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Pharmacology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes Medications

A
  1. Biguanides
  2. Sulfonylureas
  3. Meglitinide derivatives
  4. Alpha-glucosidase inhibitors
  5. thiazolidinediones (TZDs)
  6. Glucagonlike peptide-1 (GLP-1) agonists
  7. dipeptidyl peptidase IV (DPP-4) inhibitors
  8. Selective sodium-glucose transporter-2 (SGLT-2)
  9. insulins
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2
Q

example of biguanides

A

metformin (glucophage)

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3
Q

metformin indication

A

type 2 DM
PCOS
pre-diabetes

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4
Q

metformin CI

A
  1. metabolic acidosis

2. moderate to severe CKD

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5
Q

metformin MOA

A
  1. decrease hepatic glucose production
  2. decreases intestinal absorption of glucose
  3. improves insulin sensitivity by increases peripheral glucose uptake
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6
Q

metformin monotherapy or combo?

A

both

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7
Q

how much does metformin lower HbA1c

A

1-2%

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8
Q

metformin SE

A
  1. GI - abdominal pain, nausea, diarrhea
  2. reduced absorption of Vit B12 and folate
  3. mild weight loss
  4. hypoglycemia (but not really)
  5. lactic acidosis
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9
Q

Sulfonylurea examples

A
  1. glyburide / glynase
  2. glipizide / glucotrol
  3. glimerpiride / amaryl
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10
Q

Sulfonylurea MOA

A
  1. stimulate insulin secretion from beta cells of pancreas

2. reduce serum glucagon levels

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11
Q

how much do sulfonylureas lower HbA1c

A

1-2%

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12
Q

Sulfonylurea indications

A
  1. DM type 2
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13
Q

Sulfonylurea CI

A
  1. Type I DM

2. pregnancy

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14
Q

monotherapy or combo?

A

both

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15
Q

Sulfonylurea SE

A
  1. hypoglycemia
  2. flushing (w/ alcohol)
  3. weight gain
  4. tolerance - less effective over time
  5. anemia/thrombocytopenia
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16
Q

who are Sulfonylureas not the best for

A

diabetic who is not good at scheduling meals or who like to drink alcohol

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17
Q

Meglitinides examples

A
  1. Repaglinide / Prandin
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18
Q

Meglitinides indications

A
  1. DM type 2

2. postprandial hyperglycemia

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19
Q

Meglitinides CI

A 
concomitant gemfibrozil (cholesterol med) and repaglinide/Prandin
sulfonylureas
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20
Q

Meglitinides MOA

A

short acting, stimulate release of insulin from beta cells

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21
Q

who are Meglitinides good for

A

significantly elevated blood sugar post meals

irregular meals!

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22
Q

Meglitinides SE

A
  1. hypoglycemia

2. weight gain

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23
Q

special consideration for Meglitinides

A

dose adjust if liver impairment

check LFTs, urine microalbumin at lease once a year

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24
Q

alpha glucosidase inhibitors (AGIs) example

A
  1. acarbose / precose

not really seen

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25
Q

alpha glucosidase inhibitors (AGIs) indications

A
  1. DM type 2
  2. predominantly postprandial hyperglycemia
  3. new onset diabetes w/ mild HTN
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26
Q

alpha glucosidase inhibitors (AGIs) CI

A
  1. IBS

2. IBD

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27
Q

alpha glucosidase inhibitors (AGIs) monotherapy or combo?

A

both - combo w/ sulfonylureas

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28
Q

alpha glucosidase inhibitors (AGIs) MOA

A

inhibit breakdown of carbohydrates to glucose n the gut - act locally in the gut

29
Q

alpha glucosidase inhibitors (AGIs) SE

A
  1. flatulence
  2. bloating
  3. abdominal discomfort
  4. diarrhea
  5. increased liver enzymes
30
Q

Thiazolidinedoiones examples

A
  1. rosiglitazone / Avandia

2. Pioglitazone / Actos

31
Q

TZD Indications

A

DM type 2

32
Q

TZD CIs

A
  1. heat failure
  2. pregnancy
  3. breastfeeding/lactation
33
Q

how much do TZDs lower HbA1c

A

1-2%

34
Q

when to use TZDs

A
  1. if someone doesn’t tolerate metformin

2. use w/ metformin if unable to tolerate high levels of meformin

35
Q

TZDs SE

A
  1. weight gain
  2. edema
  3. cardiovascular
  4. fractures
  5. raise HDL
36
Q

if you have a diabetic patient who also tends to be a fluid retaining hypertensive, what medication class should you avoid

A

TZDs b/c can cause edema

37
Q

What does GLP-1 agonists stand for?

A

glucagonlike peptide-1 agonist

38
Q

examples of long-acting GLP-1 analogs

A

Liraglutide (Victoza)

39
Q

examples of prolonged-acting GLP-1 analogs

A
  1. dulaglutide (Trulicity)

2. semglutide (Ozempic)

40
Q

difference between long-acting and prolonged acting GLP-1 agonists

A

long-acting taken daily vs. prolonged-acting taken weekly

41
Q

GLP-1 agonists monotherapy or combo?

A

only add-in therapy (combo) - patients who have not achieved glycemic goals using metformin, a sulfonylurea or both, in combo with TZD +/- metformin

42
Q

GLP-1 agonist MOA

A
  1. mimic endogenous incretin GLP-1
  2. stimulate glucose-dependent insulin release
  3. reduce glucagon
  4. slow gastric emptying
  5. may prevent beta-cell apoptosis
43
Q

GLP-1 agonist SE

A
  1. weight loss
  2. thyroid c-cell tumors / medullary thyroid cancer
  3. Steven-Johnson syndrome
  4. angioedema
  5. upset stomach
  6. pancreatitis
  7. cholelithiasis
  8. change in vision (semiglutide/ozempic)
44
Q

GLP-1 agonist CI

A
  1. personal or family history of medullary thyroid cancer

2. exenatide in end stage renal disease

45
Q

what does DPP-IV inhibitor stand for?

A

Dipeptidyl-peptidase IV inhibitors

46
Q

DPP-IV inhibitor examples

A
  1. Linagliptin (Tradjenta)

2. Sitagliptin (Januvia)

47
Q

DPP-IV inhibitor monotherapy or combo?

A

both, combo w/ metformin or TZD

48
Q

DPP-IV inhibitor MOA

A
  1. block degradation of endogenous incretins, GLP-1 and GIP
  2. inhibit glucagon release
  3. increases insulin secretion
49
Q

benefits of DPP-IV inhibitor

A
  1. no hypoglycemia
  2. well tolerated
    * weight neutral
50
Q

how much do DPP-IV inhibitors lower HbA1c

A

0.6%

51
Q

warnings/risks with DPP-IV inhibitors

A
  1. pancreatitis
  2. joint pain
  3. saxagliptin can worse HF
52
Q

what does SGLT-2 inhibitor stand for

A
  1. Sodium glucose CoTransporter inhibitors
53
Q

SGLT-2 inhibitor examples

A
  1. Canagliflozin / Invokana

2. empagliflozin / jardiance

54
Q

SGLT-2 inhibitor MOA

A

block resorption of glucose in kidneys

55
Q

limitation of SGLT-2 inhibitors

A

not effective if eGRF <45

56
Q

benefits of SGLT-2 inhibitors

A
  1. some weight loss
  2. may reduce BP
  3. no hypoglycemia
57
Q

who are SGLT-2 inhibitors good for

A

add on therapy for patients who have greater risk of stroke and heart attack

58
Q

SGLT-2 inhibitors SE

A
  1. UTI, yeast infections, increased urination
  2. increased LDL
  3. fractures
  4. possible ketoacidosis
  5. amputations (invokana)
  6. hypotension
  7. bladder cancer? (farxiga)
59
Q

insulin indications

A

DM type 1 and 2

gestational diabetes

60
Q

insulin examples

A
  1. short acting insulin - insulin R
  2. intermediate acting insulin - NPH insulin, lente
  3. long acting insulin - insulin ultralente
61
Q

long acting insulin features

A
  1. 25 hour half life
  2. up to 42 hour glucose lowering effect
  3. relatively peakless
  4. anytime dosing
62
Q

insulin MOA

A
  1. promotes uptake of glucose by cells
  2. increased glycogen deposition in liver and muscle
  3. liver: inhibits synthesis of glucose
  4. muscle: facilitates uptake of amino acids in –> protein synthesis
  5. adipose: promotes synthesis of triglycerides and inhibits lipolysis
63
Q

insulin SE

A
  1. hypoglycemia
  2. lipodystrophy
  3. edema
64
Q

Presentation of hypoglycemia

A
  1. sweating
  2. tachycardia
  3. tremor
  4. weakness
  5. hunger
  6. blurred vision
  7. confusion
  8. convulsions
  9. coma
65
Q

Glucagon indications

A
  1. refractory hypoglycemia (after PO or IV glucose)
  2. hyperinsulin states - insulin overdose, insulinoma
  3. drug overdoses - beta blockers, ca channel blockers
  4. intestinal relaxation
66
Q

Glucagon CIs

A
  1. pheochromocytoma
67
Q

Glucagon SE

A
  1. nausea/vomiting
  2. hyperglycemia
  3. hypokalemia
68
Q

Combination drugs

A
  1. invokamet = canagliflozin + metformin
  2. synjardy = empagliflozin + metformin
  3. glyxambi = empagliflozin + linagliptin

Pharmacology (27 decks)

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