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PANCE Review > Diabetes / HTN / Hyperlipidemia Drugs > Flashcards

Diabetes / HTN / Hyperlipidemia Drugs Flashcards

1
Q

What are the Diabetes Mellitus drugs?

A
  1. Biguanides
  2. Sulfonylureas
  3. Thiazolidinediones
  4. Alpha Glucosidase Inhibitors
  5. “GLP-1” Agonists (Glucagon-Like Peptide-1)
  6. “DPP-4” Inhibitors (Dipeptidyl Peptidase)
  7. Pramintide “Amylin”
  8. Bile Acid Sequestrants
  9. Bromocriptine
  10. SGLT-2 Inhibitors
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2
Q

What are the drugs of Biguanides?

A
  1. Metformin
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3
Q

What is the action of Biguanides?

A

It reduces glucose by suppressing hepatic glucose production

*NO RISK OF HYPOGLYCEMIA

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4
Q

What are the positive side effects of Biguanides?

A
  1. Weight loss

2. REDUCES triglycerides

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5
Q

What are the negative side effects of Biguanides?

A
  1. GI “Diarrhea” (GOLD)
  2. Vitamin B12 Deficiency (Mimics peripheral neuropathy)
    - Check B12 levels IF unexplained peripheral neuropathy or anemia (HIGH MCV value)
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6
Q

What are the contraindications for Biguanides?

A
  1. INCREASED risk for lactic acidosis
  2. Serum creatinine:
    - Abnormal clearance (Male > 1.5 / Female > 1.4)
    * Normal = 0.6 - 1.2 and because of this you need to monitor the renal function prior to prescribing biguanides
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7
Q

What are the drugs of Sulfonylureas?

A
  1. Glyburide
  2. Glipizide
  3. Glimepiride

Newer:

  1. Repaglinide
  2. Nateglinide
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8
Q

What are the negative side effects of Sulfonylureas?

A
  1. INCREASED weight

2. HYPOGLYCEMIA

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9
Q

What are the drugs of Thiazolidinediones?

A
  1. Pioglitazone

2. Rosiglitazone

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10
Q

What is the action of Thiazolidinediones?

A

Sensitizes the tissue to insulin (Used alone or as an adjunct to sulfonylureas, metformin, or insulin)

*NO RISK OF HYPOGLYCEMIA

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11
Q

What are the negative side effects of Thiazolidinediones?

A
  1. Pioglitazone:
    - INCREASED risk for bladder CA
    - INCREASED weight
    - Edema
  2. Rosiglitazone:
    - Cardiac risks (Requires FDA approval)
  3. INCREASED risk of fractures
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12
Q

What are the contraindications of Thiazolidinediones?

A
  1. CHF (Class 3/4)

2. Liver disease

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13
Q

What are the drugs of Glucosidase Inhibitors?

A
  1. Acarbose

2. Miglitol

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14
Q

What is the action of Glucosidase Inhibitors?

A

Delays carbohydrate absorption by blocking “Glucosidase enzyme” thus REDUCES post-prandial glucose levels.
*Lasts for 4 hours

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15
Q

What are the negative side effects of Glucosidase Inhibitors?

A

GI

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16
Q

What are the drugs of GLP-1 Agonists?

A
  1. Exenatide (Bydureon)
  2. Livaglutide (Victoza)
  3. Albiglutide(Tanzeum) *Injectable
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17
Q

What are the actions of GLP-1 Agonists?

A
  1. Slows gastric emptying
  2. Stimulates pancreatic insulin response to glucose
  3. REDUCES glucagon post-prandial
  4. REDUCES sugar released by the liver
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18
Q

What are the negative side effects of GLP-1 Agonists?

A
  1. Nausea

2. Acute Pancreatitis

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19
Q

What are the positive side effects of GLP-1 Agonists?

A
  1. Weight loss
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20
Q

What are the contraindications of GLP-1 Agonists?

A
  1. Gastroparesis

2. Thyroid CA

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21
Q

What are the drugs of DPP-4 Inhibitors?

A
  1. Saxagliptin
  2. Sitagliptin “Januvia”
  3. Vildagliptin
  4. Linagliptin

“Gliptins”

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22
Q

What is the action of DPP-4 Inhibitors?

A

Inhibits DPP-4 which will thus prolong GLP-1 action thus causing all GLP-1 actions to occur prolonged.

  • 1 daily dose
  • NO RISK OF HYPOGLYCEMIA or WEIGHT CHANGES
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23
Q

What are the side effects of DPP-4 Inhibitors?

A
  1. Pancreatitis
  2. Urticaria
  3. Angioedema
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24
Q

What is the “Synthetic Analog of Beta-Cells”?

A

Amylin / Pramlintide

*Injectable (MUST USE WITH INSULIN)

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25
Q

What is the action of Pramlintide?

A
  1. Delays gastric emptying

2. REDUCES glucagon and appetite

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26
Q

What are the drugs of Bile Acid Sequestrants?

A
  1. Colesevelam “Welchol”

2. Cholestyramine

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27
Q

What is the action of Bile Acid Sequestrants?

A

Binds to intestinal bile acids and glucose
*REDUCES glucose and LDL’s

*NO RISK OF HYPOGLYCEMIA

28
Q

What are the contraindications of Bile Acid Sequestrants?

A
  1. HIGH triglycerides

2. Drug/Food interactions

29
Q

What is the Dopamine Agonist used for Diabetes Mellitus?

A
  1. Bromocriptine

* NO RISK OF HYPOGLYCEMIA

30
Q

What are the side effects of Bromocriptine?

A
  1. Dizziness
  2. Syncope
  3. Fatigue
  4. Rhinitis
31
Q

What is the contraindication for Bromocriptine?

A

Simultaneous use with “Ergot” containing medications.

32
Q

What drugs are of SGLT-2 Inhibitors?

A
  1. Invokana
33
Q

What is the action of SGLT-2 Inhibitors?

A

Na and glucose cotransporter inhibitor (Because of this you will see increased glucose in the urine)

34
Q

What is the side effect of SGLT-2 Inhibitors?

A
  1. INCREASED risk of acidity within the blood (DKA)
35
Q

When should one begin treating HTN?

A
  1. IF DM or CKD + > 140/90 mmHg
    - IMMEDIATELY
  2. IF Stage 2 HTN (>160 or >100 mmHg)
    - 2 drug regimen
36
Q

What are the HTN drugs?

A
  1. Diuretics
  2. Beta Blockers
  3. ACE/ARB’s
  4. Ca Channel Blockers
37
Q

What HTN drugs are capable to be used in refractory cases?

A
  1. Aldosterone Receptor Agonists
  2. Beta Blockers
  3. Central Sympatholytics
  4. Arteriolar Dilators
  5. Peripheral Sympathetic Inhibitors
  6. Aliskiren “Renal Inhibitors”
38
Q

What are the actions of Diuretics?

A
  1. REDUCES plasma volume and thus chronically reduces peripheral resistance.
    * FIRST LINE TX ESSENTIAL HTN
  • Thiazide Diuretics (GOLD)
  • Loop Diuretics (IF renal dysfunction or with close electrolyte monitoring)
  • May require K supplementation
39
Q

What are the actions of Beta Blockers?

A
  1. REDUCES HR and Cardiac Output
    * BEST FOR WHITES

*IF B/P to high and you can’t get it down then ask the patient if they have taken their BP medication today?

40
Q

In what patients are Beta Blockers best to use with HTN?

A

Post MI or with CHF
*Reduces morbidity

*Carvedilol > Metoprolol in reducing the HR with CHF patients.

41
Q

When should you use caution with Beta Blockers?

A
  1. Pulmonary disease (May trigger pulmonary conditions)
  2. Diabetes Mellitus (May disguise true hyperglycemia)

*Most cardio-selective beta blocker should be used

42
Q

What is the order of least cardio-selective - most cardio-selective beta blockers?

A

Propanolol > Carvedilol > Etanolol > Metoprolol > Nebevilol “Bystolic”

43
Q

What are the actions of ACE-Inhibitors?

A

INHIBIT bradykinin degradation (INCREASES bradykinin) + INCREASES synthesis of vasodilators (Prostaglandins) by inhibiting ACE (Angiotensin Converting Enzyme)

*STOPS the reduction of bradykinins which increases prostaglandins, which are vasodilators, thus ACE-I aid in vasodilation

44
Q

What patients are ACE-I best to use with?

A

IF:

  • HTN + (DM + CKD)
  • These help to preserve the kidney function, thus it is imperative to place patient on if you see any signs of kidney damage
  • HTN (Mild-Mod) + Young white person where a diuretic hasn’t worked
  • Post MI/CHF (Second to Beta Blockers)
45
Q

What is the greatest S/E of ACE-I?

A

Cough

46
Q

What are the action’s of ARB’s (Angiotensin Receptor Blockers)?

A

-They block the interaction of Angiotensin 2 receptors and they works similar to ACE-I without the inhibition of Bradykinin, thus NO COUGH

47
Q

What patients are ARB’s best to use with?

A

-DM + CKD (They preserve the kidney function and thus they should be used if the ACE-I cough is retractable).

48
Q

What are the actions of Calcium Channel Blockers?

A

-Peripheral vasodilation

49
Q

What are the patients that are best to use Calcium Channel Blockers on?

A

-Blacks and Elderly

50
Q

Whats the drug used for HTN as an Aldosterone Receptor Antagonist?

A
  • Spironolactone

* Best to use if refractory HTN. but as an adjunct

51
Q

When is it best to use spironolactone?

A

-As an adjunct with Beta Blockers or ACE-I/ARB’s in patients who are post MI/CHF

52
Q

What is the action of Alpha Adrenergic Antagonists?

A

-They DECREASE peripheral vascular resistance

53
Q

What patients are Alpha Adrenergic Antagonists best to use with?

A

-MEN with symptoms of BPH

54
Q

How to treat HTN urgencies or emergencies?

A
  • Parenteral agents:

* DON’T reduce HTN too fast = Cerebral Ischemia

55
Q

What are common agents to treat HTN urgency or emergency?

A
  1. Na Nitroprusside (Gold)
  2. IF Myocardial ischemia:
    - Nitroglycerin
    - Beta Blockers
  3. Diuretics and Calcium Channel Blockers:
    - Nicardipine
    - Loop Diuretic
56
Q

What’s the best drug for an “Aortic Dissection”?

A
  1. Nitroprusside + Beta Blockers (Labetolol / Esmolol)
57
Q

What’s the best Anti-HTN with ARF “Acute Renal Failure”?

A

Dopamine-1 receptor Agonist

“Fenoldopam”

58
Q

What’s the best Anti-HTN with pregnancy?

A
  1. Hydralazine “Apresoline”
  2. Methyldopa “Aldomet”
    * Methyldopa ensure you use caution when breast feeding as this is passed via the breast milk.
59
Q

What are the drugs with the class of Diuretics?

A
  1. HIGH Ceiling “Loop Diuretics” (First line for CHF)
  2. LOW Ceiling “Thiazides” (First line for HTN)
    * Thiazide-Like Diuretics
  3. Potassium Sparing
  4. Aldosterone Antagonists
  5. Carbonic Anhydrase Inhibitors
  6. Calcium Sparing Diuretics
  7. Osmotic Diuretics
60
Q

What drugs are in the class of Loop Diuretics?

A
  1. Furosemide “Lasix”
  2. Bumetanide “Bumex”
  3. Torsemide “Demadex”
  4. Ethacrynic Acid “Edecrin”
61
Q

What are the side effects of loop Diuretics?

A
  1. Electrolyte disturbances:
    a. Hypokalemia (Low K)
    b. Hyponatremia (Low Na)
  2. Metabolic Alkalosis
  3. Signs of reduced perfusion:
    a. HOTN
    b. BUN and Serum creatinine (High)
    c. HYPERuricemia (High Uric Acid)
  4. Sulfonamides, thus rash or acute interstitial nephritis
  5. Ototoxicity
62
Q

Mnemonic for remembering the diuretics?

A

Leak Over The CAN
-Loop diuretics / Osmotics / Thiazides and Thiazide like / Carbonic Anhydrase Inhibitors / Aldosterone Inhibitors / Na Channel Blockers

63
Q

What drugs are in the class of thiazide and thiazide like diuretics?

A
  1. Hydrochlorothiazide (HCTZ) “Esidrix”
  2. Chlorothiazide “Diuril”
  3. Chlorthalidone “ Thalitone”
64
Q

What are the side effects of thiazide diuretics?

A
  1. Dizziness / Lightheadedness / Headache
  2. Blurred vision
  3. Loss of appetite / Nausea
  4. Itching / Rash (SLE like)
  5. Electrolyte Abnormalities:
    a. Hypokalemia (Low K)
    b. Hypomagnesemia (Low Mg)
    c. Hyponatremia (Low Na)
    d. Hypercalcemia (High Ca)
  6. Hyperuricemia (Increased risk of gout from uric acid)
  7. Hyperlipidemia
65
Q

What drugs are in the class of potassium sparing diuretics?

A
  1. Amiloride (Midamore)
  2. Spironolactone (Aldactone)
  3. Triamterene (Dyrenium)
66
Q

What are the side effects of potassium sparing diuretics?

A
  1. Hyperkalemia (High K)
  2. GI disturbances:
    - N/V/D
    - Anorexia
  3. Impotence and sexual dysfunction
  4. Gynecomastia
  5. Rash (SLE-like syndrome)

PANCE Review (9 decks)

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