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CDCES Exam > Common Oral diabetes medications > Flashcards

Common Oral diabetes medications Flashcards

1
Q

What is the main action of biguanides?

A

Decreases hepatic glucose output and first line medication at diagnosis of type two diabetes

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2
Q

What are examples of biguanides?

A

metformin (glucophage), riomet (liquid metformin), extended release (glucophage XR, glumetza and fortamet).

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3
Q

What is common dosing of biguanides?

A

metformin 500-2250 mg (usually BID with meals)
riomet 500-2250 mg (500 mg/5 mL)

extended release 500-2500 mg (once/day with dinner)

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4
Q

What are side effects of biguanides? How can side effects be minimized?

A

Side effects: nausea, bloating, diarrhea, B12 deficiency
To minimize side effects take XR and take with meals

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5
Q

What lab needs to be checked before starting metformin?

A

GFR needs to be obtained
If GFR is less than 30 don’t use
If GFR is less than 45 don’t start
If GFR falls between 30 and 45 and already on metformin eval risk vs benefit; consider decreasing dose

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6
Q

What are benefits of metformin?

A

Lowers cholesterol, no hypoglycemia risk, weight neutral, cheap, approved for pediatrics greater than 10 years old.

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7
Q

How much does metformin lower A1C?

A

1-2%

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8
Q

What is the mechanism of action for sulfonylureas?

A

Stimulates sustained insulin release

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9
Q

What are examples of sulfonylureas?

A

glyburide (Diabeta and Glynase PresTabs), glipizide (Glucotrol and Glucotrol XL) and glimepiride (Amaryl).

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10
Q

What is common dosing of sulfonylureas?

A

Glyburide (Diabeta) 1.25-2 mg
Glynase PresTabs 0.75-12 mg

glipizide (Glucotrol) 2.5-40 mg
Glucotrol XL 2.5-20 mg
glimepiride (Amaryl) 1-8 mg

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11
Q

How often are sulfonylureas commonly taken?

A

Sulfonylureas are commonly taken 1-2 times/day before meals

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12
Q

What are benefits of sulfonylureas?

A

low cost, and generic available

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13
Q

What are common side effects of sulfonylureas?

A

hypoglycemia and weight gain. They are eliminated by the kidney so with decreased kidney function stay in the body longer.

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14
Q

Which sulfonylurea is most likely to cause hypoglycemia?

A

glyburide

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15
Q

How much can sulfonylureas lower A1C?

A

1-2%

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16
Q

What is the mechanism of action of SGLT2 inhibitors?

A

Decreases glucose reabsorption in the kidneys.

17
Q

What are examples of SGLT2 inhibitors?

A

canagliflozin (Invokana), dapagliflozin (Farxiga), expagliflozin (Jardiance) and ertugliflozin (Steflatro).

18
Q

What are common doses of SGLT 2 inhibitors?

A

canagliflozin (Invokana) - 100-300 mg once/day
dapagliflozin (Farxiga) - 5-10 mg once/day
empagliflozin (Jardiance) - 10-25 mg once/day
ertugliflozin (Steglatro). 5-15 mg once/day

19
Q

What are side effects of SGLT2 inhibitors?

A

hypotension, UTIs, genital infections, increased urination, weight loss and ketoacidosis

20
Q

What are benefits of SGLT2s?

A

canagliflozin (Invokana), dapagliflozin (Farxiga),empagliflozin (Jardiance) reduce blood glucose, cardiovascular death, and heart failure, and slow CKD

21
Q

How much can SGLT2 lower A1C?

A

0.6-1.5%

22
Q

What is a consideration for SGLT2?

A

At GFR less than 45 limited blood glucose lowering impact but still benefits the kidneys and heart.

23
Q

What is the mechanism of action for DPP 4 inhibitors?

A

Incretin enhancers
Prolong the action of gut hormones, increases insulin secretion, delays gastric emptying

24
Q

What are examples of DPP4 inhibitors?

A

sitaglipitin (Januvia), saxagliptin (onglyza), linagliptin (Trajenta) and alogliptin (Nesina)

25
Q

What are common doses of DPP4 inhibitors?

A

sitaglipitin (Januvia) - 25-100 mg/day - eliminated via the kidney
saxagliptin (onglyza) - 2.5-5 mg/day eliminated via the kidney and feces
linagliptin (Trajenta) - 5 mg/day eliminated via the feces
alogliptin (Nesia) - 6.25-25 mg/day eliminated via the kidney

26
Q

What are side effects of DPP4 inhibitors?

A

headache and flu like symptoms. Severe disabling joint pain is a potential side effect - contact MD and stop med. report signs of pancreatitis.

27
Q

Which DDP4 inhibitors increase the risk of heart failure?

A

saxaglipitin and alogliptin
notify MD of SOB, edema, weakness, etc.

28
Q

What are benefits of DPP4 inhibitors?

A

Don’t cause weight gain or hypoglycemia

29
Q

How much can DPP4 inhibitors lower A1C?

A

0.6-0.8%

CDCES Exam (6 decks)

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