
315
Do SGLTs require renal dosing?
yes
316
Do SGLT2s have weight gain or loss?
weight loss
317
Do SGLT2s have studies in. black pts for ASCVD, HF and CKD benefits?
no
318
What do you monitor in SGLT2s?
FBG/PPG
A1C
eGFR
hydration status
UTI & yeast infection sx
BP, weight
LDL cholesterol
319
How long until SGLT2s reach peak effect?
4-6 weeks
320
What drugs are GLP-1 RAs?
(-tide)
Liraglutide
Dulaglutide
Lixisenatide
Semaglutide
Exenatide
321
Are GLP-1s PO or SQ?
SQ
322
How do you dose Liraglutide?
SQ QD
323
How do you dose Dulaglutide?
SQ weekly
324
How do you dose Lixisenatide?
SQ QD, take within 60min of first meal of day
325
What GLP-1 is PO and SQ?
Semaglutide
326
How do you dose PO Semaglutide?
PO QD, take 30min prior. to first meal of day
327
How do you dose SQ Semaglutide?
SQ weekly
328
How do you dose ER Exenatide?
SQ weekly, must be reconstituted
329
How do you dose IR Exenatide?
SQ BID, taken 60min before meals
330
What is the MOA of GLP-1s?
slows gastric emptying
promotes beta cell proliferation
331
What CI is specific to Exenatide?
CI if CrCl < 30
332
What GLP-1 has a BBW?
Lixasenatide!!! Thyroid C-cell tumo
333
What DDIs with GLP-1s cause hypoglycemia?
androgens
insulins/SUs
pegvisomant
334
What DDIs with GLP-1s cause hyperglycemia?
corticosteroids
danazol
LHRH
somatropin
thiazide diuretics
335
What are CIs for GLP-1s?
severe GI diseases (IBS, Crohn's, gastroparesis, etc.)
hypoglycemia
pancreatitis
renal impairment
336
What are ADEs of GLP-1s?
hypoglycemia
N/V/D
GERD/dyspepsia
injection site rxns
jitteriness
headache
URI/cough
pancreatitis
cholethiasis
337
How should you store GLP-1s prior to initial use?
store in refrigerator
338
How should you store GLP-1s after initial use?
may be stored at room temp.
339
What should you ask about for every refill of a GLP-1?
GI upset and timing of doses
340
What efficacy are GLP-1s?
high
341
What cost are GLP-1s?
high cost
342
Do GLP-1s cause hypoglycemia?
no
343
Do GLP-1s cause weight gain or loss?
weight loss
344
What ASCVD risk do GLP-1s have?
benefit with liraglutide, SQ semaglutide, dulaglutide
345
What HF risk do GLP-1s have?
neutral
346
What CKD risk do GLP-1s have?
improved renal outcomes with liraglutide and dulaglutide
347
Do GLP-1s require renal dosing?
only exenatide
348
What GLP-1s have significant data to support use in blacks?
liraglutide and semaglutide
349
What do you monitor in GLP-1s?
renal fx
FBG, PPG ,A1C
GI Sx
patient use of device
350
How long until GLP-1s reach peak effect?
6-8 weeks depending on titration schedule
351
What is more dangerous, hyperglycemia or hypoglycemia?
Hypoglycemia
