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Pharmacotherapeutics II > Diabetes > Flashcards

Diabetes Flashcards

1
Q

A1c reduction for DPP-4 inhibitor added to SU

A

0.3-0.6

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2
Q

A1c reduction for GLP analog added to Metformin

A

0.8

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2
Q

A1c reduction for GLP analog added to SU + Metformin

A

0.7-1.3

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2
Q

A1c reduction for DPP-4 inhibitor added to SU + Metformin

A

0.6

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3
Q

A1c reduction for SU added to Metformin or Metformin added to SU

A

0.7-1.4

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4
Q

A1c reduction for TZD added to Metformin

A

0.8-1.2

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5
Q

A1c reduction for TZD added to SU

A

1.1-1.4

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5
Q

A1c reduction for GLP analog added to SU

A

0.9

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5
Q

A1c reduction for TZD added to SU +Metformin

A

1.0-1.5

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6
Q

A1c reduction for DPP-4 inhibitor added to Metformin

A

0.5-0.7

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7
Q

Available products for α-glucosidase inhibitors

A

Acarbose & Miglitol

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8
Q

Available products for SGLT-2 inhibitors

A

-aglifozin

Canaglifozin

Dapaglifozin

Emaglifozin

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9
Q

Biguanide (Metformin) A1c reduction

A

1.5-2.0

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9
Q

Biguanide (Metformin) MOA

A

Enhances insulin sensitivity of both hepatic and peripheral (muscle) tissues. This allows for increased uptake of glucose into these insulin-sensitive tissues.

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9
Q

Dipeptidyl Peptidase 4 inhibitors adverse effects

A

Weight neutral

Dose related reduction in absolute lymphocyte count

Low risk of hypoglycemia when used as monotherapy

Increases risk of peripheral edema of TZDs

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10
Q

DPP-4 inhibitor that dose not recquire dose adjustment for renal dysfunction

A

Linagliptin (Tradjenta)

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11
Q

DPP-4 Inhibitors (-agliptins) MOA

A

Dipeptidyl peptidase-IV inhibitors prolong the half-life of an endogenously produced glucagon-like peptide-1. These agents partially reduce the inappropriately elevated glucagon post-prandially and stimulate glucose-dependent insulin secretion.

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13
Q

DPP-4 Inhibitors (-agliptins) A1c reduction

A

0.3-0.5

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13
Q

DPP-4 Inhibitors CV effects

A

Weight neutral/some weight loss

Positive effects on lipids and BP

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14
Q

Glipdizide brand name and dose

A

Glucotrol

IR: 5-10 mg PO daily; Max; 40 mg daily

Divide BID if dose is >15 mg

XL: 5-10 mg PO QD; Max: 20 mg QD

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14
Q

DPP-4 Inhibitors Monitoring Parameters

A

Renal function every 6-12 months (if dose adjustment is required!)
SMBG more frequently when starting these agents

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14
Q

Exenatide brand name and dose

A

Byetta

SubQ: Initial: 5 mcg BID within 60 minutes prior to a meal; after 1 month, may be increased to 10 mcg BID (based on response)

CrCl ≥50 mL/min: No adjustment necessary

CrCl 30-50 mL/min: Use caution when initiating or escalating doses

CrCl

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15
Q

GLP-1 analog that does not need dose adjustment for renal dysfunction

A

Liraglutide (Victoza)

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16
Q

GLP-1 analogs A1c reduction

A

0.5-1

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16
GLP-1 analogs Adverse Effects
Weight loss Low risk of hypoglyceia when used as monotherapy Nausea/vomiting Pancreatitis
17
GLP-1 analogs CV effects
Weight loss Positive effects on lipids and BP
19
GLP-1 analogs MOA
Stimulates insulin secretion
20
GLP-1 analogs Monitoring Parameters
Renal function: Q6-12 months (if dose adjustment is required for renal dysfunction) SMBG: monitor more frequently upon starting these agents At start of therapy at least QD or more often to determine effectiveness and ensure no hypoglycemia (if added to a secretagogue)
22
Majority of effect is seen with 1/2 max dose with
Sulfonylureas
23
Meglitinides (-glinides) A1c reduction
0.5-1.0
25
Meglitinides (-glinides) MOA
Stimulates insulin release from the pancreatic beta cells to reduce **postprandial** hyperglycemia; amount of insulin release is dependent upon existing glucose levels
26
Meglitinides (Repaglinide & Nateglinide) Adverse Effects
Hypoglycemia (less than SUs) Weight gain (less than SUs)
27
Meglitinides (Repaglinide & Nateglinide) Monitoring Parameters
SMBG A1c stable: 3-4 days/weel Meglitinide Dose being titrated: Daily If dose is being titrated, may recommend patient monitor BG levels once daily Hypoglycmia - ask about frequency of hypoglycemia at every medical visit that is scheduled to address diabetes care Weight at every medical visit
29
Metformin Adverse Effects
Most common: diarrhea/loose stools, dyspepsia, N/V Reduced absorption of B12, metallic taste Rare: Lactic acidosis (do not screen for it)
31
Metformin Instant Release brand name and dose
Glucophage 500 mg PO BID or 850 mg PO QD In 5-7 days: 500 mg PO BID --\> 1,000 mg PO BID 850 mg PO QD --\> 850 mg PO TID FDA approved max: 2,550 mg/day Max effective: 2,00 mg/day 80% of effectiveness: 1,500 mg/day
32
Metformin manufaturer contraindications
SCr ≥1.5 for men SCr ≥1.4 for women ADA: not contraindicated, increase monitoring based on eGFR HF precaution (not contrainidication --\> monitor carefully)
33
Metformin Monitoring Parameters
Renal function - SCr, creatinine clearance At least annually Q3-6 months in patents at risk for renal dysfunction or pts with renal dysfunction (older pts) SMBG Stable A1c: 3-4 days/week Metformin being titrated: Daily
34
Pioglitazone brand name and dose
Actos 15-30 mg QD to start Can titrate to 45 mg QD max **Maximum 15 mg QD in NYHA class I and II HF**
35
Pioglitazone contraindications
NYHA Class III and IV HF
36
SGLT-2 inhibitors Adverse Effects
Genital fungal infections in men and women Volume depletion (dehydration)
37
SGLT-2 inhibitors effecton lipids, weight and hypoglycemia risk
Slight increases in LDL Weight loss Low risk of hypoglycemia when used as monotherapy (Ineffective in patients with renal impairment)
38
Glimperide brand name and dose
Amaryl 1-4 mg PO daily; Max 8 mg PO daily Divide BID if dose \>10mg
39
SGLT2 Inhibitors (-aglifozin) A1c reduction
0.7-1.0
41
SGLT2 Inhibitors (-aglifozin) MOA
SLGT2 inhibition → reduced reabsorption of glucose filtered from tubular lumen → increased excretion of glucose in urine → reduced plasma glucose
42
Sitagliptin brand name and dose
Januvia 100 mg QD CrCl 30-50 mL/min: 50 mg QD CrCl ESRD on hemodialysis: 25 mg QD
43
Start insulin immediately in a Type II if:
1. FPG \>250 mg/dL 2. Random PG consistently \>300 mg/dL 3. A1c \>10% 4. Ketonuria 5. Significant weight loss, polyuria, polydipsia
44
Starting dose of insulin for Type I or Type II monotherapy
0.5-0.6 units/kg
45
Starting dose of insulin for Type II with other medications
0.1-0.3 units/kg or a set dose 10 units (usually a long acting before dinner or at bedtime)
47
Sulfonylureas A1c reduction
1.5-2.0
49
Sulfonylureas Adverse Effects
Hypoglycemia Weight Gain Hemolytic anemia potential in people with G6PD deficiency
51
Sulfonylureas MOA
Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites
52
Sulfonylureas Monitoring Parameters
Renal function SCr, creatinine clearance (especially with active metabolites that recquire renal elimination) SMBG A1c controlled: 3-4 days/week SU Dose being titrated: Daily Hypoglycemia - ask about frequency of hypoglycemia at every medical visit that is scheduled to address diabetes care Weight at every medical visit
53
Takes up to 4-6 weeks to see effect and up to 12 weeks to see full effect
Thiazolidinediones (Pioglitazsone & Rosiglitazone)
54
Thiazolidinediones (-glitazones) A1c reduction
0.5-1.5
55
Thiazolidinediones (-glitazones) MOA
These agents activate PPAR-γ, a nuclear transcription factor important in fat cell differentiation and fatty acid metabolism. PPAR-γ agonists **enhance insulin sensitivity** in muscle, liver, and fat tissues indirectly. Insulin must be present in significant quantities for these actions to occur.
56
Thiazolidinediones (Pioglitazone & Rosiglitazone) Adverse Effects
Weight gain/fluid retention HF exacerbations Increased risk for bladder cancer **Increased fracture risk in post-menopausal women** Liver injury (more of a risk with predecessor TZD: troglitazone) Small reduction in hgb/hct of 2-4% Thought to be due to increased plasma volume Tends to occur when starting of therapy **Low risk for hypoglycemia when given as monotherapy**
57
Thiazolidinediones (Pioglitazone & Rosiglitazone) Monitoring Parameters
Liver function: AST/ALT at baseline then “periodically” SMBG Stable A1c: 3-4 times/week TZD Dost titrated: Daily Weight at every medical visit Sign/symptoms of HF exacerbation (in pts with HF or RFs for HF) Rapid weight gain (\>5 lbs in 1 week) Edema Increasing dyspnea Do NOT need to routinely monitor CBCs (but be aware that small reductions in hgb/hct may be due to TZD) Bone health screening – based on patient's risk factors
58
TZDs effects on lipids
Pioglitazone: decrease TG, increase LDL, increase HDL Rosiglitazone: increase all 3
59
α-glucosidase (acarbose and miglitol) inhibitors MOA
These agents prevent the breakdown of sucrose and complex carbohydrates in the small intestine, thereby prolonging the absorption of carbohydrates.
60
α-glucosidase (acarbose & miglitole) inhibitors A1c reduction
0.3-1
61
α-glucosidase inhibitors (Acarbose & Miglitol) Adverse Effects
Mostly GI: flatulence, gas/abdominal bloating Low risk for hypoglycemia when given as monotherapy
62
α-glucosidase inhibitors (Acarbose & Miglitol) Contraindications
Hypersensitivity, DKA, Inflammatory Bowl Disease, Colonic ulceration Acarbose: SCr \>2.0

Pharmacotherapeutics II (3 decks)

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