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Pharmacology PaxFlan > DiaBETES > Flashcards

DiaBETES Flashcards

1
Q

Biguanes

A

metformin

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2
Q

metformin MOA

A

decrease hepatic glucose production

and increase GLP-1

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3
Q

indications for metformin

A

prediabetes
1st line for an oral diabetes (non-insulin) med - *every DMII should be on it!
PCOS

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4
Q

what is prediabetes

A

fpg 100-125 or A1C 5.7-6.4%

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5
Q

steps in treating a PCOS patient

A

1: diet/exercise/metformin
2: ocp > spironolactone to decrease testosterone
3: HRT for fertility

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6
Q

dosing of metformin at start

A

250-500 mg/day

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7
Q

titration of metformin

A

250-500 mg q1-2 weeks

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8
Q

what is the usual effective dose of metformin

A

2g

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9
Q

weight implications + hypoglycemic effects of metformin

A

weight lowering/neutral

rarely causes hypoglycemia

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10
Q

other benefits of metformin

A

decrease micro/macro-vasc complications

decreases TG, decrease in LDL, increase in HDL (modest)

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11
Q

monitoring for metformin

A

H&H, RBC indices (monitor B12)

eGFR

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12
Q

what else to prescribe with metformin + why

A

multivitamin for vitamin B12 deficiency

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13
Q

who should not get metformin + why

A

HF exacerbation –> LA
renal dysfunction –> LA
hepatic dysfunction

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14
Q

renal function and metformin

A

do not start if eGFR <30!!!

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15
Q

specific interaction of metformin

A

d/c prior to and for 48 hours after procedure involving IV administration of iodinated contrast –> can cause AKI

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16
Q

ADR of metformin

A

metallic taste
N/V/D, anorexia, abdominal discomfort
macrocytic anemia, peripheral neuropathy
lactic acidosis

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17
Q

should you stop metformin if pt has a B12 deficiency?

A

no - benefit outweighs risk

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18
Q

what drug classes should you measure LFTs in

A

GLP-1
DDP-4
TZD (glitazones)

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19
Q

interactions with all diabetes meds

A

concomitant hypoglycemia meds

hyperglycemia-inducing agents (steroids)

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20
Q

sulfonylureas

A

glipizide
glyburide
glimepiride

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21
Q

what sulfonylurea should you avoid in elderly

A

glimepiride

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22
Q

what sulfonylurea is not recommended in anyone + why

A

glyburide d/t disulfram-like rxn

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23
Q

what is the best option sulfonylurea

A

glipizide

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24
Q

MOA of sulfonylurea

A

stimulation of insulin secretion via ATP-dependent K+ channels in pancreatic B-cells

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25
Q

renal function and glyburide

A

do not give if eGFR < 50

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26
Q

when should pts take sulfonylureas

A

in AM before breakfast

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27
Q

weight implications + hypoglycemic effects of sulfonylureas

A

weight gain and hypoglycemia

glyburide > glimepiride > glipizide

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28
Q

precaution for sulfonylureas

A

pts with sulfonamide allergies

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29
Q

in what patients is drug-induced hypoglycemia more common in

A 
ETOH ingestion 
a lot of exercise
low calorie intake 
1 or more glucose lowering drug
(Paxton on a plane)
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30
Q

reactions of glyburide

A

“disulfiram-like” rxn with ETOH ingestion

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31
Q

meglitinides

A

nateglinide
repaglinide
(MEG- REPents NATE)

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32
Q

meglitinides MOA

A

increase insulin secretion via ATP-dependent K+ channels in pancreatic B-cells (same as sulfonylureas)

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33
Q

when should meglintinides be taken + what should you tell pts about meals and taking the drug

A

in AM prior to meal

skip a meal - skip the drug!!

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34
Q

weight implications + hypoglycemic effects of meglitinides

A

weight neutral and hypoglycemia

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35
Q

interactions of meglitinides

A

substrate of 2C9 & 3A4

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36
Q

Thiazolidinediones

A

pioglitazone

rosiglitazone

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37
Q

TZD MOA

A

increase insulin sensitivity in muscle, adipose, liver –> increase glucose utilization and decrease glucose production
via PPAR-y agonism (genes)

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38
Q

indications for TZD

A

DMII (when you MUST)

PCOS (use metformin 1st)

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39
Q

how long should it take TZD to take full effect and why

A

6-14 weeks because it is influencing genes!

40
Q

lipid effects with TZDs

A

pioglitazone has favorable lipid effect

41
Q

contraindications/warnings for TZD

A

bladder cancer! (pioglitazone)
NYHA III or IV HF patients
MI patients

42
Q

ADRs of TZDs

A

weight gain
fluid retention –> edema
decreased bone density = increased fracture risk
hepatotoxicity

43
Q

Alpha-glucosidase inhibitors

A

acarbose

miglitol

44
Q

alpha-glucosidase MOA

A

inhibits a-glucosidase enzymes that line brush border of SI = delayed absorption of glucose & other monosaccharides

45
Q

weight implications for alpha-glucosidase inhibitors

A

weight neural

46
Q

contraindications for alpha-glucosidase inhibitors

A

pts with intestinal or bowel disease, or intestinal obstruction

47
Q

ADR of alpha-glucosidase inhibitors

A

abdominal pain, diarrhea, flatulence (d/c often because of this)

48
Q

what are the 2 incretins

A

glucose-dependent insulinotropic peptide (GIP)

glucagon-like peptide (GLP-1)

49
Q

GLP-1 incretin MOA

A

stimulates insulin secretion

inhibits glucagon secretion, hepatic glucose production, gastric emptying, appetite

50
Q

when are incretins normally released

A

throughout the day in response to a meal

51
Q

how does DPP-IV impact insulin levels

A

by increasing active levels of incretin hormones

52
Q

GLP-1 agonists

A 
(tides and glutides)
exenatide
semaglutide 
liraglutide
lixisenatide 
dulaglutide
53
Q

what is the most potent GLP-1 drug for lowering A1C

A

semaglutide

54
Q

what are the 3 GLP-1 agonists that are “pushed” by cardiologists due to its + CV effects

A

sema, lira, dula

she loves dogs

55
Q

what is an indication for liraglutide aside from DMII

A

weight loss aid (pts w BMI > 30 or >27 with weight-related condition)

56
Q

weight implications + hypoglycemic effects of GLP-1

A

weight loss, rare hypoglycemia

57
Q

storage for GLP-1

A

store in fridge

58
Q

contraindications/warnings for GLP-1s

A

gastroparesis (b/c it slows gastric emptying)
CKD patients
thyroid nodule patients

59
Q

interactions for GLP-1 and why

A

OCPs taken 1 hr before or 11 hrs after IR products because GLP-1s delay gastric emptying

60
Q

ADRs of GLP-1s

A

GI intolerance (nausea)
thyroid c-cell carcinoma
acute pancreatitis
biliary/gallbladder dz

61
Q

DPP-IV inhibitors

A 
(gliptins)
sitagliptin 
saxagliptin
linagliptin 
alogliptin
62
Q

DPP-IV inhibitors and postprandial blood glucose

A

more effective at reducing postprandial blood glucose than it is at reducing fasting blood glucose

63
Q

DPP-IVs ADRs

A

acute pancreatitis/cancer (as with GLP-1s)
hypersensitivity rxn
severe joint pain

64
Q

SGLT-2 inhibitors

A

(gliFLOZINs)
canagliflozin
dapagliflozin
empagliflozin

65
Q

SGLT-2 of choice

A

empagliflozin

66
Q

SGLT-2 MOA

A

transports filtered glucose from proximal renal tubule into tubular epithelial cells
decreased glucose/Na reabsorption, increased urinary glucose/Na excretion, decrease blood [glucose]/BP
*basically - sugar and sodium diuretic!!

67
Q

when should pts take SGLT-2s

A

before 1st meal of day

68
Q

weight implications + hypoglycemic effects of SGLT-2

A

weight loss, no hypoglycemia

69
Q

monitoring for SGLT-2s

A

renal function (like in ACE/ARB)

70
Q

contraindications for SGLT-2s

A

not for CKD patietns

71
Q

do not give SGLT-2s with what other drugs

A

ACE/ARB/NSAID (can = AKI)

72
Q

SGLT-2 ADRs

A

genital myocotic infections, UTI, Fournier’s gangrene
volume depletion/hypotension
AKI (dehydration, poor renal function, NSAID/diuretic/ACE/ARB&raquo_space;)
increased fracture risk
euglycemic DKA (DKA with normal BS!)

73
Q

dapagliflozin ADR

A

small increase risk in bladder cancer

74
Q

canagliflozin ADR

A

small risk of toe & mid-foot amputations

75
Q

prandial insulins

A

regular = fast acting

lispro, aspart, glulisine = faster acting

76
Q

basal insulins

A

NPH = intermediate-acting

glargine, detemir, degludec = long-acting

77
Q

with what patients should you decrease the dose of insulin

A

CKD patients (because insulin is broken down in kidney)

78
Q

onset + duration of regular insulin

A

onset 30-60 min, duration 5-8 hrs

79
Q

when to take regular insulin

A

30 min prior to meal

80
Q

advantages of regular insulin

A

cheap, good for DM gastroparesis

81
Q

general onset + duration of faster acting prandial insulins

A

onset 10-30 min, duration 3-5 hrs

82
Q

when to take faster acting insulins

A

right before 1st bite

83
Q

advantages to faster acting insulins

A

reduction in postprandial hyperglycemia

hypoglycemia less than regular

84
Q

onset + duration of NPH insulin

A

onset 1-2 hrs, duration 12-24 hrs

85
Q

when to take NPH insulin

A

15 min before meals when mixed with rapid-acting

30 min before if mixed with regular

86
Q

advantages of NPH insulin

87
Q

onset + duration for long-acting insulins

A

onset 60-90 min, duration 24-42 hrs

88
Q

how often to take glargine, detemir, degludec

A

qday because of long duration of action

89
Q

can long-acting insulins be combined with other insulins

90
Q

what can you try if pt refuses to take 2 injections/day

A

biphasic insulin (70% NPH, 3% regular)

91
Q

what to start with when initiating insulin

A

longer-acting, “basal” insulin once daily (10 units NPH or long-acting)

92
Q

what else to add after longer-acting insulin is started

A

1: GLP-1 agonist
2: prandial insulin (aspart) at largest meal
3: switch to premixed insulin (70/30) BID

93
Q

what non-insulin drugs can be combined with insulin

A

GLP-1, DDP-IV, gliflozins (SGLT-2)

94
Q

Metformin category in pregnancy

95
Q

what types of insulin have most data in pregnancy

A

NPH, regular

insulin is gold standard for pregnant DMII pts

Pharmacology PaxFlan (12 decks)

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