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Diabetes Flashcards

1
Q

Metformin contraindications

A

Kidney disease (GFR <30)
Liver disease or failure (hepatitis, chronic ETOH)
Heart failure

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2
Q

First line therapy for Type 2 DM

A

Metformin

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3
Q

Side effects of metformin

A 
GI effects (diarrhea, gas)
B12 deficiency
Lactic acidosis (especially with liver disease)
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4
Q

Sulfonylureas meds end in?

A

M/R/Z -ide (tolbutaMide, glybuRide, glipiZide)

DO NOT CONFUSE WITH “TIDE” the GLP-1 analogs

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5
Q

What medication class/drug requires functioning beta cells

A

Sulfonylureas “M/R/Z -ide”

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6
Q

What two types of medications classes/drugs does NOT require functioning beta cells

A

Biguanide - metformin

Thiazolidinediones - “zone” Pioglitazone

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7
Q

T/F metformin has ASCVD benefit

A

TRUE! Pre-diabetic and diabetic pts benefit from a prevention of CVD with this medication

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8
Q

Side effects of sulfonylureas (M/R/Z-ide); tolbitamide, chlorpropamide, glyburide, glimepride, glipizide

A

Hypoglycemia! Weight gain!

C-peptide

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9
Q

What is the black box warning for “TZDs” thiazolidinediones (Pioglitazone)

A

Signs of heart failure! increases CHF risk

Other side effects:
Edema, SOB, rapid weight gain
Osteopenia/fractures
Liver toxicity

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10
Q

What oral drug class MUST be taken with food?

A

Alpha-glucosidase inhibitors - Acarbose and Miglitol

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11
Q

What are common side effects of alpha-glucosidase inhibitors (Acarbose, Miglitol). What lab should be monitored?

A

GI issues! Abdominal pain, diarrhea, flatulence

Elevated liver enzymes

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12
Q

Black box warning of GLP-1 Receptors Agonists (Exenatide, Liraglutide, Albiglutide, “-TIDE”)

A

Thyroid cancer

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13
Q

What side effects are most common of the GLP-1 receptor agonists (-TIDE). What is an increased risk due to this drug class?

A

Nausea, vomiting, diarrhea

Increase risk of pancreatitis seek immediate care with severe abdominal pain

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14
Q

Any diabetic patient with a GFR 40 or less is at increased risk for?

A

Hypoglycemia

Medication dose must be decreased. Patient may need recurrent labs or referred

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15
Q

What two drug classes increase the risk of CHF?

A

Thiazolidinediones “TZDs” -glitazone

DPP4-Inhibitors -gliptins

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16
Q

What drug classes (2) are associated with weight loss as a potential beneficial side effect?

A

GLP-1 Receptor Agonists “-TIDE” (exenaTIDE, liragliTIDE, etc)

SGLT-2 Inhibitors “-gliflozin” (canagliflozin, empagliflozin, dapagliflozin)

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17
Q

What drug classes (2) are associated with weight gain as a potential side effect?

A

Sulfonylureas “M/R/Z -ide”

Thiazolidinediones “-glitazones”

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18
Q

What drug class may cause UTIs, candidiasis infections, renal failure, hyperkalemia, dehydration, or hypotension?

A

SGLT-2 inhibitors “-gliflozin”

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19
Q

What drugs have a ASCVD benefit? (6 types of drugs, 4 different classes)

Which two drugs specifically have a CHF benefit? (Same class)

A

Metformin - Biguanide
PioglitaZONE - Thiazolidinediones “TZDs”
ExenaTIDE and LiragluTIDE - GLP-1 Receptor
CanagliFLOZIN and EmpagliFLOZIN - SGLT-2

CHF benefits: GLP-1 Receptor Agonists “TIDE”

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20
Q

What is the black box warning of SGLT-2 Inhibitors? “gliflozin”

A

Amputation! (Canagliflozin)

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21
Q

What two drug classes may cause pancreatitis?

A

GLP-1 Receptor Agonists -TIDE

DPP4-Inhibitors -gliptins

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22
Q

What drug needs periodic measurement of B12 lab with therapy?

A

Metformin

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23
Q

What drug class increases LDL?

A

SGLT-2 Inhibitors -gliflozin

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24
Q

Side effects of hypoglycemia and weight gain are commonly caused by what drug class?

A

Sulfonylureas M/R/Z ide

25
Q

What drug class causes weight loss due to slowed gastric emptying? (Incretin)

A

GLP-1 Receptor Agonists “TIDE”

26
Q

What drug class is considered weight neutral?

A

DPP4-Inhibitors -gliptans

27
Q

Side effects of nasopharyngitis/URI, joint pain, GI distress and pancreatitis are commonly caused by what drug class?

A

DPP4-Inhibitors -gliptans

28
Q

What 2 drug classes may cause osteopenia or increase the risk of bone fractures? (Similar ending drug names)

A

Thiazolidinediones -glitazone

SGLT-2 Inhibitors -glifozin

29
Q

An A1C >9 will require what kind of therapy?

A

Dual therapy as initial treatment

30
Q

An A1C 10-12 will require what kind of therapy?

A

Insulin until the patient is not glycemix toxic

31
Q

A blood glucose level >300 will require what therapy?

A

Insulin, until the pt is no longer glycemic toxic

32
Q

What drug classes (2) are considered low cost?

A

Biguanide - Metformin

Sulfonylureas - M/R/Z ide

33
Q

According to ADA, what is the ONLY noninsulin medication approved for type 1 DM?

A

PramlinTIDE (GLP-1 Receptor Agonist)

MOA: decreases A1C and body weight when added to insulin

34
Q

What is essential to treatment of type 1 DM?

A

Insulin, analog - the beta cell function is absent or near-absent AUTOIMMUNE DESTRUCTION

35
Q

A drug ending in -TIDE is a what?

A 
GLP-1 Receptor Agonists 
ExenaTIDE 
LiragliTIDE 
AlbuigluTIDE
DulagluTIDE
36
Q

A drug ending in “-gliflozin” is a what?

A

SGLT-2 Inhibitor
Canagliflozin - BBwarning, bone fractures
Empagliflozin
Dapagliflozin

37
Q

A drug ending in -MIDE, RIDE, ZIDE is a what?

A

Sulfonylureas (1st and 2nd generation)
Known for weight gain and hypoglycemia, but low in cost. Be weary of giving to older adults.

Tolbutamide
Glyburide
Glimepiride
Glipizide

38
Q

A drug ending in -gliptin is a what?

A

DPP4-Inhibitors

Weight neutral, no hypoglycemia, $$$, URI and pancreatitis

Sitagliptin, Saxagliptin, Linagliptin

39
Q

A drug ending in -glitaZONE is a what?

A

Thiazolidinediones “TZD”

Doesn’t require beta cells to function
Will cause weight gian and NO HEART FAILURE (BBwarning)
Monitor for fractures and osteopenia
Can help with ASCVD

Pioglitazone

40
Q

Drug class that increases renal glucose excretion?

A

SGLT-2 Inhibitors

-gliflozin

41
Q

Beside allergy to sulfa drugs, who should NOT receive sulfonylureas?

A

Obese (due to weight gain)
Elderly (hypoglycemia and increase in falls)
Pregnancy, avoid this med!

42
Q

This drug class increases insulin secretion from beta cells of the pancreas

A

Sulfonylureas M/R/Z ide

43
Q

This drug class increases insulin secretion, decreases glucagon secretion, delays gastric emptying and improves post-prandial hyperglycemia

A

GLP-1 Receptor Agonists -TIDE

44
Q

Why will GLP-1 Receptor Agonists reduce the risk of hypoglycemic effects?

A

Route of administration - subcutaneous injection!

45
Q

This drug class increases insulin sensitivity thus decreasing insulin resistance (insulin sensitizers)

A

ThiaZOlidinediones -glitaZONEs

46
Q

This drug class inhibits hepatic glucose production (gluconeogenesis) and insulin resistance

A

Biguanides - Metformin

47
Q

What is the initial dose of metformin?

A

500 mg daily until tolerating/minimal side effects

  1. 500 mg BID
  2. 1000 mg daily
  3. 1000 mg BID
    Max dose is 2000 mg a day
48
Q

When should meglitinides be taken?

A

Before meals! Never take if meal is missed!!

49
Q

What drug class decreases glucose absorption by slowing the absorption of carbs into proximal gut blood after meals?

A

Alpha-glucosidase Inhibitors (aCARBose, Miglitol)

50
Q

Medication that can be used with both type 1 and type 2 DM

A

PramaliTIDE - injection medication, amylin analog

51
Q

Increases risk of myocardial infarction (think heart failure black box warning medications)

A

Thiazolidinediones -GLITAZONES

Rosiglitazone

52
Q

Initial dose of basal insulin (long acting: Detemir [levemir], Glargine [lantus]).

How much should the PCP titrate if the initial dose does not achieve A1C goal set?

What if the patient becomes hypoglycemic, how should you titrate insulin?

A

10 units once a day or 0.1-0.2 units/kg

Increase by 1 unit/day or 3 units/3 days until Fasting Blood Glucose is within goal (80-135)

Hypoglycemia = decrease by 4 units until FBG within range

53
Q

What is the insulin unit to carbohydrate ratio? ICR

A

1:15

1 unit to 15 carbs

54
Q

What should indicate a need to titrate insulin dosage? (Long acting or basal)

A

The morning fasting blood glucose!

Long acting is given at the same time, everyday (even without eating) alone or with a short-acting
Titration is only based on AM fasting blood glucose (80-135 is normal)

55
Q

What is the most common side effect of insulin

A

Hypoglycemia

56
Q

Patient with ASCVD and high risk of heart failure or has heart failure, should be treated with what diabetic drug class?

A

SGLT-2 Inhibitors -gliflozin

57
Q

Patient with type 2 DM and an established ASCVD (risk score >15%), should be considered for treatment with what TWO diabetic medication classes? (not a dual therapy, both classes treat DM and ASCVD)

A

SGLT-2 Inhibitors -gliflozin
or
GLP-1 Receptor Agonists -TIDES

58
Q

Patient with DM type 2 and chronic kidney disease may be treated with either TWO diabetic medication classes?

A

SGLT-2 Inhibitors -gliflozin

GLP-1 Receptor Agonists -TIDES

Diabetic Medications (1 decks)

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