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Pharm Practice 4 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Type 1 DM

A

absolute deficiency of insulin production
onset is usually during childhood
most autoimmune in nature

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2
Q

Type 2 DM

A

relative deficiency of insulin production associated with tissue insulin resistance
usually occurs during adulthood
mostly due to genetics/lifestyle
MOST COMMON

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3
Q

HYPOglycemia symptoms

A

tremors, tachycardia, diaphoresis, dizziness, anxiousness, increased appetite, impaired vision, weakness, headache, irritability

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4
Q

HYPERglycemia symptoms

A

polyuria, polydipsia, sweet/fruity breath, somnolence, increased appetite, blurred vision, nausea, vomiting

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5
Q

Non-DM drugs that cause HYPERglycemia

A

systemic corticosteroids, protease inhibitors (ritonavir), oral contraceptives (estrogens), diuretics (furosemide, HCTZ), atypical antipsychotics (olanzapine, clozapine), beta-agonists

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6
Q

Non-DM drugs that cause HYPOglycemia

A

alcohol, pentamidine, fluoroquinolones, beta blockers

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7
Q

DM treatment guidelines

A

American Diabetes Association - Standards of Medical Care in Diabetes
AMerican Association of Clinical Endocrinologists - AACE/ACE Comprehensive Type 2 DM Management

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8
Q

Metformin

A

Glucophage/Glucophage XR/Glumetza
decreases hepatic glucose production and intestinal glucose absorption
Improves insulin sensitivity by increasing glucose uptake and utilization in skeletal muscle and adipose tissue

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9
Q

Metformin AEs, Precautions, Contraindications

A

AEs: diarrhea, GI upset, vitamin B-12 deficiency, lactic acidosis
Precautions: hepatic impairment, CV disease, renal impairment (eGFR 30-45), black box warning: lactic acidosis
Contraindications: eGFR<30, acute/chronic metabolic acidosis

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10
Q

Metformin Pearls

A

take w/ food
shell of ER form may remain intact and visible in stool
drug-drug interactions: ranolazine (increases serum conc. of metformin), alcohol (increase risk of hypoglycemia)
weight neutral
d/c before contrast dye

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11
Q

Sulfonureas MOA and AEs

A

MOA: Directly stimulates insulin secretion from functioning beta cells in the pancreas
Increases insulin sensitivity and lowers hepatic glucose production
AEs: hypoglycemia, weight gain

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12
Q

Sulfonureas Precautions, contraindications and Counseling points

A

Precautions: renal/hepatic impairment, sulfa allergy, G6PD deficiency, don’t use w/ meglitinides
CIs: ketoacidosis, type 1 DM
Counseling: maintain consistent diet - take w/ breakfast, s/s of hypoglycemia, weight gain (esp. glyburide), decreased efficacy over time

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13
Q

Glipizide

A

Glucotrol/Glucotrol XL
5-20mg once/day or BID
Take 30 mins before meals

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14
Q

Glyburide

A

Diabeta/Micronase
2.5-5mg once or BID
Take w/ breakfast/1st meal of the day
Not recommended in CKD or concomitant use of bosentan

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15
Q

Glimepiride

A

Amaryl
1-4mg QD
Take w/ breakfast/1st main meal

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16
Q

Meglitinides MOA, AEs, Precautions

A

MOA: lowers glucose levels by stimulating release of insulin - interacts w/ ATP sensitive K+ channel on beta cells in pancreas
AEs: hypoglycemia, weight gain
Precautions: don’t use w/ sulfonureas, caution in renal/hepatic impairment

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17
Q

Meglitinides - benefits over sulfonureas

A

effects primarily postprandial glucose level, variable meal schedule (skipped meal = skip a dose), shorter duration of action, reduced incidence of hypoglycemia throughout the day

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18
Q

Repaglinide

A

Prandin
0.5mg TID w/ meals
Skip a meal = skip a dose, Take 30mins or less before a meal
CI w/ concurrent gemfibrozil

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19
Q

Nateglinide

A

Starlix
60-120mg TID w/ meals
Skip a meal = skip a dose, Take 30mins or less before a meal

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20
Q

Alpha-glucosidase inhibitors MOA, AEs

A

MOA: lowers postprandial glucose by competitive reversible inhibition of pancreatic alpha-amylase and membrane bound intestinal alpha-glucoside hydrolysis - inhibits hydrolysis of complex starches decreasing glucose absorption
DOESN’T ENHANCE INSULIN SECRETION
AEs: GI side effects (flatulence, diarrhea, abdominal pain), elevated AST/ALT

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21
Q

Alpha-glucosidase inhibitors Precautions and Contraindications

A

Precautions: not recommended if SCr >2mg/dl or CrCl <25
CI: ketoacidosis, inflammatory bowel disease, bowel obstruction, colonic ulceration or other chronic intestinal disorder

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22
Q

Acarbose

A

Precose
25mg TID
Take w/ 1st bite of food

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23
Q

Miglitol

A

Glyset
25mg TID
Take w/ 1st bite of food
CI in cirrhosis

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24
Q

GLP-1 mimetics MOA

A

increase insulin in presence of elevated glucose conc. (stimulates B-cells in pancreas)
decreases glucagon secretion in glucose-dependent manner (inhibits a-cells in pancreas)
delays gastric emptying
regulates appetite

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25
Q

GLP-1 mimetics AEs, Precautions, Counseling points

A

AEs: n/v/d, headache, pancreatitis
Precautions: pancreatitis, boxed warning: thyroid cancer
Counseling: injection technique, weightloss

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26
Q

Liraglutide

A

Victoza
1.8mg SQ QD
less GI side effects

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27
Q

Exenatide

A 
Byetta/Bydureon
Byetta: 5-10mcg SQ QD
can increase INR, CI: CrCl <30
Bydureon: 2mg SQ qweek
needs to be assembled
28
Q

Albiglutide

A

Tanzeum
30-50mg SQ qweek
must dissolve first

29
Q

Dulaglutide

A

Trulicity

SQ qweek

30
Q

DPP-4 inhibitors MOA

A

inhibits degradation of incretiin hormones (GLP-1) by DPP-4 - GLP-1 is an incretin hormone released in response to food intake to maintain glucose homeostasis
enhances function of GLP-1 to increase release and decrease glucagon levels in circulation in a glucose dependent manner

31
Q

DPP-4 Inhibitors AEs, Precautions, Counseling Points

A

AEs: nasopharyngitis, pancreatitis, arthralgia, angioedema, urticaria
Precautions: renal insufficiency, use w/ agents that cause hypoglycemia
Counseling: take w/ or w/o food, weight neutral

32
Q

SitaGLIPTIN

A

Januvia
100mg QD
renal adjustment
may increase digoxin levels

33
Q

LinaGLIPTIN

A

Tradjenta
5mg QD
CYP3A4 interactions

34
Q

SaxaGLIPTIN

A

Onglyza
2.5-5mg QD
renal adjustment, CYP3A4 interactions
Avoid in new/worsening HF

35
Q

AloGLIPTIN

A

Mesina
25mg QD
renal adjustment
Avoid in new/worsening HF

36
Q

SGLT-2 Inhibitors MOA

A

highly selective for SGLT-2 in S1 segment of proximal renal tubules - reduces renal threshold
reduces glucose reabsorption
increases loss of glucose in urine
reduces plasma glucose levels

37
Q

SGLT-2 Inhibitors AEs, Precautions, Counseling

A

AEs: UTI/fungal infections, increased urination, increased LDL, dizziness
Precautions: ketoacidosis, hypotension, fractures, hyperkalemia, renal impairment - CI w/ CrCL <30
Counseling: weightloss, s/s of decreased BP

38
Q

CangliFLOZIN

A 
Invokana
100mg QD
Take w/ 1st meal of the day
CYP3A4 substrate
300mg dose can be used if eGFR >60
**increased risk of leg/foot amputations
39
Q

DapagliFLOZIN

A

Farxiga

5mg QD

40
Q

EmpagliFLOZIN

A

Jardiance
10mg QD
Decrease CV mortality and hospitalization due to HF in T2DM w/ CVD
Dose adjust w/ eGFR <45

41
Q

Thiazolidinediones (TZDs) MOA

A

Skeletal muscle: increase glucose uptake
Adipose tissue: increase fatty acid uptake/lipogenesis/glucose uptake (= adipogenesis)
Liver: decrease gluconeogenesis

–> decreases plasma free fatty acids and hyperglycemia

42
Q

TZD AEs, Precautions, and Contraindications

A

AEs: edema, macular degeneration, weight gain, muscle pain, headache
Precautions: edema/macular edema, bladder cancer, fractures, drug-drug interactions
CI: HF

43
Q

PioGLITAZONE

A

Actos
15mg QD
decreased TG
may reduce CVD

44
Q

RosiGLITAZONE

A

Avandia
4mg QD
increased LDL
**Do not initiate in patients w/ stable IHD

45
Q

Glucovance

A

glyburide-metformin

46
Q

Janumet/Janumet XR

A

sitagliptan-metformin

47
Q

Jentadueto/Jentadueto XR

A

linagliptan-metformin

48
Q

Kombiglyze/Kombiglyze XR

A

saxagliptan-metformin

49
Q

Invokamet

A

canagliflozin-metformin

50
Q

Glyxambi

A

empagliflozin-linagliptin

51
Q

Duetact

A

pioglitazole-glimepiride

52
Q

Insulin Indication, AEs, Precautions

A

Type 1 & 2 DM
AEs: hypoglycemia, injection site rxn, weight gain
Precautions: hypoglycemia

53
Q

Rapid acting insulins

A

Aspart - Novolog (flexpen)
Lispro - Humalog (kwikpen)
Glulisine - Apidra (Solostar)

54
Q

Novolog/Flexpen

A 
Onset: 10-20mins
Peak: 40-50mins
Duration: 3-5hrs
expires 28 days after opening
give 5-10 mins before meal
55
Q

Humalog/Kwikpen

A 
Onset: 15-30mins
Peak: 30mins -2.5hrs
Duration: 3-5hrs
expires 28 days after opening
give 15 mins before or w/in 20mins after starting a meal
56
Q

Apidra/Solostar

A 
Onset: 25mins
Peak: 45-50mins
Duration: 4-5hrs
expires 28 days after opening
give 15 mins before or w/in 20mins after starting a meal
57
Q

Short/Intermediate Acting Insulins

A

Regular - Humulin R, Novolin R

NPH - Humulin N, Novolin N

58
Q

Humulin R

A 
Onset: 30-60mins
Peak: 1-5hrs
Duration: 4-12hrs
OTC
give 30 mins before a meal
Expires 28 days after opening
59
Q

Novolin R

A 
Onset: 30mins
Peak: 2.5-5hrs
Duration: 8 hrs
OTC
give 30 mins before a meal
Expires 42 days after opening
60
Q

Humulin N

A 
Onset: 1-2hrs
Peak: 6-14hrs
Duration: up to 24hrs
OTC
Should be cloudy
vials expire 28 days after puncturing
pens expire 14 days after 1st use
61
Q

Novolin N

A 
Onset: 90mins
Peak: 4-12hrs
Duration: up to 24hrs
OTC
Should be cloudy
expires 42 days after opening
62
Q

Basal Insulins

A

Degludec - Tresiba Flextouch
Detemir - Levemir/Flextouch
Glargine - Lantus/Solostar, Toujeo Solostar

63
Q

Tresiba Flextouch

A 
Onset: 30-90mins
Peak: none
Duration: 24+ hrs
Once daily dosing
expires 56 days after opening
64
Q

Levemir/Flextouch

A 
Onset: 1-2hrs
Peak: none
Duration: up to 24hrs
can be once or twice daily
Expires 42 days after opening
65
Q

Lantus/Solostar

Toujeo Solostar

A 
Onset: 1-2hrs
Peak: none
Duration: up to 24hrs
acidic pH
cloudy appearance
Toujeo is more concentrated than Lantus
Expires 28 days after opening
66
Q

Insulin Dosing: Type 2 DM

A

start w/ basal insulin: 0.2 units/kg (min 10units) at bedtime, check FBG daily, increase 2-4 units every 3 days until FBG target is met
If very high FBG (>250) initial dose can be higher and titration can be more aggressive
Bolus, if needed: 4-6 units w/ meals - increase by 2-3 units every 3 days until postprandial glucose target is met

67
Q

Insulin Dosing: Type 1 DM

A

Basal-bolus dosing:
0.5units/kg body weight
50% bolus dosing
50% basil dose

Pharm Practice 4 (8 decks)

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