Diabetes Medications

Question 1

How GLP-1 Receptor Agonist works?

Answer 1

Increase insulin release with food
Slow gastric emptying
Promote satiety
Suppress glucagon 
SE: pancreatitis, n/v, wt loss

Question 2

GLP-1 medications

Answer 2

exenatide (Byetta, Bydureon)
liraglutide (Victoza)
lixisenatide (Adlyxin)
albiglutide (Tanzium)
delaglutide (Trulicity)

Question 3

How Amylin Mimetic works?

Answer 3

Slow gastric emptying
Suppress glucagon
Promote satiety
SE: hypoglycemia 3 hrs post -injection, nausea, wt loss

Question 4

Amylin mimetic medications

Answer 4

pramlintide (Symlin)

Question 5

How Biguanides work?

Answer 5

Decrease hepatic glucose release

First line med at T2D diagnosis

Question 6

Biguanides medications

Answer 6

metformin (Glucophage)
Riomet (liquid metformin)
SE: B12 deficiency, nausea, bloating, diarrhea

Question 7

How Sulfonylureas work?

Answer 7

Stimulate sustained insulin release

SE: hypoglycemia. Wt gain

Question 8

Sulfonylurea medications

Answer 8

glyburide
glipizide (Glucotrol)
glimepiride (Amaryl)

Question 9

How SGLT2 Inhibitors work?

Answer 9

Decrease glucose reabsorption in kidneys

SE: risk for hypotension, increased urination, genital infection, ketoacidosis

Question 10

SGLT2 medications

Answer 10

canagliflozin (Invokana)
dapagliflozin (Farxiga)
Empagliflozin (Jardiance)

Question 11

How DPP 4 inhibitors work?

Answer 11

"Incretin Enhancers"
Prolongs action of gut hormones
Increases insulin secretion
Delays gastric emptying 
SE: Can cause severe, disabling joint pain

Question 12

DPP 4 inhibitors medications

Answer 12

sitagliptin (Januvia)
saxagliptin (Onglyza)
linagliptin (Tradjenta)
alogliptin (Nesina)

Question 13

How Thiazolidinediones TZDs work?

Answer 13

Increase insulin sensitivity

SE: CHF, increased peripheral fracture, risk of bladder cancer

Question 14

TZDs medications

Answer 14

pioglitazone (Actos)

rosiglitazone (Avandia)

Question 15

How Alpha-glucosidase Inhibitors work?

Answer 15

Inhibit the enzyme responsible for breaking down complex carbs in the small intestine. Lactose is not affected and milk is absorbed at its normal rate.
OJ, candy or regular soda have delayed metabolism in the presence of Acarbose.
Delay carb absorption
SE: GI effects

Question 16

Glucosidase Inhibitor medications

Answer 16

acarbose (Precose)

miglitol (Glyset)

Question 17

How Meglitinides work?

Answer 17

Stimulates rapid insulin burst

SE: hypoglycemia and wt gain

Question 18

Meglitinides medications

Answer 18

repaglinide (Prandin)

nateglinide (Starlix)

Question 19

Monotherapy

Answer 19

Lifestyle management +

Metformin alone

Question 20

Dual Therapy

Answer 20

Lifestyle management +
Metformin + Sulfonylurea
Metformin + TZD
Metformin + DPP- 4 inhibitor
Metformin + SGLT2 inhibitor
Metformin + GLP-1 receptor agonist
Metformin + Insulin (basal)

Question 21

Triple Therapy

Answer 21

Metformin + one of the following:
SUI + TZD or DPP 4, SGLT2-i, GLP-1, insulin
TZD + SU or DPP 4, SGLT2-i, GLP-1, insulin
DPP-4 + SU or TZD, SGLT2, insulin
SGLT2i + SU, TZD, DPP-4, GLP-1, insulin
GLP-1 + SU, TZD, SGLT2, insulin
Basal Insulin + TZD, DPP-4, SGLT2, GLP-1

Question 22

Combination Injectable Therapy

Answer 22

Basal insulin + mealtime insulin or GLP-1 RA

Alternative insulin regimen: premix insulin (2-3 injections daily)

Question 23

How many people have diabetes

Answer 23

18.8 million diagnosed
7 million have it but don’t know
76 have pre-diabetes

Question 24

empagliflozin (Jardiance) role in CVD

Answer 24

An SGLT-2 inhibitor

Reduces the risk of cardiovascular death in adults with type 2 DM.

Question 25

liraglutide (Victoza)

Answer 25

GLP-1 RA

reduces the risk of cardiovascular risk in adults with type 2 DM

Question 26

Afrezza (inhaled insulin)

Answer 26

Onset of action within 12 minutes
Peaks within 35-45 minutes 
Duration 1.5 hours for 4 unit cartridge
                3.0 hours for 12 unit cartridge 
"Ultra-rapid acting" class