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Diabetes Flashcards

1
Q

What is the MOA of GLP-1/GIP agonists?

A

analog of incretin hormone GLP-1/GIP –> GLP-1/GIP increases glucose-dependent insulin secretion, decreases glucagon secretion, and slows gastric emptying which improves satiety and promotes weight loss

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2
Q

What are boxed warnings with GLP-1/GIP?

A

Risk of thyroid C-cell carcinomas; do not use if personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome 2 (not Byetta)

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3
Q

What are warnings with GLP-1/GIP?

A
  1. pancreatitis, AKI, gallbladder disease
  2. not recommended in patients with severe GI disease, including gastroparesis
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4
Q

What are warnings with Bydureon?

A

serious injection site reactions with or without nodules

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5
Q

What are the warnings with Ozempic, Trulicity, and Mounjaro?

A

increased complication with diabetic retinopathy

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6
Q

What are SEs with GLP-1/GIP?

A
  1. weight loss
  2. N/V/D (reduced with dose titration)
  3. hypoglycemia
  4. injection site reactions
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7
Q

What is a side effect specific to Tirzepatide?

A

increased HR

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8
Q

What drug class should GLP-1/ GIP not be taken with?

A

DPP-4 inhibitors

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9
Q

Liraglutide

A

Victoza
Saxenda (weight loss)

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10
Q

Dulaglutide

A

Trulicity

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11
Q

Semaglutide

A

Ozempic
Wegovy (weight loss)
Rybelsus PO

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12
Q

Exenatide

A

Byetta

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13
Q

Exenatide ER

A

Bydureon BCise

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14
Q

How often is liraglutide given SQ?

A

daily

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15
Q

How often is dulaglutide given SQ?

A

weekly

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16
Q

How often is semaglutide given SQ?

A

weekly

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17
Q

How often is semaglutide given PO?

A

daily

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18
Q

How often is exenatide given SQ?

A

BID

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19
Q

How often is exenatide ER given SQ

20
Q

Which GLP-1/GIP cannot be used with CrCl <30?

21
Q

Which GLP-1/GIP cannot be used with CrCl <45?

A

exenatide ER

22
Q

What drugs can be affected by GLP-1/GIP slowing gastric emptying?

A
  1. antibiotics
  2. oral contraceptives
  3. narrow therapeutic index
23
Q

Patients taking which GLP-1/GIP should be using a non-oral or barrier method of contraception for 4 weeks after initiation and 4 weeks after each dose increase?

A

Mounjaro/ Zepbound

24
Q

What is the MOA of SGLT-2 inhibitors?

A

inhibits sodium-glucose cotransporter 2 expressed in renal proximal tubules –> reduced reabsorption of glucose and increases urinary blood glucose concentrations

25
Q

What are warnings with SGLT-2i?

A
  1. ketoacidosis (D/C prior to surgery to decrease risk)
  2. genital mycotic infections
  3. UTI (urosepsis, pyelonephritis)
  4. necrotizing fasciitis
  5. hypotension and AKI due to volume depletion
  6. not recommended in dialysis
26
Q

What are warnings specific to canagliflozin and bexagliflozin?

A
  1. increased risk of foot and leg amputations
  2. risk of fractures
  3. hyperkalemia risk when used with other drugs that increase K
27
Q

What drugs in combination with SGLT-2i can increase risk of intravascular volume depletion?

A
  1. diuretics
  2. RAAS inhibitors
  3. NSAIDs
28
Q

Canagliflozin

29
Q

Dapagliflozin

30
Q

Empagliflozin

31
Q

What are SEs with SGLT-2i?

A
  1. increased urination
  2. increased thirst
  3. hypoglycemia
  4. high Mg/PO4
32
Q

What is the MOA of biguanide/metformin?

A

decreases hepatic glucose production and intestinal absorption of glucose; increases insulin sensitivity

33
Q

What are boxed warnings for metformin?

A

lactic acidosis –> increased risk with renal impairment, contrast dye, excessive alcohol, topiramate, hypoxia

34
Q

What are CIs to starting metformin?

A
  1. eGFR<30; not recommended to start if eGFR <45
  2. metabolic acidosis (acute or chronic)
35
Q

What are the warnings with metformin?

A

vitamin B12 deficiency; monitor levels every 1-2 years

36
Q

How long after a procedure using iodinated contrast should metformin be held?

37
Q

What are SEs with metformin?

A

GI symptoms (usually resolve over time)
1. nausea
2. diarrhea
3. flatulence
4. cramping

38
Q

What is a patient counseling point for metformin ER?

A

Swallow whole; cal leave ghost tablet in the stool

39
Q

What is the MOA of DPP-4 inhibitors?

A

prevent DPP-4 enzyme from breaking down incretin hormones GLP-1/GIP, increase glucose-dependent insulin secretion and decrease glucagon secretion

40
Q

What are the warnings with DPP-4 inhibitors?

A
  1. pancreatitis
  2. severe arthralgias
  3. acute renal failure
  4. bullous pemphigoid
  5. risk of HF
  6. hepatotoxicity (alogliptin)
41
Q

All DPP-4 inhibitors have what ending?

42
Q

Sitagliptin

43
Q

Linagliptin

44
Q

Saxagliptin

45
Q

Alogliptin

46
Q

What DPP-4 inhibitor does not require renal adjustment?

A

linagliptin

RxPrep (67 decks)

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