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PHM 602 > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Sulfonylureas

A

MOA:
Stimulate insulin release from Beta cells (Pancreas)
“Insulin secretagogues”

Oral.

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2
Q

What meds are SUs?

A

Glyburide (DiaBeta, Micronase) BEERS list
Glipizide (Glucotrol)
Glimepiride (Amaryl) BEERS list

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3
Q

SU dosing

A

Glyburide 1.25-20 daily
Glipizide 2.5-20, 1-2 times daily
Glimepiride 1-4mg daily

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4
Q

SU side effects

A

Hypoglycemia
N/V
Weight gain
Use w/ caution in elderly

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5
Q

SU Drug interactions

A

Alcohol
Displaced protein binding
Decreased renal secretion

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6
Q

SU Contraindications

A 
DKA
Hypersensitivity
T1DM
CrCl<50 for glyburide
Near-term pregnancy (hlyburide/glipizide)
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7
Q

SU counseling points

A

Take 1st thing in morning with 1st meal, with food if upset stomach.
Avoid alcohol.
Ask about hypoglycemia and weight gain

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8
Q

SU Monitoring

A 
Hypoglycemia
FBG
A1c
Weight gain
Allergies
Sun sensitivity
4-6 weeks for full effect
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9
Q

Meglitinides

A

MOA:
Stimulate insulin release from Beta cells (Pancreas)
Insulin secretagogues, short acting.
(same MOA as SUs, but shorter acting)

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10
Q

Which meds are Meglitinides?

A

Repaglinide (Prandin)

Nateglinide (Starlix)

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11
Q 
Meglitinides dosing
(Multiple times a day, since short acting)
A

Nateglinide 60-120 b4 meals

Repaglinide 0.5-2 mg b4 meals

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12
Q

Meglitinides side effects

A

Hypoglycemia
GI disturbances
Weight gain
Headache

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13
Q

Meglitinides DI

A

Repaglinide and NPH insulin : increased risk of MI

Repaglinide and gemfibrozil : avoid

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14
Q

Meglitinides Contraindications

A

Hypersensitivity
T1DM
DKA

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15
Q

Meglitinides Precautions

A

Severe renal disease
Impaired liver function
Use with insulin

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16
Q

Meglitinides counseling points

A

Administer before meal

Repaglini

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17
Q

Meglitinides monitoring

A

PPG
Hypoglycemia
A1c
Weight gain

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18
Q

Biguanides Primary MOA

A

Decrease glucose output from the liver (hepatic glucose production)
- Liver

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19
Q

Biguanides Secondary MOA

A

Increase peripheral
muscle glucose sensitivity (glucose uptake and
utilization)
- Muscles

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20
Q

Which meds are Biguanides?

A

Metformin

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21
Q

Biguanides dosing

A

Initial 500 BID or 850 daily
Optimal dosing 1000 BID
titrate slowly

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22
Q

Biguanides Renal dosing

A
  • eGFR 30-45 mL/min: half dose, up to 1,000mg/day
  • eGFR ≤ 30 mL/min: Discontinue
  • ARF: Discontinue until reversed
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23
Q

Biguanides Side effects

A 
GI trouble (N/V/D)
Weight loss
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24
Q

Biguanides DI

A

Radiopaque contrast dyes (Stop Metformin 24hrs before and 48hrs after)

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25
Biguanides CI
(Dehydration, Sepsis,Surgery ) All sick day issues. Medication should be stopped until resolution
26
Biguanides Precautions
Elderly Excessive alcohol CHF with drug therapy
27
Biguanides counseling points
Take with food to decrease GI effects Start low, go slow Avoid alcohol use GI upset/diarrhea should decrease over time Ask about: GI upset, weight loss, Lactic acidosis
28
Biguanides Monitoring
Renal function ( 6 weeks, then annually) 6-8 weeks to max effect A1c Q3months
29
Thiazolidinediones (TZD)
Primary MOA: Increase peripheral muscle glucose sensitivity (glucose uptake and utilization) - Muscles
30
Thiazolidinediones (TZD) | Secondary MOA
Decrease glucose output from the liver (hepatic glucose production) - Liver
31
Which meds are TZDs?
Rosiglitazone (Avandia) | Pioglitazone (Actos)
32
TZD dosing
Pioglitazone (Actos) 15-30 PO daily
33
TZD Side effects
``` Edema (major) Bladder cancer Weight gain Hepatotoxicity Fractures ```
34
Pioglitazone DI
(Actos) Oral contraceptives Progestins Pazonib
35
TZD CI
Active bladder cancer Hypersensitivity/T1DM/DKA CHF (symptomatic) ACS
36
TZD Precautions
``` CHF Edema MI (Rosiglitazone) Isulin/SU Bladder cancer history Females (ovulation) Fracture risk ```
37
TZD BBW
Can exacerbate CHF (monitor for Sx: weight gain, dyspmea, edema) MI for Rosiglitazone
38
Rosiglitazone DI
Insulin | Nitrates
39
TZD counseling points
Take once a day at the same time each day Avoid alcohol Report weight gain or swelling immediately Do not use in CHF Class 3-4
40
TZD monitoring
``` LFTs Edema Weight gain Cholesterol FBG/PPG A1c 6-8 weeks to max effect ```
41
Alpha-Glucosidase inhibitors (AGI) MOA
Decreases breakdown of sucrose and complex carbs in brush border of the small intestine (GI)
42
Which meds are AGIs?
Acarbose (Precose) | Miglitol (Glyset)
43
AGI dosing
Acarbose: 25 PO TID | Miglitol 25 PO TID
44
AGI Side effects
GI upset: - Abdominal pain - Diarrhea - Flatulence - Bloating
45
AGI CI
Hypersensitivity/DKA Cirrhosis IBS and other gut problems SCr > 2.0
46
AGI Precautions
Impaired renal function
47
AGI counseling points
- Start low, go slow (cause GI effects) - Take with the 1st bite of each meal (Skip meal, skip dose as well) - Call MD if severe diarrhea or vomiting
48
AGI Monitoring
PPG A1c GI intolerance 4-6 weeks to max effects
49
Gliptins/DPP4-i MOA
Potentiate the effects of incretin hormones (involved in regulation of glucose homeostasis)
50
Which meds are DPP4s/Giptins
- Sitagliptin (Januvia) - Linagliptin (Tradjenta) - Saxagliptin (Onglyza) - Alogliptin (Nesina)
51
DPP4 dosing
Dosed daily. Sita, Saxa, Alo need renal adjustments Lina does not
52
DPP4s/Gliptins Side effects
- Nasopharyngitis - URI - Pancreatitis - Heart failure (Saxa, Alo)
53
Gliptins/DPP4 CI
Hypersensitivity/T1DM/DKA
54
Gliptins/DPP4 Precautions
- Impaired renal /hepatic function - History of pancreatitis - HF (Saxa, Alo) - Avoid use with GLP-1
55
DPP4s counseling points
- Take once a day, same time - With or without food - Avoid alcohol
56
DPP4s/Gliptins Monitoring
- FBG/PPG - A1c - URI Sx - GI intolerance 6-8 weeks to max effects
57
sglt-2i MOA
Inhibits SGLT2 thus reabsorption of filtered glucose is reduced and the renal threshold for glucose is lowered. - Urinary glucose excretion increases.
58
Which drugs are SGLT2i?
Canagliflozin (Invokana) Farxiga (Dapagliflozin) Jardiance (Empagliflozin) Steglatro (Ertugliflozin)
59
SGLT2i dosing
``` PO daily All contraindicated if eGFR<30 mL/min Canagliflozin (Invokana) NO if GFR<45 Farxiga (Dapagliflozin) NO if GFR<60 Jardiance (Empagliflozin) NO if GFR<45 Steglatro (Ertugliflozin) NO if GFR <60 ```
60
SGLT2i side effects
- Genital mycotic infections - Increased urination - UTIs - Weight loss - Ketoacidosis - gangrene -
61
Canagliflozin (invokana) specific side effects
- Lower limb amputation/bone fractures | - Hyperkalemia
62
Dapagliflozin (Farxiga) Specific side effects
Bladder cancer
63
SGLT2i DI
UGT enzyme inducers Rifampin, Ritonavir, Phenytoin. Phenobarbital Hypotention with ACE/ARB/diuretic Monitor digoxin levels
64
SGLT2i CI
- Dialysis - Renal failure (GFR<30) - ESRD
65
SGLT2 precautions
- Hypotension - Infections (UTI, genital) - AKI - Ketoacidosis - Hyperkalemia (Cana) - Amputation (Cana) - Bladder cancer (Dapa)
66
SGLT2i counseling points
Once a day at the same time - Hydrate (ketoacidosis) - Hyperkalemia Hx - Bladder cancer Hx - Renal Fx
67
Which SGLT2 have ASCVD and HF benefits?
Cana Empa Dapa
68
SGLT2 monitoring
FBG/PPG (all the side effects) LDL cholesterol 4-6 weeks to max effect
69
GLP-1 RA MOA
- Suppresses glucagon secretion (glucagon increases blood sugar) - Increases insulin secretion - slows gastric emptying - Promotes b-cell proliferation
70
GLP-1 RA dosed weekly
- Bydureon (Exenatide ER) - Trulicity (Dulaglutide) - Ozempic (Semaglutide)
71
GLP-1 RA dosed daily
- Byetta (Exenatide IR) - Victoza (Liraglutide) - Adylxin (Lixisenatide) - Rybelsus (Semaglutide) ORAL
72
GLP-1 RA side effects
- Hypoglycemia - Nausea/Vomitting/Diarrhea - Pancreatitis
73
GLP- 1 DIs that cause HYPOglycemia
- Androgens - Insulin/SU - Pegvisomant
74
GLP-1 DIs that cause HYPERglycemia
- Corticosteroids - Danazol - LHRH - Somatropin - Thiazide diuretic
75
GLP-1 RA CI
- Thyroid tumors (Medullary thyroid carcinoma, multiple endocrine neoplasia) - Severe GI disease - Pancreatitis - Renal impairment - ----ESRD or CrCl <30 (Exenatide -Bydureon, Byetta-)
76
GLP-1 RA counseling point
- Upset stomach - Eat smaller meals more frequently - Refrigerate before initial use - Ask about GI upset and timing at refills
77
What counseling point is specific to Rybelsus (Semaglutide)?
Take EXACTLY 30 minutes before eating first meal. | With minimal water (4 oz)
78
GLP-1 RA monitoring
- Renal Fx - FBG - PPG - GI Sx - Proper use of device 6-8 weeks to max effects

PHM 602 (1 decks)

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