Diabetes Hrometz

Question 1

Metformin MOA

Answer 1

Blocks glucagon from stim GLU output from liver.
Increases peripheral GLU uptake
Decreases GLU absorption from GI

Question 2

Metformin dosing/timing

Answer 2

Give CF to avoid SE
Lowers fasting and post-p GLU
Give ER at dinnertime

Question 3

Metformin SE

Answer 3

N/V/D
Lactic Acidosis of kidney & liver
risk w/ heart failure, hepatic disease, or pts >80

Question 4

Metformin Contraindications

Answer 4

Renal dz
Scr >1.5 in male or >1.4 in female
Acute or chronic M-acidosis or DKA

Question 5

Gliptin MOA

Answer 5

Prolongs half-life of endogenous GLP-1
Stim insulin when high BG
Suppress inappropriate glucagon
Slows gastric emptying

Question 6

Gliptin dosing/timing

Answer 6

QD, w or w/o food
can be used in combo
greater effect post-prandially

Question 7

Gliptin SE

Answer 7

Infection, headache, UTIs

b/c DPP-4 acts on immune cells

Question 8

Sulfonylurea MOA

Answer 8

Inactivates K+ channels»B cell depol»insulin and amylin secretion

Question 9

Sulfonylurea Dosing/Timing

Answer 9

30mins before main meal
lowers both kinds of GLU
No renal dosing w/ GLIPIZIDE

Question 10

Sulfonylurea SE

Answer 10

Hyperinsulinemia
hypoglycemia
wt gain

Question 11

DKA Signs and Symptoms

Answer 11

BG>300
Polys x24hrs
Acidosis (pH<7.3)
N&V
Increased glucagon
Abdominal Pain
Fruity breath
stupor and/or coma

Question 12

Type 2 DM Characteristics

Answer 12

Insulin Resistance (defective GLUT-4)
B-cell dysfunction
Excess glucagon

Question 13

Exenatide (Byetta)

Answer 13

2.4 hr t1/2
Give up to 1hr before 2 main meals
Diarrhea AE
90% auto-Ab chance
Pancreatitis

Question 14

Liraglutide (Victoza)

Answer 14

13hr t1/2
QD independent of food
less potent (25-100%)
Diarrhea AE
only 9% auto-Ab chance
Thyroid Cx and pancreatitis

Question 15

Exenatide (Bydureon)

Answer 15

2.4hr t1/2 but microspheres
Qwk independent of food
Diarrhea & inj site rxn
45% auto-Ab chance
Thyroid Cx and pancreatitis