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medications Flashcards

(56 cards)

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1
Q

what medication is a Biguanides?

A

Metformin

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2
Q

what is metformin’s main mechanism of action? What else does it do?

A

MOA: decreases hepatic glucose production and increases peripheral glucose utilization

also: decreases GI intestinal glucose absorption, increases insulin sensitivity (no effect on pancreatic beta cells)

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3
Q

because metformin has no affect on pancreatic beta cells what does that mean?

A

no hypoglycemia, no weight gain

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4
Q

why do you not give metformin to patients with renal impairment?

A

Lactic acidosis

Creatine has to be greater than 1.5

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5
Q

MOA: stimulates pancreatic beta cell insulin release by closing kATP channel

Primarily reduce fasting glucose without large effects on postprandial

A

Sulfonylureas (Glipizide, Glimperide)

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6
Q

what medications are sulfonylureas?

A

Glipizide, Glimperide

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7
Q

what are side effects of medications like Glipizide and Glimperide?

A

Hypoglycemia
GI upset (reduced if taken with food)
Dilsufiram reaction
Cardiac arrythmias
Weight gain

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8
Q

MOA: Stimulates pancreatic beta cell insulin release?

A

Meglitinides (Repaglinide, Nateglinide)

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9
Q

What are side effects to medications like repalinide, nateglinide?

A

Hypoglycemia
Weight Gain

Hypoglycemia is still less than sulfonylureas

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10
Q

What medications are metaglitinides?

A

Repaglinide, Nateglinide

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11
Q

MOA: delays intestinal glucose absorption (inhibits pancreatic alpha amylase and intestinal alpha glucosidase hydrolase)
does not affect insulin secretion

A

Glucosidase inhibitors (Acarbose)

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12
Q

which medication’s are glucosidase inhibitors?

A

Acarbose

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13
Q

side effects of Acarbose?

A

Hepatitis
Increased LFT’s
flatulence
diarrhea
abdominal pain

Cautious use in pts with gastroparesis, IBD, or on bile acid resins

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14
Q

MOA: increases insulin sensitivity at the peripheral receptor site adipose & muscle
no effect on pancreatic beta cells

A

Thiazolidinediones (pioglitazone, rosiglitazone)

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15
Q

which medications are Thiozoldinediones?

A

pioglitazone, rosiglizaone

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16
Q

what are side effects to medications such as pioglitazone, rosiglitazone?

A

Fluid retention and edema
Hepatotoxicity
bladder cancer
fractures
Cardiaovascular toxicity with rosiglitazone
weight gain
anemia

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17
Q

MOA: mimics incretin–> increases insulin secretion, delays gastric emptying, Decreases glucagon secretion
no weight gain

A

Glucagon-Like Peptide 1 (GLP-1)
(Exenatide, liraglutide)

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18
Q

what medications are GLP-1s?

A

Liraglutide, exenatide, bydureon

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19
Q

what are side effects to medications such as exenatide, liraglutide?

A

Hypoglycemia (less than sulfonylureas b/c glucose dependent)
pancreatitis
Caution with history of gastroparesis

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20
Q

which medications are dopamine agonists? what are they used to treat?

A

Bromocriptine, Cabergoline
prolactinomas

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21
Q

what are the only hormones secreted by the posterior pituitary

A

ADH and Oxytocin

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22
Q

what are medical therapy options for ED?

A

PDE-5i’s
(sildenafil, vardenafil, tadalafil, avanafil)

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23
Q

MOA: potentiate the effect of cGMP to prolong erections and increase sexual satisfaction

Study These Flashcards
A

PDE5 Inhibitors

24
Q

what is an absolute contraindication to PDE5i’s? what should be used with caution

Study These Flashcards
A

Contraindication- nitrates
Caution- alpha blockers

25
which medication is especially effective at lowering fasting glucose (by 50-70mg/dL)?
metformin
26
what are contraindications for metformin?
* renal insufficency (NO in eGFR <30) * severe CHF * Acute or chronic acidosis * pts receiving IV contrast
27
contraindications for sulfonylureas?
not indicated in type 1 patients known hypersensitivity
28
when is glipizide and glimeperide more effective?
15-30 minutes before meal than with meal
29
due to mechanism, will take several weeks to month to produce clinical response
pioglitazone
30
contraindication for TZD's
Baseline liver transaminases >2.5x pre-existing liver disease class III or IV heart failure significant caution in any CHF
31
contraindications of Acarbose?
cirrhosis inflammatory bowel disease other significant bowel disease/malabsorption
32
which medications are DPP-4 inhibitors?
sitagliptin
33
MOA: inhibit breakdown of GLP-1 and GIP incretin hormones that stimulate glucose dependent insulin secretion
DPP-4
34
efficacy of DPP4
reduced fasting plasma glucose and post-prandial
35
side effects of DPP4
well tolerated hypoglycemia in 0.5-2%, higher in combination therapy pancreatitis
36
contraindication of DPP4 inhibitors?
hypersensitivity
37
what medications are SGLT2 inhibitors?
Canaglifozin dapagliflozin empaglifozin
38
MOA: inhibit glucose reabsorption in proximal tubule of kidney increase loss of glucose in urine
SGLT2 inhibitors
39
efficacy of SGLT2
Reduces fasting plasma glucose by about 20mg/dL
40
side effects of SGLT2?
Genital mycotic infections (10-15%) urinary tract infections dehydration increase in LDL cholesterol hyperkalemia ketoacidosis fracture risk- decreased bone density amputation risk
41
side effects of SGLT2?
Genital mycotic infections (10-15%) urinary tract infections dehydration increase in LDL cholesterol hyperkalemia ketoacidosis fracture risk- decreased bone density amputation risk
42
what is an important "good side effect" of SGLT2
* reduces progression of kidney disease (dapagliflozin) * Reduced CV risk (empagliflozin, canagliflozin) * approved to treat heart failure and reduce CV deaths and hospitalization (dapagliflozin and empagliflozin)
43
contraindications of SGLT2 inhibitors
* Severe renal impairment (GFR<45, ESRD or on dialysis) newer trials show efficacy down to 30 * caution with hypotension, hyperkalemia * not approved for use in type 1 but off label use may be considered (may cause ketosis)
44
which medications target prandial and fasting glucose?
metglitinides acarbose DPP4 inhibitors GLP-1
45
side effects of GLP-1 receptor agonists
* GI disturbance (Nausea!!) usually subsides * pancreatitis * hypoglycemia (rare as a single agent, more common with SU) * May have increased risk of medullary thyroid cancer
46
what are contraindication for GLP-1 receptor agonists?
severe renal impairment (risk of dehydration, worsening renal function)
47
Peptide hormone that is made in the beta cells in the pancrease. Helps to lower blood glucose by pushing glucose into the tissues suppresses glucose output from the liver
insulin
48
intermediate acting insulin Onset 2H, peak 4-6H, duration 12-16H
NPH
49
somewhat short acting Onset 30-60min, Peak 2-4H, Duration 6-8H
regular
50
what are the long acting insulin medications what is the onset? duration?
Glargine (onset 2H, duration 24) detemir (onset 2h, 14-16 duration) degludec (90 min onset, 24h duration) ## Footnote ALL PEAKS ARE FLAT
51
rapid acting insulin medication what is the onset, peak, duration?
Lispro (onset 5-15min, peak 1h, duration 4-5h) aspart(onset 5-15min, peak 1h, duration 4-5h)
52
what can be a good strategy in type 2 paitents not controlled on oral agents?
Basal insulin alone can use NPH or glargine/detemir
53
how do you dose multiple daily injections?
use long acting analog(glargine, detemir) as basal once daily- 50% total daily dose use rapid acting (lispro/aspart) with meals (add up to 50% total daily dose)
54
how do you dose pre-mixed insulins?
give 2/3 of total daily dose in the morning, 15-30 minutes before breakfast don't skip lunch give 1/3 of total daily dose in the evening, 15-30 minutes before dinner
55
how do you dose twice daily split mixed regimen?
by mixing separate insulins (NPH can mix with regular or rapid acting) sometimes will move evening NPH to bedtime to cover am fasting sugars better
56
What is the only "long-acting" insulin that can be mixed?
NPH

Endocrine (2 decks)

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