Medications Flashcards
(165 cards)
1
Q
What are the brand names for Metformin?
A
Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet
2
Q
What is the MOA for Metformin?
A
decreases hepatic glucose output, increases insulin sensitivity, and decreases intestinal glucose absorption
3
Q
By how much does metformin affect a persons A1C?
A
decrease by 1-1.5%
4
Q
Does metformin cause hypoglycemia?
A
no
5
Q
does metformin cause weight gain?
A
no, may potentially have some modest loss
6
Q
what is the big benefit of metformin?
A
well tolerated, GI side effects usually subside over time, no weight gain, good decrease in A1C and may potentially have some CVD benefit
7
Q
What is the dosing of metformin?
A
IR: 500 mg PO daily or BID to start then titrate up to 2000 mg
ER: start 500 mg PO daily with dinner then titrate to 2000 mg
8
Q
what are the side effects of metformin?
A
diarrhea, flatulence, nausea, dyspepsia
9
Q
What are some notes to give with metformin?
A
make sure to take with a meal to decrease nausea. For the ER tablet make sure to take with dinner and swallow whole. The ER tablet may leave a ghost tablet in stool
10
Q
What is the black boxed warning with metformin?
A
there is an increased risk for lactic acidosis with renal disease, alcoholism and hypoxia
11
Q
What are the warnings associated with metformin?
A
can cause a vitamin B12 deficiency, stop prior to an iodinated contrast media, and do not begin if the eGFR is between 30-45
12
Q
when is metformin contraindicated?
A
if the eGFR is less than 30
13
Q
what are medications are in the thiazolidinediones (TZD) class?
A
pioglitazone and rosiglitazone
14
Q
What is the brand name for pioglitazone?
A
Actos
15
Q
What is the brand name for rosiglitazone?
A
Avandia
16
Q
What is the MOA for TZD’s?
A
increase muscle cell sensitivity to insulin to increase blood glucose entry
17
Q
By how much do TZD’s affect an A1c?
A
by 1%
18
Q
Can TZD’s cause hypoglycemia?
A
not by itself, however it will enhance the effect of insulin so the insulin dose may need to be decreased in combination
19
Q
Can TZD’s affect weight?
A
yes, they cause weight gain
20
Q
What is the dosing for pioglitazone?
A
start 15-30 mg daily, then max at 45 mg
21
Q
What is the dosing for rosiglitazone?
A
start 4-8 mg daily, then max at 8 mg
22
Q
Do you need to dose adjust for renal impairment in TZD’s?
A
no, but these medications are generally not used due to fluid retention
23
Q
What are side effects for TZD’s?
A
edema, weight gain, bone fractures, URTI’s
24
Q
what is a note to know about rosiglitazone?
A
increases LDL/HDL/Total Cholesterol/BP
25
What is a boxed warning with TZD's?
do NOT use w/ NYHA Class III or IV HF
26
What warnings are associated with TZD's?
hepatic failure; edema, including maculor; can cause or worsen HF; fractures (esp. in females); can stimulate ovulation, may need contraception if premenopausal
27
What type of cancer should you avoid pioglitazone with?
bladder cancer
28
What medications are SGLT2 inhibitors?
canagliflozin, empagliflozin, dapagliflozin, ertugliflozin
29
What is brand name fore canagliflozin?
Invokana
30
What is brand name for empagliflozin?
Jardiance
31
What is brand name for dapagliflozin?
Farxiga
32
What is brand name for ertugliflozin?
Steglatro
33
What is the MOA for SGLT2i?
increase BG renal excretion
34
How much does SGLT2i affect A1c?
0.7-1%
35
Can SGLT2i cause hypoglycemia?
not by itself, but enhances the effect of insulin. in combo insulin dose may need to be reduced
36
Does SGLT2i cause weight change?
weight loss (only about 5 lbs)
37
What SGLT2i has heart failure and renal benefit?
canagliflozin and empagliflozin
38
What SGLT2i is able to decrease HF hospitalization?
dapagliflozin
39
What is the dose for canagliflozin?
start 100 mg PO QAM, before 1st meal, max 300 mg
40
What is the dose for emagliflozin?
start 10 mg PO QAM, max 25 mg
41
Do SGLT2i need to be dosed differently with renal impairement?
yes, decrease dose with renal impairment
42
What are side effects of SGLT2i?
UTI's; genital fungal infections; weight loss; increased urination and increased thirst
43
What happens if someone is taking a SGLT2i and needs surgery?
discontinue 3 days prior to surgery to decrease risk of ketoacidosis, restart when normal oral intake is resumed. steglatro should be d/c 4 days prior to surgery
44
what is the boxed warning with canagliflozin?
amputation risk; avoid with foot problems/peripheral neuropathy
45
What are the warnings with SGLT2i?
increased LDL; hyperkalemia; fluid loss, hypotension; ketoacidosis, even with BG < 250; severe UTI's, genital fungal infxns; risk of fournier's gangrene (rare)
46
Which SGLT2i has a warning for bone fractures and should be avoided in those with a fracture risk?
canagliflozin
47
When are SGLT2i contraindicated?
eGFR < 30
48
What medications are DPP-4 inhibitors?
sitagliptin, linagliptin, saxagliptin, alogliptin
49
What is brand name for sitagliptin?
Januvia
50
What is brand name for linagliptin?
Tradjenta
51
What is brand name for saxagliptin?
Onglyza
52
What is brand name for alogliptin?
Nesina
53
What is the MOA for DPP-4i?
increase incretin -> less glucagon -> lowers BG
54
How much do DPP-4i affect A1c?
1%
55
Can DPP-4i cause hypoglycemia?
not by themselves, but enhance effect of insulin
56
Can DPP-4i cause weight change?
no
57
What class should DPP-4i not be used with?
GLP-1 RA due to a similar MOA
58
what is the dose for sitagliptin?
100 mg daily
59
What is the dose for linagliptin?
5 mg daily
60
What DPP-4i does NOT have to be dose adjusted with renal impairment?
linagliptin
61
what are the side effects of DPP-4i?
can cause nasopharyngitis (common cold), headache
62
What side effects does saxagliptin have that the others do not?
edema; UTI's; and hypoglycemia when used with insulin/SU's
63
what are the warnings associated with DPP-4i's?
pancreatitis; severe arthralgia (joint pain); acute renal failure
64
What type of toxicity can alogliptin cause?
hepatotoxicity
65
What condition should you not use alogliptin or saxagliptin in?
HF
66
What medications are part of sulfonylureas?
glipizide, glimepiride, glyburide
67
What is brand name for glipizide?
glucotorol, glucotrol XL
68
What is brand name for glimepiride?
amaryl
69
What is brand name for glyburide?
glynase
70
What is the MOA for SU?
increase insulin secretion
71
how much do SU decrease the A1c?
0.8%
72
Can SU's cause hypoglycemia?
yes
73
Can SU's cause weight change?
gain
74
What medication should not be used with SU's?
insulin or meglitinides
75
What is the dose for glipizide?
start 5 mg daily, max 40 mg daily. if it is the IR formulation take 30 mins before breakfast and the other formulations with breakfast
76
What is the dose for glimipiride?
start 1-2 mg daily, max 8 mg daily
77
What is the dose for glyburide?
start 2.5-5 mg daily, max 20 mg daily
78
What is important to counsel on Glucotorol XL?
OROS formulation; ghost tablet in stool; will decrease efficacy after long-term use due to beta cell function declining
79
Who are SU's contraindicated in?
those with a sulfa allergy; it is not likely to cross react, use cautiously in those with severe sulfa allergy
80
What are the warnings associated with SU's?
hypoglycemia and beer's criteria due to hypoglycemia
81
Which SU's have the highest risk on the beers criteria?
glyburide and 1st gens such as chlorpropamide
82
What medications are meglitinides?
repaglinide and nateglinide
83
What is brand name for repaglinide?
prandin
84
What is brand name for nateglinide?
starlix
85
What is the MOA for meglitinides?
increase insulin secretion (meal time)
86
How does a meglitinide affect A1c?
by 1%
87
Do meglitinides cause hypoglycemia?
yes, especially if the dose is taken and they skip their dose
88
Do meglitinides cause weight change?
yes, gain
89
What is the dosing for repaglinide?
start 0.5-1 mg PO TID 15-30 mins before meals, start at 0.5 if A1c is close to goal
90
What is the dosing for nateglinide?
start 60-120 mg PO TID 15-30 mins before meals, start at 60 if A1c is close to goal
91
what are the side effects for meglitinides?
hypoglycemia, weight gain
92
What is important to counsel patients with meglitinides regarding taking their dose?
skip meal, skip dose
93
What warnings are associated with meglitinides?
hypoglycemia
94
What medications should not be used with meglitinides?
insulin or SU's
95
What medications are apart of the GLP-1 RA?
liraglutide, dulaglutide, exenatide, exenatide ER, lixisenatide, semaglutide
96
What GLP-1 RA comes in oral form?
semaglutide as Rybelsus
97
What is the brand name for liraglutide?
victoza
98
What is the brand name for liraglutide used for weight loss?
Saxenda
99
What is the brand name for dulaglutide?
trulicity
100
What is the brand name for exenatide?
byetta
101
what is the brand name for exenatide ER?
bydureon
102
What is the brand name for lixisenatide?
adlyxin
103
what is brand name for semaglutide?
ozempic
104
What is the MOA for GLP-1 RA?
increase incretin -> less glucagon -> lowers BG and slows gastric emptying -> increase satiety
105
How does GLP-1 RA affect A1C?
1%
106
Can GLP-1 RA cause hypoglycemia?
not by themselves, but in combo with a drug that causes hypoglycemia can worsen low BG
107
What affect do GLP-1 RA have on weight?
loss
108
What GLP-1 RA have a benefit on ASCVD?
liraglutide, dulaglutide, semaglutide
109
What medication should you not use with a GLP-1 RA?
DPP-4i
110
What is the dose for liraglutide?
0.6 mg SC daily x 1 week, then 1.2 mg SC daily; can increase to 1.8 mg SC daily
111
What is the dose for dulaglutide?
start 0.75 mg SC once weekly; can increase to 1.5 mg SC weekly
112
Which GLP-1 RA have to be given within 60 mins of meals?
byetta and adlyxin
113
Do we need to dose adjust with renal impairment in GLP-1 RAs?
exenatide is the only one we need to decrease dose
114
who is exenatide contraindicated in?
CrCl < 30 mL/min
115
Who is lixisenatide contraindicated in?
< 15 mL/min
116
What are the side effects with GLP-1 RA?
nausea/vomiting; diarrhea; decreased appetite/weight loss; dyspepsia; injection site reactions
117
How often should byetta be used?
twice daily
118
Which GLP-1 RAs come with pen needles?
those that are weekly injections
119
What is a boxed warning for GLP-1 RA, except for byetta and adlyxin?
do not use if personal/family history of medullary thyroid CA (MTC)
120
What is a boxed warning for all GLP-1 RA?
dont use if history of multiple endocrine neoplasia (MEN2)
121
What are the warnings with GLP-1 RA?
pancreatitis; AKI/CKD (kidney damage), from fluid loss/dehydration (from vomiting, diarrhea); hypersensitivity, including anaphylaxis, angioedema; gallbladder disease; do not use with gastroparesis
122
what is a specific warning for bydureon?
serious injection-site reactions such as abscess or skin nodules
123
What is a specific warning for ozempic?
diabetic retinopathy
124
What is brand for pramlintide?
symlin pen
125
T/F: pramlintide can be used in type 1 and type 2 diabetes
true
126
What is the MOA of pramlintide?
synthetic analog of amylin, slows gastric emptying, increases satiety
127
How does pramlintide affect A1C?
decrease by 0.3%
128
Can pramlintide cause hypoglycemia?
yes
129
Can pramlintide cause weight change?
weight loss
130
What is the benefit for pramlintide?
weight loss, less insulin
131
What is the dose for pramlintide?
T1: start at 15 mcg, can increase to 60 mcg/dose
T2: start at 60 mcg, can increase to 120 mcg/dose
132
Whose contraindicated to pramlintide?
those with gastroparesis and hypoglycemia unawareness
133
What are the side effects of pramlintide?
nausea/vomiting, anorexia, headache, weight loss
134
What should we counsel patients to do when taking pramlintide?
skip if < 30 g carbs; inject at meal times; do not mix with insulin
135
What is the boxed warning for pramlintide?
severe hypoglycemia when used with insulin (3 hrs after administration); must decrease meal time insulin dose by 50%
136
What medications are alpha-glucosidase inhibitors?
acarbose and miglitol
137
What is the brand name for acarbose?
precose
138
What is the brand name for miglitol?
glyset
139
What is the MOA for alpha-glucosidase inhibitors?
inhibits sucrose breakdown in gut which decreases glucose absorption
140
Can alpha-glucosidase inhibitors cause hypoglycemia?
no
141
Can alpha-glucosidase inhibitors cause weight change?
no
142
How do you dose alpha-glucosidase inhibitors?
start both at 25 mg PO TID with the first bite of each meal. can start with one meal to decrease GI effects. dont take if skipping meal
143
What are side effects with alpha-glucosidase inhibitors?
flatulence, diarrhea, abdominal pain
144
What are the warnings associated with alpha-glucosidase inhibitors?
They will not cause hypoglycemia, however if it does occur due to another drug the low BG cannot be treated with sucrose; treat with hypoglycemia with glucose tablets or gel
145
what is a bile-acid binding resin?
colesevelam (Welchol)
146
When is a bile-acid binding resin used?
for diabetes AND dyslipidemia
147
Does bile-acid binding resin cause hypoglycemia?
no
148
Does bile-acid binding resin cause weight change?
no
149
How do you dose colesevelam?
3.75 g/day in 1-2 divided doses (large tablets)
150
What is a counseling point with colesevelam?
decreases ADEK vitamins, take a multivitamin at a different time
151
What are the side effects for bile-acid binding resin?
constipation and increased TGs
152
T/F: colesevelam has no drug interactions
false!! has many
153
Who are bile-acid binding resin contraindicated in?
those with TG > 500 mg/dL, history of hypertriglyceridemia-induced pancreatitis; bowel obstruction
154
What is a dopamine agonist used for DM?
Bromocriptine (Cycloset)
155
when is bromocriptine used?
for diabetes and parkinsons (Parlodel)
156
can bromocriptine cause hypoglycemia?
not by itself
157
Can bromocriptine cause weight change?
yes, weight gain
158
how do you dose bromocriptine?
start 0.8 mg PO QAM; increase weekly to max 4.8 mg/day
159
What are side effects of bromocriptine?
dizziness, fatigue, nausea, headache
160
T/F: bromocriptine has many drug interactions
true
161
what are the warnings with bromocriptine?
hypotension/syncope; cardiovascular effects
162
when is bromocriptine contraindicated?
syncopal migraine, breastfeeding
163
what is the brand name for the combo metformin/pioglitazone?
Actoplus Met
164
What is the brand name for the combo metformin/sitagliptin?
Janumet, Janumet XR
165
What is the brand name for the combo metformin/canagliflozin?
invokamet, invokamet XR
