Pharmacotherapy of Oral Diabetes and Non-Insulin Injectable Medications Flashcards
(124 cards)
1
Q
What are the hallmark symptoms of hyperglycemia?
A
Polydipsia, Polyuria, and Polyphagia
2
Q
What are the reasons for an alternate goal?
A
High risk for hypoglycemia, high risk for complication of hypoglycemia occurs, barriers to drug therapy required for optimal control, lower risk for chronic complications, and elderly
3
Q
What is the A1c goal of healthy patient with few coexisting chronic illnesses and intact cognitive function?
A
<7-7.5%
4
Q
What is the A1c goal for a complex patient with multiple coexisting chronic illnesses with mild cognitive impairment?
A
<8%
5
Q
What is the A1c goal of a very complex end stage chronic illness with mod/severe cognitive impairment?
A
Avoid reliance on A1c
6
Q
What is the primary action of Metformin?
A
Decreases hepatic glucose production
7
Q
What is the use of Metformin?
A
Should always be considered in type 2 DM unless there is a CI
8
Q
What is the dose adjustment of Metformin for eGFR >45?
A
No adjustment
9
Q
What is the dose adjustment of Metformin for eGFR 30-45?
A
Can initiate at 500 mg QD and titrate to 500 mg BID for new therapy
Continuation of therapy = 50% REDUCTION
10
Q
What is the max dose of Metformin in eGFR 30-45?
A
1 g/day
11
Q
What is the dose adjustment of Metformin for eGFR <30?
A
CI due to increased risk of lactic acidosis
12
Q
What are the A/Es of Metformin?
A
Diarrhea and Decreased B12
13
Q
What are the warnings/DIs of Metformin?
A
Lactic Acidosis or Age >80 due to decreased renal clearance
14
Q
What do you monitor for Metformin?
A
Renal Function and B12
15
Q
What is the place in therapy for Metformin?
A
First Line
A1c Lowering 1.5-2%
Highest lowering effect
16
Q
What are the pearls of Metformin?
A
Improve HDL and LDL, Max Dose = 2000mg, Weight Neutral
17
Q
What is the primary action of Sulfonylureas?
A
Increases insulin secretion = glucose INDEPENDENT
18
Q
What is the brand name of Glimepiride?
A
Amaryl
19
Q
When do you avoid Amaryl?
A
Avoid eGFR <15 other than that no renal dosing
20
Q
What is the brand name of Glipizide?
A
Glucotrol
21
Q
Do you renally dose adjust in Glucotrol?
A
No
22
Q
What is the brand name of Glyburide?
A
Glynase
23
Q
When is Glynase not recommended?
A
eGFR <60
24
Q
What are the A/Es of Sulfonylureas?
A
Hypoglycemia and Weight Gain
25
What do you monitor in Sulfonylureas?
Hypoglycemia and Renal Function
26
What is the place of therapy for Sulfonylureas?
2nd or 3rd line
A1c lowering 1-2% (better as mono therapy and not adjunct)
27
What 2 Sulfonylurea's are on the BEER's List?
Glyburide and Glimepiride
28
What is the primary action of Meglitinides?
Increases insulin secretion, glucose DEPENDENT
29
What is the brand name of Repaglinide?
Prandin
30
What is the brand name of Nateglinide?
Starlix
31
What are the A/E of Meglitinides?
Hypoglycemia and Weight Gain
32
What is the warning associated with Meglitinides?
Not recommended to use together with SU
33
What is the place in therapy of Meglitinides?
2nd or 3rd line
A1c lowering 0.8-1%
34
What are the pearls of Meglitinides?
Skip is the patient skips a meal, however useful for patients with inconsistent eating patterns
35
What is the primary action of Thiazolidinediones?
Increased insulin sensitivity, takes 6-12 wks for MAX effect
36
What is the brand name of Pioglitazone?
Actos
37
What is the brand name of Rosiglitazone?
Avandia
38
When do you DC TZD therapy?
When LFTs are elevated
39
What are the A/Es of TZDs?
Peripheral edema/fluid retention, elevated LFTs, and weight gain
40
What is a CI of TZDs?
NYHA III or IV Heart Failure
41
What is a warning of TZDs?
Can exacerbate HF at any stage with fluid retention (black box) and hepatotoxicity
42
What do you monitor with TZDs?
LFT, Alkaline phosphatase, and total bilirubin at baseline
43
What is the place of therapy for TZDs?
3rd line
A1c Lowering 1-1.5%
44
Why is Rosiglitazone NOT so Rosy?
Can increase risk of MI
45
What is the primary action of GLP-1 Agonists?
Increase insulin secretion, decrease glucagon secretion (glucose DEPENDENT), slow gastric emptying, and increase satiety
46
What is the brand name of Exenatide IR and ER?
IR: Byetta
ER: Bydureon
47
What is the dosing for Byetta/Bydureon
Byetta: BID
Bydureon: once weekly
48
What is the renal dosing for Byetta/Bydureon?
CrCl < 30 = DC
49
What is the brand name of Liraglutide?
Victoza
50
What is the dosing of Victoza?
QD for 1 week before titrating up dose strength
51
What is the brand name for Dulaglutide?
Trulicity
52
What is the dosing for Trulicity?
Once weekly
53
What is the brand name for Lixisenatide?
Adlyxin
54
What is the dosing for Adlyxin?
QD
55
What is the brand name of Semaglutide?
Ozempic or Rybelsus
56
What is the dosing for Ozempic/Rysbelsus?
Ozempic: once weekly
Rysbelsus: QD
57
What are the A/Es of GLP-1 Agonists?
GI upset, nausea, vomiting, diarrhea
58
What are the CIs of GLP-1 Agonists?
Personal or FH of medullary thyroid carcinoma (black box) EXCEPT for Lixisenatide
59
What are the warnings for GLP-1 Agonists?
Acute pancreatitis, gallbladder disease, and gastroparesis
60
What is the place in therapy for GLP-1 Agonists?
1st or 2nd line
A1c lowering 0.5-1.9%
CVD: Liraglutide, Dulaglutide, and Semaglutide
61
Do GLP-1 Agonists promote weight loss?
Yes
62
LEADER Result
Liraglutide-Risk reduction of major CV events in adults with type 2 DM and established CVD
63
SUSTAIN 6 Results
Semaglutide-Risk reduction of major CV events in adults with type 2 DM and established CVD
64
REWIND Results
Dulaglutide-Risk reduction of major CV events in adults with type 2 diabetes who have established CVD or multiple CV risk
65
What is the primary action of DPP4 Inhibitors?
Indirectly increases insulin secretion and decreases glucagon secretion, glucose DEPENDENT
66
What is the brand name of Sitagliptin?
Januvia
67
What is the brand name of Saxagliptin?
Onglyza
68
What is the brand name of Linagliptin?
Tradjenta
69
What is the brand name of Alogliptin?
Nesina
70
How are DPP4-Inhibitors dosed?
QD orally
71
What are the A/E and Monitoring concerns of DPP4-Inhibitors?
Increased LFTs, monitor LFT and renal function
72
What are the warnings for DPP4-Inhibitors?
HF: Saxagliptin and Alogliptin
Renal Impairment
Hepatotoxicity
73
What is the place of therapy for DPP4-Inhibitors?
2nd or 3rd line
A1c lowering 0.6-0.8%
74
Do DPP4-Inhibitors cause weight gain?
NO
75
What is the primary action of SGLT2 Inhibitors?
Blocks glucose reabsorption by the kidney
76
What is the brand name of Canagliflozin?
Invokana
77
What is the brand name of Dapagliflozin?
Farxiga
78
What is the brand name of Empagliflozin?
Jardiance
79
What is the brand name of Ertugliflozin?
Steglatro
80
How are SGLT2-Inhibitors dosed?
QD and orally
81
What are the A/Es of SGLT-2 Inhibitors?
UTI, Genital mycotic infections
82
What are warnings for SGLT2 Inhibitors?
Increased risk of bone fractures, ketoacidosis, lower limb amputations, fournier's gangrene, and pancreatis
83
What is the place in therapy for SGLT2 Inhibitors?
1st or 2nd line
A1c Lowering 0.5-1%
84
Does SGLT2 Inhibitors cause weight gain?
NO
85
Which SGLT2 Inhibitors have CVD benefits?
Canagliflozin, Empagliflozin, and Dapagliflozin
86
Which SGLT2 Inhibitors have HF benefits?
Empagliflozin
Dapagliflozin for HFrEF
87
What SGLT2 Inhibitors have CKD benefits?
Canagliflozin and Dapagliflozin
88
EMPA-REG Results
Empagliflozin-Risk reduction of CV mortality in adults with type 2 and established CVD
89
CANVAS Results
Canagliflozin-Risk reduction of CV mortality in adults with type 2 and CVD
90
CREDENCE RESULTS
Canagliflozin-Risk reduction in ESRD, doubling of serum creatinine, CV death, and hospitalization for HF in adults with type 2 DM and diabetic nephropathy with urinary albumin excretion >300 mg/day
91
DECLARE TIMI 58 RESULTS
Dapagliflozin-Risk reduction for hospitalization for HF in patients with type 2 diabetes and established CVD or multiple CV risk factors
92
DAPA-HF RESULTS
Dapagliflozin-SEPARATE INDICATION, HFrEF to reduced the risk of hospitalization or death
93
EMPEROR-Reduced RESULTS
Empagliflozin-August, 18, 2021 FDA approved indication for use in HF in adults with HFrEF
94
EMPEROR Reserved RESULTS
Empagliflozin-February 4, 2022: FDA approved use in HF in adults with HFpEF
95
DAPA-CKD RESULTS
Dapagliflozin-Adjunct therapy for CKD
96
What the primary action of Alpha Glucosidase Inhibitors AGi?
Slows intestinal CHO digestion/absorption
97
What is the brand name of Acarbose?
Precose
98
What is the brand name of Miglitol?
Glyset
99
How are AGi's dosed?
TID with meals
100
What are the A/E's of AGi's?
Significant in GI upset and Increased LFTs (Acarbose)
101
What are the CIs of AGi?
Inflammatory bowel disease, colonic ulceration, intestinal obstruction, malabsorption disorders
102
What is the place in therapy for AGi?
A1c lowering 0.3-1%
103
What are the clinical pearls for AGi?
Minimal hypoglycemia, no weight gain, and TID dosing, and hepatotoxicty
104
What is the primary action of Amylin Analogue?
Reduces postprandial elevations by prolonging gastric emptying, suppresses glucagon secretion, and produces satiety
105
What is the brand name of Symlin?
Pramlintide?
106
What are the A/E of Amylin Analogue?
Significant hypoglycemia (black box), HA, nausea, and anorexia
107
What is the CI and warning associated with Amylin Analogues?
CI: gastroparesis
Warning: hypoglycemia
108
What is the place of therapy for Amylin Analogues?
A1c lowering 0.6-0.8%
109
What are the pearls for Amylin analogue?
Weight loss and decrease mealtime insulin by 50%
110
What is the primary action for Dopamine 2 Agonists?
Increases insulin sensitivity
111
What drug is a Dopamine 2-Agonist and its place in therapy?
Bromocriptine, A1c lowering 0.6-1.2% not commonly used
112
What is the primary action for Bile Acid Sequestrant BAS?
Decrease hepatic glucose production and increase incretin levels
113
What drug is a BAS and what is its place in therapy?
Colesvelam/Welchol, A1c lowering 0.5%
114
What drugs are utilized for a therapy target of fasting blood glucose?
Biguanide, TZDs, SU, SGLT-2, Dopamine Agonists, Bromocriptine, DPP4, and GLP-1
115
What drugs are utilized for therapy target postprandial blood glucose?
Meglitinide, DPP4, GLP-1, and AGi
116
When do you measure for therapy target for postprandial blood glucose?
Pre and 2 hours after same meal or before the next meal
117
When should you consider metformin for prediabetes patients?
BMI >35, Age <60, and Women with prior GDM
118
What drugs categories should you avoid with HF?
TZDs and DPP4
119
What drugs categories should you avoid with Renal Impairment?
Metformin
120
What drugs categories should you avoid with GI Disorders?
AGi and GLP-1
121
What drugs categories should you avoid with Bone Fractures?
SGLT2 and TZD
122
What drugs categories should you avoid with Hepatotoxicity?
TZD, DPP4, and AGi
123
What drugs categories should you avoid with Thyroid Carcinoma?
GLP-1
124
What are the common barriers to monitoring and control?
Concurrent health conditions, life stressors with higher priority, inadequate knowledge, inadequate access, poor adherence, fear of hypoglycemia
