Diabetes

Question 1

ADA range guidelines

Answer 1

A1C < 7%
Pre-prand 80-130
Post-prand <180

Question 2

Metformin black box warning

Answer 2

lactic acidosis (increased with contrast and xray)

Question 3

Metformin SE

Answer 3

GI upset
vitamin B12 deficiency
*A1c lowering about 2%. Pregnancy ok

Question 4

Which diabetic meds can help with weight loss?

Answer 4

SGLT2 inhibitor (invokana, farxiga, jardiance)
GLP1 agonist (Byetta, Victoza, Trulicity)

Question 5

Sulfonylureas

*avoid in sulfa allergy

Answer 5

Glyburide(Glucovance, Diabeta)
Glipizide(Glucotrol)
Glimepiride(Amaryl)
*don't mix w/ insulin-hypoglycemia
maybe weight gain
take IR 30 mins before food

Question 6

Sulfonylurea interactions

Answer 6

increased level(hypoglycemia)=Warfarin, Bactrim, Azoles
Decreased level=Beta blockers, HCTZ, Steroids, Thyroid, Estrogen, Phenytoin, Isoniazid

Question 7

Starlix generic

Answer 7

Nateglinide
120 mg TID. before meals! hypoglycemia risk, *skip dose with skipped meal
CYP3A4 and 2C9

Question 8

Prandin generic

Answer 8

Repaglinide
(Prandimet w/ metformin)
**avoid w/ plavix and NPH insulin(MI risk)
avoid Gemfibrozil (CYP)

Question 9

Black box warning for TZDs (pioglitazone)

Answer 9

Cause or worsen congestive heart failure

Question 10

Risk of bladder cancer with what diabetic med?

Answer 10

Pioglitazone (Actos)

*also, contra in HF

Question 11

Avandia generic

Answer 11

Rosiglitazone *medguide

Avandamet or Avandryl

Question 12

Januvia

Answer 12

Sitagliptin

Question 13

Onglyza generic

Answer 13

Saxagliptin

Major CYP3A4

Question 14

Kombiglyze

Answer 14

Saxagliptin + Metformin

Question 15

Tradjenta

Answer 15

Linagliptin

Question 16

Invokana

Answer 16

Canagliflozin
*lower limb amputations with CVD
bladder issues

Question 17

Farxiga

Answer 17

Dapagliflozin

Question 18

Jardiance

Answer 18

Empagliflozin

Question 19

Digoxin affected by which diabetic meds?

Answer 19

Invokana, Farxiga, Jardiance

weight loss ones

Question 20

Precose

Answer 20

Acarbose = type 2 only
GI upset
take glucose if hypoglycemia with insulin or sulfonylureas

Question 21

Cycloset

Answer 21

Bromocriptine
dopamine receptor agonist
MOA-maybe reverse insulin resistance in hypothalamus
Major CYP3A4 - can decrease NTG

Question 22

Which cholesterol med also can treat diabetes?

Answer 22

Welchol (colesevelam) but watch out for phenylalanine/phenylketonuria
once daily with food
can reduce absorption of fat soluble vitamins

Question 23

Byetta

Answer 23

Exenatide

BID dosing

Question 24

Bydureon

Answer 24

Exenatide
*severe renal impairment
once weekly

Question 25

Victoza

Answer 25

Liraglutide

dosing: 0.6 mg subQ DAILY x 1 week then up to 1.2 or 1.8/day

Question 26

Trulicity

Answer 26

Dulaglutide
max 1.5 mg/week
watch for cardio AV block

Question 27

Adlyxin

Answer 27

Lixisenatide
Medguide req. once daily, discard after 14 days
separate birth control 1 hr before or 11 hrs after

Question 28

Tanzeum

Answer 28

Albiglutide

Question 29

Symlin

Answer 29

Pramlintide
give with insulin
slows gastric emptying - take orals 1 hr before or 2 hrs afterward
Type 1 or 2(higher dosing)

Question 30

Afrezza

Answer 30

inhaled rapid insulin

Question 31

Rapid Insulins (most are 1:1)

Answer 31

Aspart - Novolog
Lispro - Humalog
Glulisine - Apidra
can be out of fridge for 4 weeks

Question 32

Regular insulin

Answer 32

Humulin R or Novolin R
ok in IV (but not the U-500)
can purchase OTC

Question 33

NPH Insulin (Intermediate)

Answer 33

Humulin N or Novolin N 
CLOUDY
2-4 hr onset
can purchase OTC
if mixed, draw clear first (rapid or short)
pens good for 14 days, vials 6 weeks

Question 34

Long acting Insulin (1:1)

Answer 34

Detemir = Levemir
Glargine = Lantus, Toujeo, Basaglar
most are good for 4 weeks after opening
can have duration of action up to 24 hrs

Question 35

Which combo insulin is OTC?

Answer 35

70 NPH/30 Regular - Humulin or Novolin