Diabetes Medication Management Flashcards
When monitoring DM, how often do you repeat HgA1C?
Q 3 months when titrating or unstable
Q 6 months once stable
At what HgA1C would you consider adding additional medications?
> 8.0 (always check compliance prior to adding a new med)
What is the gold standard for diagnosing DM?
FBS reading >126 over 2 seperate occasions
Outside of gold standard and HgA1C, when can a random BS dx DM?
Any random glucose >220 w/ classical sx of DM such as increased urination, thirst, dry mouth, or infection
What two drug types are considered sensitizers?
Biguanides (metformin)
and
TZDs (Actos/Avandia)
How does metformin work?
Increases sensitvity to insulin
Decreasing hepatic glucose production by decreasing glyconeogenesis
Increase glucose uptake by skeletal muscles
Inhibit GI glucose absorbtion
What are some benefits of metformin over other ODAs?
Price- inexpensive
Weight loss
Less side affects than other agents
Long-term use of this drug can lead to B12 deficiency?
Metformin
Which drugs are preferred 2nd/3rd line ODAs?
GLP-1RA “tides”
SGLT-2I “flozins”
DPP-4i “liptins”
Alph-Glucosidase inhibitors (AGi) “o/ose”
What considerations are issued for TZDs and SU/GLNs when considering as 1st/2nd/3rd line agents?
Caution is advised due to side affects:
TZDs -actos (CHF, fracture risk and weight gain)
Sulfonylureas (SU) “ides” & Meglitinides (GLN) “linides”- (weight gain, ASCD risk)
TZDs (zones) works by what mechanism?
Actos/Avandia works are also sensitizers activate a nuclear receptor (PPAR Gama gene) which increases use of insulin by the liver, muscle cells and adipose tissue.
Also reduces hepatic glucose production so that appropriate amount of glucagon is produced.
Which two drug types are considered secretogogues?
Sulfonylureas (ides) - glipizide, glyburide
Meglitinides (glinides)- repaglinide (prandin), nateglinide (starlix)
How do secretagogues work?
Close potassium channel in the beta cells which opens the calcium channel thusly increasing insulin secretion.
Which type of drug’s main benefit is for patients with post prandial glucose spikes and why?
Meglitinides (Prandin/Starlix) are both short acting pro insulin secreting drugs. Works similar to normal insulin response to elevated glucose.
The are usually administered TID PP
Sulfonylureas are more likely to cause this side affect?
Hypoglycemia
Alpha glycocidase inhibitors (AGi) (acarbose/precose, miglitol/glyset) affect blood sugar by?
Slowing carbohydrate metabolism and absorbtion through the GI tract.
Alpha glycocidase inhibitors (AGi) (acarbose/precose, miglitol/glyset) have what common side affect?
GI disturbance- diarrhea, bloating, flatulence
True or false? AGi have greater reduction in A1C in combination with another drug?
True
These peptide analoges work like secretagoges to improve insulin secretion?
GLP-1”tides” Dulglutide (trulicity), Exenatide (byetta), Liraglutide (Victoza), Semaglutide (Ozempic)
DDP-4 “liptin” Sitagliptin (Januvia)
Which GLP1 RA may reduce risk of CVD death?
Liraglutide (Victoza)
Benefits of GLP-1RA include?
Some weight loss and significant lowering of BS
Januvia is what type of ODA?
DDP-4 i
What type of ODA has the highest risk of joint pain and HF risk?
DDP-4 i “liptin” sitagliptin (Januvia)
Glycosurics reduce blood sugar by eliminating glucose in the urine, which type of drug belongs to this class?
SGLT-2 i “flozins” Canaglifolzin (Invokana), Empagliflozin (Jardiance)
SGLT-2i “flozins” have the highest risk for?
DKA
What drugs should not be given with Metformin because they oppose the action of metformin?
Loop & thiazide diuretics
Steroids
This drug needs to be held 48 hours prior (if possible) and 48 hours after the administration of IV contrast dye?
Metformin
Which drug can lower triglyceride and LDL levels?
Metformin
Which ODA class can raise HDL and LDL levels?
TZDs (actos/avandia)
When on a SGLT-2i “lozin,” what may happen to the LDL?
Elevate
Which drug is contraindicated in HF patients?
TZDs (actos/avandia)
Liver enzymes should be monitored when someone is taking this drug?
TZDs (actos/avandia)
Actos/Avandia are what type of drugs?
TZDs
Glipizide/Glucotrol, Glimeperide/Amaryl and Glyburide/Diabeta are what type of drugs?
Sulfonylureas: secretagoges with high hypoglycemia and weight gain risk
Sitagliptin (Januvia) Saxagliptin (Onglyza) Linaglipitn (Tradjenta) Aloglipitn (Nesina) Are what type of ODA?
DDP4-i: secretagogues that affect postprandial with No hypoglycemia
Expensive
Pepaglinide (Prandin) and nateglinide (Starlix) are what type of ODAs?
Meglintides which minizime postprandial blood sugar
Exenatide (Byetta), liraglutide (Victoza), albiglutide (tanzeum) and dulaglutide (trulicity) are which types of ODAs?
GLP-1 agonist: increases insulin release postprandial.
Canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance) are what type of ODAs?
SGLT2 inhibitors: increase glucose secreted in the urine.
Acarbose (Precose) and Miglitol (Glyset) are which type of ODAs?
Alpha-glucosidase inhibitors: slows intestinal carbohydrate digestion & absorbtion
Slows GI emptying- decreasing appetite and weight loss.
Expensive and by injection only
watch N/V GI distress. Cannot use with gastroparesis.
Which ODA class would this be?
GLP-1
Which ODAs have the highest effect on A1C (= or > 1%)
Biguanides (1-1.5%), GLP-1(1%) and SGLT-2 (.7-1%)
Which ODA has the lowest affect on A1c and is generally not given alone?
AG i
This class has High hypoglycemia risk if used w/ sulfonylurea, DPP4 & GLP1.
Additional risk profile includes DKA & urosepsis. One drug in this class,
Jardiance, has the benefit of Weight loss and lowers BP.
SGLT inhibitors (flozins)
