Diabetes

Question 1

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

Answer 1

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

Question 2

What are boxed warnings with GLP-1/GIP?

Answer 2

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)

Question 3

What are warnings with GLP-1/GIP?

Answer 3

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

Question 4

What are warnings with Bydureon?

Answer 4

serious injection site reactions with or without nodules

Question 5

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

Answer 5

increased complication with diabetic retinopathy

Question 6

What are SEs with GLP-1/GIP?

Answer 6

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

Question 7

What is a side effect specific to Tirzepatide?

Answer 7

increased HR

Question 8

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

Answer 8

DPP-4 inhibitors

Question 9

Liraglutide

Answer 9

Victoza
Saxenda (weight loss)

Question 10

Dulaglutide

Answer 10

Trulicity

Question 11

Semaglutide

Answer 11

Ozempic
Wegovy (weight loss)
Rybelsus PO

Question 12

Exenatide

Answer 12

Byetta

Question 13

Exenatide ER

Answer 13

Bydureon BCise

Question 14

How often is liraglutide given SQ?

Answer 14

daily

Question 15

How often is dulaglutide given SQ?

Answer 15

weekly

Question 16

How often is semaglutide given SQ?

Answer 16

weekly

Question 17

How often is semaglutide given PO?

Answer 17

daily

Question 18

How often is exenatide given SQ?

Answer 18

BID

Question 19

How often is exenatide ER given SQ

Answer 19

weekly

Question 20

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

Answer 20

exenatide

Question 21

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

Answer 21

exenatide ER

Question 22

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

Answer 22

1. antibiotics
2. oral contraceptives
3. narrow therapeutic index

Question 23

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?

Answer 23

Mounjaro/ Zepbound

Question 24

What is the MOA of SGLT-2 inhibitors?

Answer 24

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

Question 25

What are warnings with SGLT-2i?

Answer 25

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

Question 26

What are warnings specific to canagliflozin and bexagliflozin?

Answer 26

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

Question 27

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

Answer 27

1. diuretics 2. RAAS inhibitors 3. NSAIDs

Question 28

Canagliflozin

Answer 28

Invokana

Question 29

Dapagliflozin

Answer 29

Farxiga

Question 30

Empagliflozin

Answer 30

Jardience

Question 31

What are SEs with SGLT-2i?

Answer 31

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

Question 32

What is the MOA of biguanide/metformin?

Answer 32

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

Question 33

What are boxed warnings for metformin?

Answer 33

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

Question 34

What are CIs to starting metformin?

Answer 34

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

Question 35

What are the warnings with metformin?

Answer 35

vitamin B12 deficiency; monitor levels every 1-2 years

Question 36

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

Answer 36

48 hours

Question 37

What are SEs with metformin?

Answer 37

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

Question 38

What is a patient counseling point for metformin ER?

Answer 38

Swallow whole; cal leave ghost tablet in the stool

Question 39

What is the MOA of DPP-4 inhibitors?

Answer 39

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

Question 40

What are the warnings with DPP-4 inhibitors?

Answer 40

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

Question 41

All DPP-4 inhibitors have what ending?

Answer 41

-gliptin

Question 42

Sitagliptin

Answer 42

Januvia

Question 43

Linagliptin

Answer 43

Tradjenta

Question 44

Saxagliptin

Answer 44

Onglyza

Question 45

Alogliptin

Answer 45

Nesia

Question 46

What DPP-4 inhibitor does not require renal adjustment?

Answer 46

linagliptin