Diabetes 2: Medications Flashcards
What are the 3 best medications for type 2 diabetes
Metformin, GLP-1 agonist, SGLT2- inhibitors
What is MOA of metformin
Decreases hepatic glucose output, increases insulin sensitivity, less intestinal glucose absorption
What are the side-effects of metformin
DIARRHEA, NAUSEA, flatulence, dyspepsia
What is an important note associated with metformin, what about ER tablets
Give with meals in order to lower nausea/ ER formulations leave a ghost tablet in stool
What is BBW for metformin
LACTIC ACIDOSIS- increased risk of renal disease
What is the contraindication for Metformin, 3 big warnings
eGFR less than 30// Do not start with eGFR 30 to 45, Vitamin B12 deficiency, stop prior to iodinated contrast media
What is the MOA of Thiazolidenediones (TZDs)
Increase muscle cell sensitivity to insulin to increase blood glucose uptake
What are the two main TZDs
Pioglitazone (ACTOS) AND Rosiglitazone (AVANDIA)
What are the side effects of TZDs
Edema, Weight gain, bone fractures, Upper respiratory Infections, HEPATIC FAILURE
What is the BBW for TZDs, Warnings
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
What is the MOA of SGLT2 inhibitors
Increase blood glucose excreted through urine
What are the four SGLT2 inhibitors
Canagliflozin (INVOKANA), Empagliflozin (JARDIANCE), Dapagliflozin (Farxiga), Ertugliflozin (Steglatro)
What are the side effects of SGLT2 inhibitors
UTIs, Genital Fungal infections, Weight loss
Which SGLT2-inhibtor has BBW, what is the BBW regarding, warnings, contraindications
Canagliflozin-increased risk of amputations// Increased LDL, hyperkalemia, fluid loss and hypotension. ketoacidosis, Sever UTIs and fungal infections// eGFR is less than 30
What are the two main DPP-4 inhibitors
Sitagliptin (JANUVIA) AND Linagliptin (TRADJENTA)
T/F: All DPP-4 inhibitors DO NOT NEED renal adjustments
False: All DPP-4 inhibitors would need a renal adjustment EXCEPT Linagliptin (TRADJENTA)
What are the warnings associated with DPP-4 inhibitors
PANCREATITIS, Severe ARTHRALGIA (Joint Pain), ACUTE RENAL FAILURE
What are the three main Sulfonylureas , MOA, Main side effects
Glipizide (GLUCOTROL) Glimepiride (AMARYL) Glyburide (GLYNASE) Increased secretion of insulin from the pancreas Weight gain and hypoglycemia
What are the GLP-1 agonists
Liraglutide (VICTOZA AND SAXENDA) Dulaglutide (TRULICITY) Exenatide (Byetta) Exenatide (Bydureon and Bydureon BCise) Semaglutide (Ozempic and Rybelsus)
Which GLP-1 agonist come with needles, which do not
Trulicity, Bydureon and Bydureion BCise, Ozempic// Byetta, Victoza, and Ozempic
What is Pramlintide (SymlinPen 60 and SymlinPen 120), MOA
A synthetic Amylin analog// decreases glucagon secretion, delays gastric empyting, slows and decreases appetite
What are the contraindications of Pramlinitide, side effects, BBW
Gastroparesis// Nausea and vomiting, anorexia, headache// Severe hypoglycemia risk when used with insulin–reduce meal time insulin by HALF
T/F: Pramlinitide is the only diabetes medication besides insulin that can be taken for Type 1 diabetes
True
What are the diabetes medications that cause weight gains, weight loss
TZDs, Sulfonylureas// Metformin (possibly), SGLT2-inhibitors, GLP-1 agonist, Pramlintide
Which Insulin is preferred for IV solutions
Regular (Humulin R and Novolin R)
What are the three vaccines every diabetes patient should have
Hep B
Flu vaccine innactivated
Pneummococal
What are the warnings for using insulin
Increased risk of weight gain, Increased risk of hypoglycemia, hypokalemia, rotate injection sites to avoid lipoatrophy AND lipohypertrophy
What are the rapid acting insulins, tips for use
Insulin Aspart (Novolog) Insulin Lispro (Humalog) Inject 15 to 30 mins before a meal , used for sliding scales and correction doses
What are the short acting insulins, tips for use
Regular (Humulin R and Novolin R)
Inject 30 mins before meals
What to insulins can be mixed and how are they mixed
Regular insulin and NPH, REGULAR INSULIN is drawn up FIRST then NPH
What are the intermediate insulins, benefit of use and loss
NPH (Humulin N and Novolin N)
Cheaper alternative for a basal insulin but higher risk of hypoglycemia
What are the long acting insulins, What are the concentrations
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
Which rapid acting insulin is concentrated as 200 units/mL
Lispro (HUMALOG 200)
T/F: Females with polycystic ovary syndrome have an increased risk of type 2 diabetes
True
What insulin is concentrated at 500 units per mL
Regular
What are the things given for hypoglycemia if conscious// unconscious
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
How should DKA be treated initially
Give normal saline initially along with REGULAR insulin, correct potassium as needed/ give sodium bicarbonate if the ph is less than 6.9
