Non-insulin meds

Question 1

What is the DOC for newly diagnosed DM2 pt’s?

Answer 1

Metformin (which is a biguanide)

Question 2

What is are ADR’s of Metformin?

Answer 2

GI - d/n/v/f

can lead to vitamin B12 deficiency long term

Question 3

When should you d/c Metformin in clinical situations?

5 conditions

Answer 3

• cardiovascular collapse
• respirator failure
• acute MI
• acute CHF
• septicemia
  (want to d/c in situations predisposing pt’s to hypoxia)

Question 4

At what GFR is Metformin not recommended?

Answer 4

GFR of 30-45mL/min

Question 5

What are contraindications for Metformin?

Answer 5

• severe renal dysfunction (GFR<35ml/min)
• acute or chronic metabolic acidosis

(use caution in pt’s with heart failure, hepatic impairment, renal impairement, elderly (avoid in pt’s >80))

Question 6

In which situation should Metformin be discontinued for diagnostic testing?

Answer 6

when pt is undergoing testing that needs IV radiographic contrast agents

Question 7

What are the drugs in the Thiazolidinediones class?

Answer 7

• Pioglitazone (Actos)

- Rosiglitazone (Avandia)

Question 8

What is the MOA of sulfonylrureas?

Answer 8

Stimulate insulin secretion by blocking the ATP-sensitive K+ channels

Question 9

What are ADRs for thiazolidinediones?

Answer 9

• edema
• heart failure
• URI
• anemia

Question 10

What is the BBW for Thiazolidinediones?

Answer 10

Heart failure risk

Question 11

What should you do before prescribing Thiazolidinediones?

Answer 11

baseline liver enzymes (due to risk of liver failure)

Question 12

What are ADRs of α-Glucosidase Inhibitors?

Answer 12

farting, diarrhea, bloating, cramping

Question 13

What drugs are in the class Dipeptidyl Peptidase-4 (DPP-4) Inhibitors? (four drugs)

Answer 13

Alogliptin (Nesina)
Linagliptin (Tradjenta)
Saxagliptin (Onglyza)
Sitagliptin (Januvia)

Question 14

Which of the DPP-4 inhibitors does not need dose adjustments for renal/hepatic failure?

Answer 14

Linagliptin

Question 15

What drugs are in the class SGLT2 Inhibitors?

Answer 15

Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)

Question 16

What is the MOA of SGLT2 Inhibitors?

Answer 16

will inhibit the SGLT2 transporter in proximal renal tubules to reduce the reabsorption of glucose. (they can also help weight loss and BP)

Question 17

What are the ADRs for SGLT2 Inhibitors?

Answer 17

• vaginal yeast infections*
• UTIs*
• Hyperkalemia
• Increased LDL

Question 18

What are the CI’s for SGLT2 Inhibitors?

Answer 18

Severe renal impairment, ESRD, dialysis

Question 19

What should you be careful about when prescribing SGLT2 Inhibitors in terms of DDIs?

Answer 19

• be careful with other drugs that work for the kidneys like ACEIs, ARBs, duiretics

Question 20

Which of the SGLT2 Inhibitors has a BBW for leg and foot amputations?

Answer 20

Canagliflozin

Question 21

Which SGLT2 Inhibitors showed trends for reduced CV?

Answer 21

Empagliflozin (jardiance)

Question 22

Which pt population should you be cautious with when prescribing Sulfonylureas?

Answer 22

elderly pt’s due to risk of hypoglycemia/falls

Question 23

Which drugs are in the class Meglitinides?

Answer 23

Nateglinide (Starlix)

Repaglinide (Prandin)

Question 24

which two classes of non-insulin drugs should not be prescribed together?

Answer 24

Meglitinides and Sulfonylureas

Question 25

Which drug is a synthetic amylin Analog?

Answer 25

Pramlintide (Symlin, Symlinpen)

Question 26

What are the ADR's of APramlintide (Symlin, Symlinpen) and what cautions should you take when prescribing it?

Answer 26

ADRs: hypoglycemia, GI upset, n/v/anorexia Warning: avoid use in pt's w/ diabetic gastroparesis or / hypoglycemic unawareness

Question 27

What are some injectable GLP-1 agonists? (5)

Answer 27

``` Exenatide (Byetta, Bydureon) Liraglutide (Victoza) Albiglutide (Tanzeum) Dulaglutide (Trulicity) Lixisenatide (Adlyxin) ```

Question 28

What are the ADRs of GLP-1 agonists?

Answer 28

GI issues: n/v/d/c

Question 29

What is the BBW for GLP-1 agonists?

Answer 29

thyroid tumors in animal studies, pancreatitis risk (so avoid in pt's w/ thyroid disease), severe GI disease or gastroparesis, avoid in pt's w/ gallbladder disease and hypersensitivity

Question 30

Which of the GLP-1 receptor agonists can have anti-drug antibodies formed against them?

Answer 30

Exenatide liraglutide lixisenatide

Question 31

Which GLP-1 agonist causes tachycardia, PR interval prolongation, AV block?

Answer 31

Dulaglutide

Question 32

Which of the GLP-1 receptor agonists increases resting heart rate?

Answer 32

Liraglutide

Question 33

Which GLP-1 receptor agonist has a new indication to reduce the risk of major adverse CV events in adults w/ type II DM ?

Answer 33

Liraglutide Note: the brand Saxenda of liraglutide is indicated for weight loss