oral hypoglycemic agents

Question 1

what is the MOA for a sulfonylurea?

Answer 1

act at pancreatic beta cells to simulate release of insulin

Question 2

T/F sulfs can cause hypoglycemia

Answer 2

TRUE

they have the HIGHEST incidence

Question 3

Which drug class has high failure rates?

Answer 3

sulfonylureas

20% primary failures
10-15% secondary failures

Question 4

which drug class should you avoid in patients with sulfa allergy?

Answer 4

sulfonylureas.

some that are allergic to sulfa ABX are OK though.

Question 5

which drug has a high risk of hypoglycemia in renal failure patients

Answer 5

sulfonylureas.

because there are active and inactive metabolites

Question 6

which is the safest sulf to use in renal dysfunction?

which is the worst?

Answer 6

gylpizide is safest

glyburide & chlorpropamide is worst - one your CC is less than 50, your risk of fluid retention and hypoglycemia increases dramatically

Question 7

T/F Sulfonylureas may cause fetal hypoglycemia

Answer 7

TRUE

Question 8

T/F Although hypoglycemia with sulfs is less frequent than with insulin, it is often more prolonged and more dangerous

Answer 8

TRUE

It can require prolonged infusions of glucose-containing solutions

Question 9

sulfonylureas should be avoided in patients with liver disease, except ______

Answer 9

acetohexamide

Question 10

____ are contraindicated in patients with hypoglycemia unawareness

Answer 10

Sulfonylureas

remember bc they have the greatest risk of hypoglycemia!

Question 11

what is the shortest acting and least potent sulf?

Answer 11

tolbutamide (orinase)

also has the fewest side effects

Question 12

most of the hypoglycemic action of acetohexamide is due to

Answer 12

its principle metabolite

Question 13

what is the longest acting sulf

Answer 13

chlopropamide (diabeinese)

may approach 72h.

Question 14

what sulf is associated with disulfiram-like reactions

Answer 14

chlopropamide (diabeinese)

Question 15

what sulf is associated with severe hyponatremia? why?

Answer 15

chlopropamide (diabeinese)

when you have large glucose molecules floating around in the blood, it changes the osmolarity and in response to that, your body will start pulling water out of cells and into the blood stream - an osmotic type movement of water - body tries to combat the increase in osmolarity , causing a dilatational hyponatremia.

If you can treat the hyperglycemia, the sodium will correct itself.

Question 16

what drugs are alpha-glucosidase inhibitors?

Answer 16

acarbose (precose)
miglitol (glyset)

alphas = acar + mig

Question 17

whats the MOA of alpha-glucosidase inhibitors? (acar/mig)

Answer 17

think: alphas—absorption (inhibit)

decrease intestinal hydrolysis of complex carbs

inhibits the enzyme that breaks down complex carbs. you can’t absorb them, just eliminate them. so less glucose in the blood stream,.

Question 18

whats the MOA of meglitinides

Answer 18

increase insulin secretion from islet cells (like sulfonylureas)

Question 19

T/F Meglitinides have a faster onset and shorter duration than sulfs

Answer 19

TRUE

Question 20

which drugs are meglitinides

Answer 20

RepaGLINIDE (Prandin)
NateGLINIDE (starlix)

meglitINIDES = repGLINIDE and NateGLINIDE

Question 21

T/F Meglitinides are active whether glucose is present or not

Answer 21

FALSE - only active in the presence of glucose.

this decreases the risk of prolonged hypoglycemic episodes

Question 22

meglitinies cause you to ___ weight

Answer 22

gain

Question 23

the #1 med for new onset type!! diabetes that requires medication =

Answer 23

metformin

Question 24

what class is metformin

Answer 24

bigauanides

bc metformin is the big dog

Question 25

T/F Metformin has a high risk of hypoglycemia

Answer 25

FALSE - it decreases BG concentrations with only a very low risk of hypoglycemia - almost neutral when it comes to hypoglycemic events

Question 26

what is the MOA of metformin? 3 points

Answer 26

- decreases hepatic glucose production (reduces gluconeogenesis) - reduces glucose absorption from the intestine - increases insulin sensitivity

Question 27

why can someone who's on metformin get off of their sulfonylurea?

Answer 27

because metformin reduces glucose absorption from the SI so you don't need the sulf to increase beta islet insulin release

Question 28

which drug produces satisfactory results in 50% of the sulf failures

Answer 28

metformin

Question 29

whats the BB warning with metformin?

Answer 29

lactic acidosis n/v, inc RR, HR, abd pain, shock

Question 30

how long before surgery should metformin be d/c'd?

Answer 30

48h

Question 31

whats the best way to prevent lactic acidosis

Answer 31

hydration

Question 32

hold metformin ___h prior to and after IV contrast because of

Answer 32

48, nephrotoxicity

Question 33

whats the package insert for metformin say

Answer 33

that withholding food/fluids during surgery may increase the risk for volume depletion, hOt, renal impairment.. so temporarily d/c metformin while patients have restricted food and fluid intake.

Question 34

metformin is contraindicated if GFR is

Answer 34

30

Question 35

do not initiate or re-evaulate patents with GFR

Answer 35

45

Question 36

metformin is contradicted in patents aged >__

Answer 36

80

Question 37

metformin has high rates of ____ upset

Answer 37

GI

Question 38

new recommendations for metformin are based on ___ NOT ___ and ____

Answer 38

GFR.. | not gender and cr

Question 39

T/F metformin is contraindicated in CHF and hepatic impairment

Answer 39

TRUE

Question 40

which drugs are thiazolidinediones

Answer 40

rosiglitaZONE and pioglitaZONE Thia is in the ZONE

Question 41

which drug class is esp effective in the obese

Answer 41

TZD's

Question 42

whats the MOA of TZD's

Answer 42

decrease hepatic glucose output and decrease insulin resistance so TZD's stop the liver and stop resistance

Question 43

which drug class cause hepatotoxicity

Answer 43

TZD's think: they work in the liver decreasing hepatic glucose output

Question 44

which drug class has a bizarre risk of bone fx

Answer 44

TZD's

Question 45

TZDs cause weight ___

Answer 45

gain

Question 46

T/F: higher rates of CV deaths and MI's in patients that take TZD's

Answer 46

TRUE - avandia (ros) aVan = cV death

Question 47

TZD's have Three Terrible side effects like:

Answer 47

hepatotoxic, peripheral edema, CHF exacerbations

Question 48

DPP-4 inhibitor drugs =

Answer 48

gliptins sitagliptin (Januvia) Saxagliptin (onglyza) linagliptin (tradjenta) alogliptin

Question 49

DPP4 MOA

Answer 49

- increases pancreatic insulin secretion - limits glucagon secretion - slows gastric emptying - promotes satiety glucagon-like peptide.. when you eat, it is released.. tells you youre full and not to eat anymore and also kick starts a couple of processes to prep for glucose load.. pancreas/liver. so DPP4 is dipeptidyl peptidase and that reduces the breakdown of GLP1. so it lasts longer and continues to stimulate satiety so it is working at different places where your glucagon like peptide normally works, to inc the amt of it.. to then limit glucagon sectretion, increase insulin secretion, slow gastric emptying , making you feel full revise this card.....

Question 50

which drugs basically cause a forced gastroparesis

Answer 50

DDP4 inhibitors - the gliptins

Question 51

DPP4 inhibitors have 4 really bad side effects that were discovered post-marketing =

Answer 51

pancreatitis, angioedema, Stevens johnsons, anaphylaxis `

Question 52

which drugs have infection risk

Answer 52

DDP4 inhibitors - the gliptins risk of URI + UTI's

Question 53

which 2 drug classes fall under incretin mimetics

Answer 53

GLP-1 analogs & amylin analogs

Question 54

how do GLP1 analogs work

Answer 54

prolong gastric emptying, reduce post-prandial glucagon secretion think: DPP4 inhibitors work like this too bc they reduce the breakdown of GLP1

Question 55

which drugs are GLP1 analogs?

Answer 55

the TIDES exanatide (byetta, bydureon) liraglutide (victoza) albiglutide (tandem) dulaglutida (trulicity)

Question 56

avoid which GLP1 analog in renal failure

Answer 56

exanatide (byetta) BYEpass Byetta in RF

Question 57

avoid which GLP1 analog in thyroid carcinoma

Answer 57

liraglutide (victoza) vicotza is NOT a victory in thyroid cancer

Question 58

how do amylin analogs work?

Answer 58

they increase insulin secretion, slow gastric emptying, increase beta cell growth, central appetite suppression

Question 59

which drug is an amylin analog

Answer 59

pramlinide (symlin) slimy like the gila monster

Question 60

whats the BB warning with Amylin

Answer 60

hypoglycemia (esp type1)

Question 61

which drugs are SLGT2 inhibitors

Answer 61

the gliflozin's canagliflozin (invokana) dapagliflozin (farxiga) empagliflozin (jardiance) gliFLOZIN's get the glucose FLO goin

Question 62

how do SLGT2 inhibitors work

Answer 62

increase urinary glucose excretion. make you pee it out. within the kidneys there is a sodium and glucose transporter and by inhibiting this, we are now holding on to less glucose, we are peeing more out. think STG = sodium glucose transporter

Question 63

SLGT2 inhibitors are contraindicated with

Answer 63

crcl <30 ESRD HD

Question 64

since SLGT2's increase urinary glucose excretion, what side effects are you thinking of

Answer 64

s/e r/t fluid shifts so hOtn UTI (d/t extra glucose in urinary tract) toe amputations (bc of the dehydration/fluid shifts/PVD)