Test 2 - Oral Diabetics (Josh) Flashcards Preview

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Flashcards in Test 2 - Oral Diabetics (Josh) Deck (50)
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1
Q

Oral meds are for which type of diabetes?

A

Type 2

2
Q

Why should we not call them oral hypoglycemics?

A

it implies that they lower blood sugar, but the really don’t. (then you’d have to worry a/b hypoglycemia)

they actually just block it from going up

3
Q

MAO: Oral Diabetic Meds

A

block blood sugar from going up

4
Q

Which drug is the cornerstone of T2DM mgmt?

A

Metformin

5
Q

Which oral drug can be given prophylactically for T2DM?

A

Metformin

6
Q

Flatulence and Diarrhea are common w/ —–

A

Metformin

tends to go away w/ time

7
Q

Which oral agent lowers absorption of b12 & folic acid? What does this cause

A

Metformin

causes anemia

8
Q

How can lowering B12 be very problematic w/ Diabetics taking Metformin?

A

lowering B12 leads to neuropathy. Metformin lowers B12. Neuropathy is already caused by diabetes, so it could be severe

9
Q

How rare is lactic acidosis as a side effect for Metformin?

A

3 clients per 100,000 client years

10
Q

Kussmaul respirations could be seen with which drug?

A

Metformin, b/c it can cause acidosis

11
Q

Which oral diabetic drug is ‘weight neutral’?

A

Metformin

12
Q

If having kidney problems, which oral agent should we monitor?

A

Sulfonylureas, b/c it is renally excreted

13
Q

MOA: Sulfonylureas

A

causes the pancreas to increase insulin (hits it w/ a bat)

can result in hypoglycemia (b/c insulin moves the sugar out of blood into muscle cells)

14
Q

Don’t drink —– when taking a sulfonylurea.

A

alcohol

15
Q

Which drug is an add-on to metformin?

A

TZD

16
Q

A client taking rosiglitazone sees no results after 3 wks, should they change drug?

A

no, TZD drugs work on DNA, which takes 3-4 months to take effect

17
Q

Which medication should your worry about hypoglycemia?

A

sulfonylureas

18
Q

Which medication should you worry about weight gain?

A

TZDs

Sulfonylureas (5-10 lbs)

19
Q

Best oral diabetic drug?

A

Metformin

20
Q

Client has lots of gas and diarrhea, which oral diabetic drug is she likley taking?

A

Metformin

21
Q

Five types of Oral Diabetics:

A

1) Metformin
2) Sulfonylureas
3) TZDs
4) DPP-4 inhibitors
5) SGLT-2 inhibitors

22
Q

MOA: Metformin

A
  • tells LIVER to decrease glucose production
  • tells GUT to decrease glucose absorption
  • tells MUSCLE CELLS to increase sensitivity of insulin receptors
23
Q

Do you worry about weight gain w/ Metformin?

A

no, it is weight neutral

24
Q

Adverse Effects of Metformin:

A
  • Diarrhea & Flatulence (most common)
  • Decreased Vit B12
  • Decreased Folic Acid
  • Lactic Acidosis (rare)
25
Q

Second most common T2DM medication?

A

sulfonylureas

  • Glipizide
  • Glyburide
  • Glimepiride
26
Q

Major Sulfonlurea Medications (Oral Diabetic Meds)

A

Glipizide

Glyburide

Glimepride

27
Q

Adverse effects: Sulfonylureas

A
  • Hypoglycemia (b/c it makes insulin)
  • Weight gain (5-10 lbs)
  • Burn out (5-10 years)
28
Q

Which class of oral diabetic meds has the adverse effect of ‘burn out’?

A

Sulfonlureas (Glipizide, Glyburide, Glimepiride)

b/c the pancreas gets tired of being stimulated to produce insulin and just stops

29
Q

Which class of T2DM oral meds are renally exrcreted?

A

Sulfonylureas

monitor kidney function

30
Q

Which drug has an adverse effect w/ alcohol?

A

Sulfinylureas (Glipizide, Glyburide, Glimepride)

  • has disulfiram like reaction (stress test in a pill)
  • potentiates the hypoglycemic effect
31
Q

If a client taking Glipizide begins to drink alcohol, what should we see?

A
  • stress test like symptoms (acts like disulfiram

- very low blood sugar (alcohol potentiates the hypoglycemic effect)

32
Q

Which T2DM Oral Med is typically an add-on to Metformin?

A

TZD (Thiazolidinediones)

33
Q

MOA: TZD

A

Goes to DNA and increases insulin sensitivity of cells

prob is that DNA drugs take a long time to take effect (3-4 months)

34
Q

Major TZD (T2DM Oral Agent)

A

RosiGLITAZONE

PioGLITAZONE

35
Q

Which T2DM Oral Agent has a mixed effect on lipids?

A

Pioglitazone (TZD)

raises HDL (good)
lowers TGs (good)
raises LDL (bad)
36
Q

Adverse effects of Rosiglitazone & Pioglitazone (TZD):

A
  • Edema (causes kidneys to retain Na+)
  • Weight gain (from the edema)
  • Bone fractures
  • Hepatotoxicity (rare)
  • Bladder Cancer (rare)
37
Q

How do DPP-4 Inhibitors work?

A

they lower blood glucose by preventing DPP-4 from breaking down Incretin Hormones (which increase gastric emptying, increase insulin, & decrease glucagon)

38
Q

—- —– are secreted by body to help stomach digest food and help increase insulin production (lowering blood glucose). They are broken down by —–, which leads to an increase in blood glucose.

A

Incretin Hormones

DPP-4

important to know b/c DPP-4 Inhibitors block the breakdown of these hormones, and allows more of them to make insulin and lower blood sugar

39
Q

Sitagliptan

A

DPP-4 Inhibitor (T2DM Oral Agent)

  • well-tolerated
  • upper respiratory issues is most common (runny nose, etc.)
  • rarely causes PANCREATITIS
40
Q

Which T2DM Oral Agents work in the nephron, altering the reabsorption of glucose?

A

SGLT-2 Inhibitors

41
Q

When should you take SGLT-2 Inhibitors.

A

Before breakfast

42
Q

If blood sugar is 180, sugar ——-

A

is reabsorbed

reabsorption is blocked

43
Q

SGLT-2 Inhibitors block reabsorption of sugar when it is —–

A

> 80

44
Q

Canagliflozin

A

SGLT-2 Inhibitor (T2DM Oral Agent)

canagliFLOzin allows urine to FLOw (along w/ the sugar)

45
Q

Adverse Effects w/ canagliflozin

A
  • Weight loss (5-7 lbs)
  • Dehydration
  • Hyperkalemia
  • Genital Infections
46
Q

Adverse Effects for canagliflozin (SGLT-2 Inhibitor): Weight Loss

A

patient loses 5-7 lbs due to increase in water loss

47
Q

Adverse Effects for canagliflozin (SGLT-2 Inhibitor): Dehydration

A

water follows the sugar out into the urine

48
Q

Adverse Effects for canagliflozin (SGLT-2 Inhibitor): Hyperkalemia

A

when sugar is being excreted, it allows less space for K+ to be excreted, leading to buildup of K+

49
Q

Adverse Effects for canagliflozin (SGLT-2 Inhibitor): Genital Infections

A

yeast infection happens with 10% of women and 3-4% of men

50
Q

Which oral medication works prophylactically (delays development of T2DM in at risk clients?

A

Metformin