Anemia, PO DM meds

Question 1

first line if A1C is <7.5%

Answer 1

metformin

Question 2

site of action: Alpha Glucosidase Inhibitors

Answer 2

intestines

Question 3

class: Acarbose, miglitol

Answer 3

Alpha Glucosidase Inhibitors

Question 4

site of action: Meglitinides

Answer 4

pancreas

Question 5

class: Repaglinide, nateglinide

Answer 5

Meglitinides

Question 6

main SE of Repaglinide, nateglinide

Answer 6

hypoglycemia (severe if also on gemfibrozil)

Question 7

site of action: Sulfonylureas

Answer 7

pancreas

Question 8

class: Glyburide, glipizide, glimepiride

Answer 8

Sulfonylureas

Question 9

MOA: blocks ATP sensitive K channels – insulin release from functional beta cells, decreased efficacy w/ time
o Increases insulin secretion

Answer 9

Sulfonylureas

Question 10

AEs: **Hypoglycemia
o Weight gain
o Nausea, dyspepsia, diarrhea

Answer 10

Sulfonylureas

Question 11

cautions: Sulfonylureas

Answer 11

elderly, renal and hepatic dysfunction

Question 12

CI: Sulfonylureas

Answer 12

pregnancy, sulfa allergy, type 1 DM

Question 13

site of action: Biguanides

Answer 13

liver, muscle

Question 14

class: metformin

Answer 14

Biguanides

Question 15

initial dosing for metformin

Answer 15

IR 500mg Qd or bid / XR 500mg QD

Question 16

MOA: reduces liver gluconeogenesis and glycogenolysis
o Decreases liver glucose formation/release
o Increase glucose uptake by skeletal muscle and adipose tissue à increases insulin sensitivity

Answer 16

metformin

Question 17

metformin - hypoglycemia risk as monotherapy?

Answer 17

no

Question 18

AEs: ovulation, N/V/**D, flatulence, macrocytic anemia / peripheral neuropathy – must monitor renal function and Vit B12

Answer 18

metformin

Question 19

BBW: metformin

Answer 19

LACTIC ACIDOSIS
§ in pts w/ CHF, hepatic or renal dysfunction, elderly, alcohol abuse

Question 20

stie of action: Thiazolidinediones (Glitazones)

Answer 20

liver, muscle, adipose tissue

Question 21

class: Pioglitazone, rosiglitazone

Answer 21

Thiazolidinediones (Glitazones)

Question 22

MOA: PPARg agonist à increase GLUT-4 transporters, increase insulin sensitivity of tissues. decreases gluconeogenesis

Answer 22

Thiazolidinediones (Glitazones)

Question 23

AEs: Weight gain, URI, HA
o Fluid retention
o ­ Risk of bone fracture
o ­ **Risk of BLADDER CANCER
can induce ovulation

Answer 23

Thiazolidinediones (Glitazones)

Question 24

BBW: Thiazolidinediones (Glitazones)

Answer 24

fluid retention in CHF

Question 25

which Thiazolidinediones (Glitazones) causes bladder cancer?

Answer 25

pioglitazone

Question 26

site of action: Dipeptidyl peptidase-4 Inhibitors (DPP-4)

Answer 26

intestines

Question 27

MOA: blocks breakdown of GLP-1 -- increases endogenous GLP-1 o “Incretin enhancer”

Answer 27

Dipeptidyl peptidase-4 Inhibitors (DPP-4)

Question 28

AEs: **URI, sore throat o **Hypersensitivity rxn o **Pancreatitis o HA, diarrhea, joint pain

Answer 28

Dipeptidyl peptidase-4 Inhibitors (DPP-4)

Question 29

class: Sitagliptin, saxagliptin, linagliptin, alogliptin

Answer 29

Dipeptidyl peptidase-4 Inhibitors (DPP-4)

Question 30

cautions: Dipeptidyl peptidase-4 Inhibitors (DPP-4)

Answer 30

HF, pancreatitis

Question 31

CI: Dipeptidyl peptidase-4 Inhibitors (DPP-4)

Answer 31

type 1 DM, use w/ GLP1 receptor agonists

Question 32

site of action: Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)

Answer 32

kidneys

Question 33

class: Canaglifozin, dapaglifozin, empaglifozin, ertuglifozin

Answer 33

Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)

Question 34

MOA: Inhibits glucose reabsorption in proximal tubule of kidneys à excess glucose excreted in urine

Answer 34

Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)

Question 35

AEs: **hyperK Polyuria, constipation, hypotension o Increased risk of UTI and genital fungal infections o Increased risk of bone fracture and pancreatitis

Answer 35

Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)

Question 36

BBW: Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)

Answer 36

lower limb amputation risk

Question 37

cautions: Selective Sodium-Dependent Glucose Cotransporter-2 Inhibitor (SGLT2 Inhibitors)

Answer 37

bladder / breast cancer hx

Question 38

dopamine agonist indicated for DM

Answer 38

bromocriptine

Question 39

class: Colesevelam

Answer 39

bile acid sequestrant

Question 40

AEs: GI disturbances -- constipation, bloating, gas o Impaired absorption of lipid soluble vitamins and drugs

Answer 40

Colesevelam

Question 41

iron deficiency causes ____ anemia

Answer 41

microcytic

Question 42

Vit B12 and folate defic cause ____ anemia

Answer 42

macrocytic

Question 43

anemia of chronic dz causes ____ anemia

Answer 43

normocytic

Question 44

Low ferritin means ___ iron

Answer 44

low

Question 45

High transferrin means ___ iron

Answer 45

low

Question 46

High TIBC means __ iron

Answer 46

low

Question 47

1st line for iron defic anemia

Answer 47

PO iron

Question 48

counseling for PO iron

Answer 48

counseling: Take on an empty stomach but if you have GI upset you can take with food except dairy or caffeine. You may experience dark stools or constipation take w/ orange juice or vitamin C

Question 49

Take separately from calcium-containing foods/beverages/supplements, cereals, dietary fiber, tea, coffee, eggs

Answer 49

PO iron

Question 50

4 meds iron impairs absoprtion of:

Answer 50

Levothyroxine § Levodopa/methyldopa § Fluroquinolones § Tetracycline and doxycycline

Question 51

AEs: GI side effects common: metallic taste, nausea, flatulence, constipation, N/V/D, epigastric discomfort o Black/green or tarry stools staining clothing or cause anxiety about bleeding

Answer 51

PO iron

Question 52

tx for iron toxicity

Answer 52

IV fluids o Whole bowel irritation w/ polyethylene glycol o Deferoxamine (Desferal)

Question 53

AEs: flushing, rash, abdominal pain, hypotension

Answer 53

IV irons: Ferric carboxylmaltose (Injectafer), iron sucrose (Venofer)

Question 54

long term metformin use can cause vitamin ___ defic

Answer 54

B12

Question 55

folate DIs

Answer 55

Phenytoin – reduces absorption of folic acid, may lead to deficiency. Folic acid may decrease serum concentration of phenytoin * DNA synthesis inhibitors: Azathioprine, 6-MP, 5-FU, hydroxyurea, zidovudine. May cause folate deficiency * Folate antagonists: methotrexate, trimethoprim, pentamidine, triamterene. Leucovorin (folinic acid) used to circumvent action of methotrexate -- reduces toxicity of high dose methotrexate

Question 56

class: Epoetin, darbepoetin

Answer 56

Erythropoiesis-Stimulating Agents (ESAs) – ALL IV