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Pharmacology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Glyburide
Glipizide
Glimeperide

A

Sulfonylureas

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2
Q

Which Sulfonylurea does NOT require a dose adjustment, and you should choose it in renal impairment

A

Glipizide

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3
Q

MOA sulfonylureas

A

enhance insulin secretion from pancreatic beta cells (even if glucose is not present)

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4
Q

what are the adverse effects of suflonylureas?

A

hypoglycemia and weight gain

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5
Q

Repaglinide

Nateglinide

A

Non-sulfonylurea secretagogues

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6
Q

How does the MOA of nonsulfonylureas differ from its similar group sulfonylureas

A

shorter onset and duration of action

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7
Q

what is the rare but dangerous adverse effect with metformin?

A

Lactic acidosis

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8
Q

What are some common AE’s of metformin?

A

GI (diarrhea, nausea) and interference of B12 absorption

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9
Q

CONTRAINDICATIONS of metformin?

A

Abnormal CrCl
SCr > 1.4 or 1.5 if male
Liver disease

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10
Q

Metformin

A

Biguanides

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11
Q

Pioglitazone

Rosiglitazone

A

Thiazolinediones

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12
Q

Acarbose

Miglitol

A

Alpha-glucosidase inhibitors

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13
Q

this class of drugs stimulates PPAR-gamma receptors, increasing insulin sensitivity and decreasing plasma fatty acids

A

Thiazolidinediones

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14
Q

How long do you need to take Pioglitazone and Rosiglitazone for maximum effect?

A

12 weeks

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15
Q

Of the 2 thiazolidinediones, which increases triglycerides and which decreases them?

A

INCREASE - rosiglitazone

DECREASE - pioglitazone

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16
Q

what are the main adverse effects of thiazolidinediones?`

A

fluid retention
hepatotoxicity
increased limb fracture

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17
Q

what should you counsel premenopausal anovulatory women on when starting them on thiazolidinediones?

A

they may begin to ovulate

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18
Q

MOA alpha-glucosidase inhibitors?

A

competes with enzymes of small intestine that normally break down complex carbs, delaying the absorption of carbs

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19
Q

What is the main adverse effect of acarbose and miglitol that limits their use?

A

GI disturbances - flatulence, abdominal discomfort, diarrhea

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20
Q

Alpha-glucosidase inhibitor CONTRAINDICATION?

A

chronic intestinal disease (IBD)

-avoid if SCr <2 mg/dL

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21
Q

Sitagliptin
Saxagliptin
Linagliptin
Alogliptin

A

DPP-4 inhibitors

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22
Q

What are the AE’s of the DPP-4 inhibitors?

A

headache, nasopharyngitis

RARE: hypoglycemia, acute pancreatitis

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23
Q

Canagliflozin
Dapagliflozin
Empagliflozin

A

SGLT-2 inhibitors

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24
Q

This medication inhibits the receptor responsible for 90% of glucose reabsorption in proximal tubule. Inhibiting this means glucose is excreted in urine

A

MOA of SGLT-2 inhibitors

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25
Q

Bromocriptine

A

central-acting dopamine agonist

26
Q

when is the best time to take bromocriptine?

A

in the AM, 2 hours after waking WITH FOOD

27
Q

Contraindications with bromocriptine

A

Syncopal migraine

lactating women

28
Q

Colesevelam

A

Bile acid sequestrant

29
Q

Which medications commonly interfere with the absorption of colesevelam

A

levothyroxine, glyburide, OCs, phenytoin, warfarin, Digoxin, Vit A,D,E,K

30
Q

Exenatide
Liraglutide
Albiglutide
Dulaglutide

A

Non-insulin injectable agents (GLP-1 agonists)

31
Q

what is the black box warning for GLP-1 agonists?

A

thyroid C-cell tumors; contraindicated if family hx medullary thyroid cancer and endocrine tumors

32
Q

which GLP-1 agonist is eliminated renally and should be avoided in CrCl < 30

A

exenatide

33
Q

avoid use of GLP-1 agonists in patients with a history of ___?

A

hx medullary thyroid cancer

hx multiple endocrine tumors

34
Q

this medication is a synthetic analog of human amylin, and slows gastric emptying

A

Pramlintide

35
Q

True or false: since pramlintide is eliminated by the kidneys, renal adjustment needs to be made for dysfunction

A

FALSE - no adjustment needed even tho it is metabolized by kidney

36
Q

when starting a patient on Pramlintide, what to do about insulin short acting bolus?

A

decrease dose by 30-50% first

37
Q

name 2 scenarios in which sulfonylureas don’t work

A
  • failed beta cells

- cannot stimulate insulin if glucose levels are extremely high

38
Q

Sulfonylureas are metabolized by which pathway?

A

CYP2C9

39
Q

how soon before a meal should your patient take their Repaglinide/Nateglinide

A

15-30 minutes

40
Q

MOA metformin

A

decreases HEPATIC glucose production, increases insulin sensitivity

41
Q

other than lifestyle change, what is the GOLD STANDARD and often the first line treatment for type2 DM?

A

metformin

42
Q

patient is on metformin, and will be undergoing surgery. Can he continue the metformin?

A

Temporarily D/C

43
Q

You’re thinking about starting a patient on a type2 DM medication. Their AST/ALT are >3x above the normal limits. What med can you ESPECIALLY not prescribe?

A

Thiazolidinediones

44
Q

What is the role of DPP-4 in glucose/insuin in a normal body?

A

DPP-4 degrades GLP-1 (which is increased with food intake). GLP-1 triggers insulin release, so inhibiting DPP-4 allows insulin to stick around longer

45
Q

what is the MOA of SGLT-2 inhibitors?

A

inhibits SGLT-2 (which is responsible for glucose absorption) = glucose is excreted in the urine.

46
Q

AE of Canagliflozin (and others)

A

UTI, genital mycotic infections, increased urination, hypotension

(peeing out sugar)

47
Q

when is the best time for a patient to take her Bromocriptine?

A

in the AM, with food

48
Q

AE bromocriptine

A

rhinitis, sinusitis, headache, dizziness, nausea

49
Q

Contraindications of Central-acting dopamine agonist

A

lactating women

syncopal migraine

50
Q

MOA of Colesevelam

A

acts on intestinal lumen - binds bile acid

51
Q

AE colesevelam

A

constipation, dyspepsia, malabsorption of vitamins ADEK

52
Q

due to interactions with colesevelam and many medications (Absorption interference), what do you advise your patient

A

take meds 4+ hours BEFORE they take their colesevelam

levothyroxine, OCs, phenytoin, warfarin, Vit ADEK

53
Q

Exenatide
Liraglutide
Albiglutide
Dulaglutide

A

GLP-1 Agonist

non-insulin injectable

54
Q

which GLP-1 agonist needs to be avoided in a CrCl < 30?

A

Exenatide

55
Q

which drug has black box warning “C-cell tumors”

A

GLP-1 agonists (contraindicated if family hx medullary thyroid cancer)

56
Q

this non-insulin injectable agent is commonly added to insulin for further help with managing diabetes

A

Pramlintide (amylin)

57
Q

what effect does amylin have on the GI tract?

A

slows gastric emptying without altering absorption of nutrients

58
Q

what are the 2 types of basal insulins?

A

Intermediate (NPH)

long-acting (glargine, detemir, degludec)

59
Q

why is NPH (intermediate insulin) not favored?

A

duration of action is <24 hours, and difficult to predict peaks; some patient’s are also allergic to protamine

60
Q

when is a higher A1C level ok?

A

in elderly, since they have a higher risk of falling with hypoglycemia

Pharmacology (12 decks)

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