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PHARM > Antidiabetics > Flashcards

Antidiabetics Flashcards

1
Q

Which medication is used with an unconscious hypoglycemic patient?

A

Glucagon (GlucaGen) IV

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2
Q

MOA of Glucagon?

A

stimulates hepatic production of glucose from glycogen stores (glycogenolysis)

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3
Q

Adverse effects of Glucagon?

A

N/V

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4
Q

Precautionary measures when giving Glucagon?

A

Position patient in a side lying position d/t potential V and have suction available

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5
Q

Can IV Glucagon be administered through a line containing D5W?

A

No

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6
Q

What should be the rate of administration of Glucagon?

A

not exceeding 1mg/min

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7
Q

Biguanides are oral agent that act on which organ?

A

liver to decrease glucose production

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8
Q

What is the 1st line Biguanide medication?

A

Metformin (Glucophage)

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9
Q

Therapeutic use of Metformin?

A

T2DM, pre-diabetes, gestational diabetes, and POS

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10
Q

MOA of Metformin?

A
  1. Decreases hepatic glucose production.
  2. Decreases intestinal glucose absorption.
  3. Increases sensitivity to insulin.
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11
Q

Adverse effects of Metformin?

A

GI: Abdominal bloating, N/V/D

unpleasant metallic taste, decreased vitamin B12 levels

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12
Q

What is the black box warning for Metformin?

A

risk of lactic acidosis (chills, diarrhea, ↓BP ↓ HR, dyspnea, weakness)

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13
Q

Interactions with Metformin?

A

acute/chronic alcohol ingestion or iodine contrast media, and cimetidine (Tagamet)

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14
Q

What is the interaction of iodine contrast media with Metformin?

A

increases risk of lactic acidosis

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15
Q

Dosing schedule for Metformin administration?

A

immediate release (BID) and extended release (QD) w/ meals d/t GI upset

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16
Q

High risk patients for Metformin use?

A

renal insufficiency, liver disease, severe infection, HF, hx of lactic acidosis, shock or other conditions that cause hypoxemia, ETOH use

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17
Q

What does it mean that Metformin is weight neutral?

A

It will not cause patient’s to gain weight. Weight may actually decrease

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18
Q

T/F. Metformin will not cause hypoglycemia when given alone?

A

True

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19
Q

What causes reduced vitamin B12 levels when taking Metformin?

A

altered absorption

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20
Q

How can severe lactic acidosis be treated?

A

hemodialysis

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21
Q

Sulfonylureas and Meglitinides act on which organ?

A

the pancreas to increase the secretion of insulin

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22
Q

What is the prototype for Sulfonylureas?

A

Glyburide (DiaBeta)

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23
Q

Therapeutic use of Glyburide?

A

blood sugar control in T2DM when diet therapy fails.

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24
Q

MOA of Glyburide?

A
  1. Lowers blood sugar by stimulating the release of insulin from the pancreas.
  2. Increasing the sensitivity to insulin at receptor sites.
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25
Q

Adverse effects of Glyburide?

A

hypoglycemia, photosensitivity, and weight gain

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26
Q

Interactions with Glyburide?

A

beta blockers, NSAIDs, sulfonamide abx all which will increase hypoglycemia

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27
Q

T/F. Any drug that increases insulin secretion will cause increased weight gain.

A

True

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28
Q

Glyburide contraindications?

A

pregnancy and lactation

29
Q

Why should you avoid alcohol use with Glyburide?

A

increase risk of disulfiram like reactions (abdominal cramps, N, flushing, HA, and hypoglycemia)

30
Q

Should Glyburide be taken with or without food?

A

with food

31
Q

T/F. Kidney and liver dysfunction are high risk patients with Glyburide use?

A

True

32
Q

Prototype for Meglitinides “Glinides”?

A

Repaglinide (Prandin)

33
Q

Therapeutic use of of Repaglinide (Prandin)?

A

T2DM with diet and exercise, may be used with Metformin, rosiglitazone, or pioglitazone

34
Q

MOA of Repaglinide?

A

stimulates the release of insulin from the pancreatic beta cells by closing K channels, which results in the opening of Ca channels in the beta cells

35
Q

Adverse effects of Repaglinide?

A

Hypoglycemia

36
Q

Interactions with Repaglinide?

A

Gemfribrozil (Lopid), multiple interactions

37
Q

Why should patients with liver impairment be cautious if taking Repaglinide?

A

May increase risk of hypoglycemia

38
Q

Does Repaglinide need to be taken with a meal?

A

yes, 30 minutes or less before eating

39
Q

What is the interaction of Gemfibrozil with Repaglinide?

A

slows metabolism of glinides → increasing levels → risk of hypoglycemia

40
Q

Alpha-glucosidase inhibitors (AGI) act on which system?

A

The GI tract to decrease absorption of glucose

41
Q

Prototype for AGIs?

A

Acarbose (Precose)

42
Q

Therapeutic use of Acarbose ?

A

management of T2DM

43
Q

MOA of Acarbose?

A

inhibits the enzyme alpha-glucosidase in the GI tract → delays and reduces glucose absorption

44
Q

Adverse effects of Acarbose?

A

ABDOMINAL PAIN, diarrhea, flatulence, and liver dysfunction

45
Q

Interactions with Acarbose?

A

Several

46
Q

Acarbose contraindications?

A

hypersensitivity, DKA, and cirrhosis

47
Q

Should Acarbose be taken with meals?

A

with 1st bite of each meal TID

48
Q

Is Acarbose used in the US?

A

No d/t side effects

49
Q

T/F. All oral agents are contraindicated in T1DM

A

True

50
Q

Dipeptidyl Peptidase 4 (DPP-4) inhibitors act on which organ?

A

pancreas to prolong the action of incretin hormones

51
Q

Prototype for DPP-4 inhibitors?

A

Sitagliptin (Januvia)

52
Q

MOA of Sitagliptin?

A

prolong the action of incretin hormones → increases insulin release → decreases glucagon levels

53
Q

Therapeutic use of Sitagliptin?

A

T2DM glycemic control. May be used as monotherapy or combination therapy.

54
Q

Adverse effects of SitagliptiN?

A

HA, N, acute renal failure, URI, stuffy or runny nose, ST, drug induced pancreatitis. Serious hypersensitivity rxns (anaphylaxis, angioedema, Steven-Johnson syndrome).

55
Q

Sitagliptin contraindications?

A

DKA and hypersensitivity

56
Q

Does Sitagliptin need to be taken with food?

A

With or without food

57
Q

Symptoms of pancreatitis?

A

severe and persistent abdominal pain w/ or w/o vomiting.

58
Q

Interactions with Sitagliptin?

A

Glyburide, Glipizide, or Glimepiride → can increase risk of hypoglycemia

59
Q

Prototype for Glucagon-like peptide 1 receptor Agonist (GLP-1RA)?

A

Exenatide (Byetaa)

60
Q

Therapeutic use of Exenatide?

A

T2DM management as adjunct to diet and exercise

61
Q

MOA of Exenatide?

A

mimics the action of incretin which promotes endogenous insulin secretion and promotes other mechanisms of glucose lowering

62
Q

Adverse effects of ExeNatiDe?

A

N/V/D (most common), dyspepsia, weight loss, decreased appetite, hypoglycemia, acute renal failure, and pancreatitis

63
Q

Interactions with Exenatide?

A

will slow absorption of oral medications like oral contraceptives and abx

64
Q

What are benefits of Exenatide?

A

protective factors for atherosclerotic CVD, HF, and CKD. Will help minimize hypoglycemia or promote weight loss.

65
Q

Exenatide contraindications?

A

severe renal impairment

66
Q

Exenatide precautions?

A

kidney transplant recipients

67
Q

Route and dosing schedule for Exenatide?

A

Route: subcut

60 min before morning and evening meals, not PC

68
Q

Can Exenatide be mixed with insulin?

A

No

69
Q

Can patients still take oral contraceptives or abx with Exenatide?

A

yes but 1hr before Exenatide

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