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NMT200 midterm (wk1-6) > pharm wk 4 > Flashcards

pharm wk 4 Flashcards

(75 cards)

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1
Q

what drugs can cause dysglycemia

A

Beta-blockers (drugs ending in –olol)

Corticosteroids (prednisone)

HMG-CoA Reductase Inhibitors (drugs ending in statin)

Thiazide or loop diuretics (hydrochlorothiazide, furosemide)

Protease antiviral medications

Second-generation antipsychotics (olanzapine, quetiapine)

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2
Q

goals of T2D treatment

A

Establish and maintain glycemic control while avoiding hypoglycemia

Prevent or minimize the risk of acute and chronic complications

Achieve optimal control of associated risk factors such as hypertension, obesity, and dyslipidemia

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3
Q

where does insulin drugs come from

A

Most available are human insulin and insulin analogues since they cause less antibody generation and adverse effects

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4
Q

rapid onset insulin vs long-acting insulin- when are they useful?

A

Rapid onset insulin preparation are useful for postprandial insulin injections or use with an insulin pump (continuous infusion)

Long-acting insulin preparations are useful for basal insulin infusion

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5
Q

adverse effects of insulin preparations

A

Hypoglycemia is the most common and is usually the result of a missed meal or an increase in exercise

Localized fat hypertrophy

Allergic reactions

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6
Q

what type of drug is metformin

A

biguanides

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7
Q

examples of biguanides

A

metformin

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8
Q

what is the first choice drug for patients with new and uncomplicated T2D

A

metformin

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9
Q

what does metformin do

A

Decreases hepatic glucose production

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10
Q

how much does metformin lower HbA1c by

A

1-1.5%

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11
Q

what is metformin not associated with

A

weight gain

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12
Q

adverse effects of metformin

A

Nausea, diarrhea, abdominal discomfort, anorexia, metallic taste

May cause lactic acidosis in patients with existing hepatic or renal disease - contraindicated

Vitamin B12 deficiency with long-term use

Risk of hypoglycemia is low when used as monotherapy

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13
Q

vitamin deficiency in metformin

A

Vitamin B12 deficiency with long-term use

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14
Q

who is metformin contraindicated for

A

May cause lactic acidosis in patients with existing hepatic or renal disease - contraindicated

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15
Q

what is acarbose drug class

A

alpha-glucosidase inhibitors

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16
Q

what is an example of alpha-glucosidase inhibitors

A

acarbose

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17
Q

what does acarbose do

A

Inhibits intestinal alpha-glucosidases resulting in delayed digestion of starches and disaccharides which reduces postprandial glucose levels

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18
Q

what type of carb does acarbose work on

A

starches and disaccharides

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19
Q

what does acarbose not significantly inhibit

A

Does not significantly inhibit intestinal lactase

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20
Q

when must you take acarbose

A

only effective if taken with a meal

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21
Q

dosing on acarbose

A

TID

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22
Q

acarbose effect on HbA1c

A

lowers is by 1% or less

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23
Q

what should hypoglycemic patients taking acarbose be treated with

A

Hypoglycemic patients taking acarbose should be treated with glucose rather than sucrose

this is because they cant break down complex carbs

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24
Q

what does acarbose not cause

A

weight gain

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25
adverse effects of acarbose
Flatulence, diarrhea, abdominal pain, cramps, nausea.
26
contradindications for acarbose
Contraindicated in irritable bowel syndrome, inflammatory bowel disease
27
what does acarbose reduce bioavailabitly of
metformin
28
sitagliptin is a ...
DIPEPTIDYL PEPTIDASE-4 INHIBITOR
29
DIPEPTIDYL PEPTIDASE-4 INHIBITOR example
sitagliptin Generic naming: -gliptin
30
what does sitagliptin
Inhibit the enzyme (DPP4) responsible for the degradation of GLP-1 and other active peptides involved in glucose homeostasis
31
what does sitagliptin indirectly act as
incretin mimetic
32
how much do DPP4 inhibitors/ sitagliptin lower HbA1c
1% or less
33
effect of sitagliptin on weight
Do not cause weight gain (considered weight neutral)
34
effect of sitagliptin on CVD risk
none
35
adverse effets of sitalgiptin
Nasopharyngitis, hypersensitivity reactions Rare events of pancreatitis and severe joint pain Sitagliptin does not inhibit cytochrome P450 isozymes resulting in a low potential for drug interactions Low risk of hypoglycemia
36
2 examples of GLP-1 agonists
semaglutide and liraglutide
37
semaglutide and liraglutide action...
Direct incretin mimetics by acting on GLP-1 receptors Increases insulin secretion, suppresses postprandial glucagon secretion, slows gastric emptying, increases satiety
38
how is semiglutide and liraglutide usually given
Usually given by subcutaneous injection although there is an oral formulation of semaglutide
39
semaglutide and liraglutide lower HbA1c by
1-1.5%
40
effect of semiglutide and liraglutide on weight and CVD
Do not cause weight gain (cause weight loss) Evidence suggesting prevention of cardiovascular events in both primary and secondary prevention patients
41
adverse effects of semiglutide and liraglutide (GLP1 agonist)
GI adverse effects are common and nausea upon initiation is a common experience May also cause injection site reactions Rarely causes acute pancreatitis Caution in patients with heart rhythm disturbances and severe renal impairment Contraindicated in pregnancy and those with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
42
contraindications for GLP1 agonist
pregnancy some cancer historys
43
example of sulfonylureas
glyburideg Generic names often begin with gly or gli
44
glyburide is a
sulfonylurea
45
what does glyburide (a sulfonylurea) do?
Considered an insulin secretagogue which stimulates both basal and meal-stimulated insulin release
46
what can you add glyburide to as a therapy
Generally considered add-on therapies to metformin rather than used as monotherapy
47
how much does glyburide lower HbA1c by
1-1.5%
48
differences in sulfonyleureas
Significant differences exist between the available drugs in this class in terms of effectiveness, risk of hypoglycemia, and weight gain
49
glyburide effect on weight
Glyburide is associated with a higher risk of hypoglycemia and more weight gain
50
adverse effects of glyburide
Weight gain; prolonged hypoglycemia. Risk of hypoglycemia may be greater compared with gliclazide and glimepiride, especially in elderly or patients with renal impairment beta-blockers may mask hypoglycemic symptoms
51
what is repaglinide an example of
meglitinides
52
example of meglitinides
repaglinide
53
what is repaglinide
A different class of insulin secretagogues
54
meglitinides (ie.. repaglinide) is a different class of insulin secretagogue . what else is a insulin secretagogue?
sulfonylureas (i.e. glyburide)
55
what is the similarity and differences between meglitinides (ie.. repaglinide) and sulfonylureas (i.e. glyburide)
Stimulate insulin release but the activity is much shorter Effect and adverse effects are similar to those with sulfonylureas
56
what is the pro and con of meglitinides (ie.. repaglinide) vs sulfonylureas (i.e. glyburide)
meglitinides: Lower risk of hypoglycemia in the context of skipped meals More extensive metabolic drug interactions
57
what is an example of a SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (SGC2I)
canagliflozin
58
canagliflozin is an example of
SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (SGC2I)
59
what does canagliflozin work on
Work by preventing glucose reabsorption in the kidneys which leads to enhanced glucose excretion
60
pneumonic for canagliflozin
"glifozin" = glucose flow Work by preventing glucose reabsorption in the kidneys which leads to enhanced glucose excretion
61
effect of canagliflozin on weight
weight loss
62
effect of cangliflozin on HbA1c
1% or less
63
what effects do SGC2I / canaglifozin have
Shown to reduce the risk of cardiovascular mortality, major adverse cardiovascular events, and hospitalization due to heart failure Cause a small decrease in blood pressure Shown to slow the progression of nephropathy
64
what organ function is important for canagliflozin / SGC2I
Require sufficient kidney function to work; as kidney function declines so does the antihyperglycemic effect Shown to slow the progression of nephropathy
65
adverse effects of canagliflozin / SGC2I
Increased risk of genitourinary infections Reduced intravascular volume resulting in hypotension Hyperkalemia, Risk of diabetic ketoacidosis Use with loop diuretics increase risk of hypotension
66
example of THIAZOLIDINEDIONES
pioglitazone
67
pioglitazone is a
THIAZOLIDINEDIONES
68
what is the mechanism of THIAZOLIDINEDIONES (pioglitazone)
act on PPARG receptors --> up regulate GLUT4 transporters --> reabsorb glucose This class acts as agonists at peroxisome proliferator-activated receptor gamma (PPARG) receptors located on the cell nucleus (particularly in adipose tissue) This influences gene expression including upregulation of GLUT4 transporters and lipoprotein lipase This enhances glucose reabsorption and hydrolysis of circulating triglycerides, respectively Precise mechanism is still unclear
69
what do thiazolidinediones (pioglitazone) do
Increased peripheral glucose uptake Enhanced fat cell sensitivity to insulin Decreased hepatic glucose output
70
thiazolidinediones (pioglitazone) effect on HbA1c
reduce by 1-1.5%
71
thiazolidinediones (pioglitazone) effect on weight
weight gain
72
adverse effects of thiazolidinediones (pioglitazone)
Increased incidence of heart failure likely because of their ability to cause increased fluid retention and edema Increase the risk of fractures (hip and wrist) Worsen macular edema
73
what needs to be done every time thiazolidinediones (pioglitazone) is prescribed
written consent To ensure that the risks and benefits of this medication have been clearly communicated, Health Canada requires that physicians counsel patients and obtain their written consent for all new and renewed rosiglitazone prescriptions
74
Which of the following medications is generally considered first-line therapy for most patients with type 2 diabetes? A. Glyburide B. Metformin C. Canagliflozin D. Semaglutide
B. Metformin
75

NMT200 midterm (wk1-6) (22 decks)

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