Antidiabetics 2 Flashcards

Question

Exenatide: Adverse Effects?

Answer 1

• Nausea, vomiting and diarrhea. • Acute pancreatitis. • Should not be used in patients with gastroparesis.

Answer 2

Sitagliptin • Selective inhibitor of DPP-IV. • Increases circulating GLP-1 and insulin levels. • Given orally.

Answer 3

• Pancreatitis. • Hypersensitivity reactions including urticaria, angioedema, anaphylaxis, and skin reactions such as Stevens-Johnson syndrome.

Answer 4

• Synthetic analog of amylin. • Peptide co-secreted with insulin from pancreatic β-cells. • Inhibits food intake, gastric emptying, and glucagon secretion. • Injectable

Answer 5

``` • Bile-acid sequestrant used to lower LDL cholesterol. • Approved for treatment of type 2 DM. • Mechanism unclear. • Given orally. ```

Answer 6

Canagliflozin • Glucose is filtered by the glomerulus and reabsorbed in the proximal tubule by sodium glucose transporters (SGLTs). • SGLT2 is responsible for most of glucose reabsorption. • Canagliflozin blocks SGLT2. • This leads to decreased glucose reabsorption, increased glucose excretion, and decreased blood glucose levels. • Given orally.

Answer 7

• Increased incidence of genital and urinary tract infections. • The osmotic diuresis can cause volume depletion, increased serum creatinine levels, hyperkalemia, hypermagnesemia, hyperphosphatemia and hypotension. • Contraindicated in patients with GFR < 45 ml/min/1.73 m2.

Answer 8

• Metformin is the preferred first agent. • Started if lifestyle intervention did not achieve HbA1c goals. • Monotherapy with most non-insulin antidiabetic agents can reduce HbA1c ~ 1%. • Patients with HbA1c ≥9.0% are unlikely to achieve HbA1c goals with monotherapy. • Therefore, therapy may be started with a combination of two noninsulin agents or with insulin itself.

Answer 9

• If monotherapy does not achieve HbA1c goal over ∼3 months, the next step is to add a second agent. • The choice could be: oral agent, exenatide, or insulin. • The higher the HbA1c, the more likely insulin will be required. • If the two-drug combination fails to achieve the glycemic target a third agent can be added. • Diabetes is associated with progressive β-cell loss: many patients will eventually need to be transitioned to insulin. • The decision to transition to insulin should be favored when the HbA1c ≥ 8.5%.

Answer 10

• Insulin is typically begun at a low dose, with a single injection of basal insulin. • The dose is then uptitrated. • If there is postprandial hyperglycemia the patient will require addition of prandial insulin therapy. • Typically, rapid-acting insulins are used: lispro, aspart or glulisine.

Answer 11

• Insulin is the most effective of diabetes medications in lowering glycemia. • It can decrease any level of elevated HbA1C to, or close to, the therapeutic goal. • There is no maximum dose of insulin beyond which a therapeutic effect will not occur. • Large doses of insulin may be necessary to overcome the insulin resistance of type 2 diabetes.

Answer 12

``` Insulin may be warranted as initial therapy for patients with type 2 diabetes with: • Significant hyperglycemic symptoms • Ketonuria • HbA1c > 10% • Random glucose > 300 mg/dL ```

Answer 13

``` • Gestational Diabetes Mellitus • Preexisting Type 1 Diabetes & Type 2 Diabetes •Insulin is the preferred agent. •It does not cross the placenta to a measurable extent. ```

Answer 14

• All insulins are category B except glargine, glulisine, and degludec, which are C. • Use of insulin preparations of low antigenicity minimizes transplacental transport of insulin antibodies. • Human insulin is the least immunogenic • Lispro, aspart, and glulisine are comparable in immunogenicity to human insulin. • Only lispro and aspart have been shown to be safe in pregnancy. • A typical regimen may start with a single dose of bedtime NPH insulin. • If postprandial glucose control is required injections of lispro or aspart can be added.

Answer 15

``` CARDIOVASCULAR DISEASE • Hypertension • Dyslipidemia • Antiplatelet Therapy • NEPHROPATHY • NEUROPATHY • Neuropathic Pain • Gastroparesis • Erectile Dysfunction ```

Answer 16

• CVD is the major cause of morbidity and mortality for individuals with diabetes. Hypertension • Patients with diabetes and hypertension should be given either an ACE inhibitor or an ARB. Dyslipidemia • Statins should be given, regardless of lipid levels, to diabetic patients: • With overt CVD • Aged < 40 yr with CVD risk factors • Aged > 40 yr with or without CVD risk Antiplatelet Agents • Aspirin therapy should be considered as a primary prevention strategy in patients with type 1 or type 2 diabetes at increased CV risk.

Answer 17

Severe Hypoglycemia • Used to treat severe hypoglycemia in patients with diabetes treated with insulin. Radiology Of The Bowel • Used because of its ability to relax intestine. beta-Blocker Poisoning • Antidote for beta-blocker overdose. Glucagon C-peptide Test • Test for residual β-cell function in diabetes.

Answer 18

NEPHROPATHY • ACE inhibitors or ARBs are recommended for patients with albuminuria. ``` Neuropathic Pain • Drugs used for neuropathic pain include: • Amitriptyline • Pregabalin • Gabapentin • Duloxetine • Venlafaxine • Valproate • Opioids Gastroparesis • Gastroparesis symptoms may improve with dietary changes and prokinetic agents such as metoclopramide or erythromycin. Erectile Dysfunction • Treatments for erectile dysfunction may include phosphodiesterase type 5 inhibitors. ```