Diabetes 2: Medications

Question 1

What are the 3 best medications for type 2 diabetes

Answer 1

Metformin, GLP-1 agonist, SGLT2- inhibitors

Question 2

What is MOA of metformin

Answer 2

Decreases hepatic glucose output, increases insulin sensitivity, less intestinal glucose absorption

Question 3

What are the side-effects of metformin

Answer 3

DIARRHEA, NAUSEA, flatulence, dyspepsia

Question 4

What is an important note associated with metformin, what about ER tablets

Answer 4

Give with meals in order to lower nausea/ ER formulations leave a ghost tablet in stool

Question 5

What is BBW for metformin

Answer 5

LACTIC ACIDOSIS- increased risk of renal disease

Question 6

What is the contraindication for Metformin, 3 big warnings

Answer 6

eGFR less than 30// Do not start with eGFR 30 to 45, Vitamin B12 deficiency, stop prior to iodinated contrast media

Question 7

What is the MOA of Thiazolidenediones (TZDs)

Answer 7

Increase muscle cell sensitivity to insulin to increase blood glucose uptake

Question 8

What are the two main TZDs

Answer 8

Pioglitazone (ACTOS) AND Rosiglitazone (AVANDIA)

Question 9

What are the side effects of TZDs

Answer 9

Edema, Weight gain, bone fractures, Upper respiratory Infections, HEPATIC FAILURE

Question 10

What is the BBW for TZDs, Warnings

Answer 10

Can not be used in patients with Class 3 and 4 heart failure// Hepatic failure, Edema. cause or worsen HF, Fractures, Stimulate ovulation, Bladder cancer

Question 11

What is the MOA of SGLT2 inhibitors

Answer 11

Increase blood glucose excreted through urine

Question 12

What are the four SGLT2 inhibitors

Answer 12

Canagliflozin (INVOKANA), Empagliflozin (JARDIANCE), Dapagliflozin (Farxiga), Ertugliflozin (Steglatro)

Question 13

What are the side effects of SGLT2 inhibitors

Answer 13

UTIs, Genital Fungal infections, Weight loss

Question 14

Which SGLT2-inhibtor has BBW, what is the BBW regarding, warnings, contraindications

Answer 14

Canagliflozin-increased risk of amputations// Increased LDL, hyperkalemia, fluid loss and hypotension. ketoacidosis, Sever UTIs and fungal infections// eGFR is less than 30

Question 15

What are the two main DPP-4 inhibitors

Answer 15

Sitagliptin (JANUVIA) AND Linagliptin (TRADJENTA)

Question 16

T/F: All DPP-4 inhibitors DO NOT NEED renal adjustments

Answer 16

False: All DPP-4 inhibitors would need a renal adjustment EXCEPT Linagliptin (TRADJENTA)

Question 17

What are the warnings associated with DPP-4 inhibitors

Answer 17

PANCREATITIS, Severe ARTHRALGIA (Joint Pain), ACUTE RENAL FAILURE

Question 18

What are the three main Sulfonylureas , MOA, Main side effects

Answer 18

Glipizide (GLUCOTROL)
Glimepiride (AMARYL)
Glyburide (GLYNASE)
Increased secretion of insulin from the pancreas
Weight gain and hypoglycemia

Question 19

What are the GLP-1 agonists

Answer 19

Liraglutide (VICTOZA AND SAXENDA)
Dulaglutide (TRULICITY) 
Exenatide (Byetta)
Exenatide (Bydureon and Bydureon BCise)
Semaglutide (Ozempic and Rybelsus)

Question 20

Which GLP-1 agonist come with needles, which do not

Answer 20

Trulicity, Bydureon and Bydureion BCise, Ozempic// Byetta, Victoza, and Ozempic

Question 21

What is Pramlintide (SymlinPen 60 and SymlinPen 120), MOA

Answer 21

A synthetic Amylin analog// decreases glucagon secretion, delays gastric empyting, slows and decreases appetite

Question 22

What are the contraindications of Pramlinitide, side effects, BBW

Answer 22

Gastroparesis// Nausea and vomiting, anorexia, headache// Severe hypoglycemia risk when used with insulin–reduce meal time insulin by HALF

Question 23

T/F: Pramlinitide is the only diabetes medication besides insulin that can be taken for Type 1 diabetes

Answer 23

True

Question 24

What are the diabetes medications that cause weight gains, weight loss

Answer 24

TZDs, Sulfonylureas// Metformin (possibly), SGLT2-inhibitors, GLP-1 agonist, Pramlintide

Question 25

Which Insulin is preferred for IV solutions

Answer 25

Regular (Humulin R and Novolin R)

Question 26

What are the three vaccines every diabetes patient should have

Answer 26

Hep B
Flu vaccine innactivated
Pneummococal

Question 27

What are the warnings for using insulin

Answer 27

Increased risk of weight gain, Increased risk of hypoglycemia, hypokalemia, rotate injection sites to avoid lipoatrophy AND lipohypertrophy

Question 28

What are the rapid acting insulins, tips for use

Answer 28

Insulin Aspart (Novolog)
Insulin Lispro (Humalog)
Inject 15 to 30 mins before a meal , used for sliding scales and correction doses

Question 29

What are the short acting insulins, tips for use

Answer 29

Regular (Humulin R and Novolin R)

Inject 30 mins before meals

Question 30

What to insulins can be mixed and how are they mixed

Answer 30

Regular insulin and NPH, REGULAR INSULIN is drawn up FIRST then NPH

Question 31

What are the intermediate insulins, benefit of use and loss

Answer 31

NPH (Humulin N and Novolin N)

Cheaper alternative for a basal insulin but higher risk of hypoglycemia

Question 32

What are the long acting insulins, What are the concentrations

Answer 32

Insulin Determir (Levemir)
Insulin Glargine (Lantus, Basaglar, Troujeo)
Levemir (insulin detemir), Lantus and Basaglar (Insulin glargine) are ALL 100 units/mL BUT Troujeo is 300 units/mL

Question 33

Which rapid acting insulin is concentrated as 200 units/mL

Answer 33

Lispro (HUMALOG 200)

Question 34

T/F: Females with polycystic ovary syndrome have an increased risk of type 2 diabetes

Answer 34

True

Question 35

What insulin is concentrated at 500 units per mL

Answer 35

Regular

Question 36

What are the things given for hypoglycemia if conscious// unconscious

Answer 36

4 ounces of orange juice, 4 ounces of regular soda. 8 ounces of milk, 3 to 4 glucose tablets OR 1 serving of glucose gel// Glucagon and dextrose if IV access is available

Question 37

How should DKA be treated initially

Answer 37

Give normal saline initially along with REGULAR insulin, correct potassium as needed/ give sodium bicarbonate if the ph is less than 6.9