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Diabetes meds Flashcards

1
Q

One time, I got an old lady’s blood in my eye, and the ED doc said I’m at risk of catching her diabetes.

A

Don’t be like that doc.

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2
Q

Glipizide: class

A

Sulfonylurea

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3
Q

Glipizide: MOA

A

Increases beta cell insulin secretion

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4
Q

Glipizide: indication

A

T2DM

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5
Q

Glipizide: side effects

A

Hypoglycemia, wt gain

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6
Q

Glipizide: contraindications

A

Sulfa allergy; T1DM

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7
Q

Glipizide: Dx-Dx

A

Beta blockers may mask hypoglycemic sxs

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8
Q

Do not exceed this daily dose of Glipizide…

A

20mg

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9
Q

You’re Pt’s on Glipizide. What are you expecting to happen one day?

A

B-cell burnout.

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10
Q

Repaglinide: class

A

Meglitinide

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11
Q

Repaglinide: MOA

A

Binds adjacent to the sulfonylurea receptor in increases B-cell insulin secretion.

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12
Q

Repaglinide: indication

A

T2DM with a sulfa allergy

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13
Q

Repaglinide: side effects

A

Hypoglycemia, seizures with OD

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14
Q

Repaglinide: contraindication

A

Advanced renal/hepatic disease; T1DM

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15
Q

Repaglinide: Dx-Dx

A

Multiple (CYP3A4 substrate)

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16
Q

Let’s compare Repaglinide to Glipizide…

A

Repaglinide has a faster onset and shorter duration.

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17
Q

How do you take Repaglinide?

A

PO TID 15 mins before meals

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18
Q

Metformin: class

A

Biguanide

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19
Q

Metformin: MOA

A

Decr hepatic glucose production
Decr insulin resistance
Slows intestinal glucose absorption

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20
Q

Metformin: indication

A

DOC for T2DM

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21
Q

Metformin: side effects

A

GI upset; possible lactic acidosis

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22
Q

Metformin: contrainidcations

A

Renal/hepatic disease

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23
Q

Metformin: Dx-Dx

A

IV contrast, etoh, diuretics

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24
Q

Actos: class

A

TZD

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25
Actos: MOA
Decr insulin resistance by activating nuclear PPAR-y.
26
Actos: indication
T2DM
27
Actos: side effects
Edema, may incr Fx risk in women
28
Actos: contraindication
Pregnancy, diabetic retinopathy
29
Actos: Dx-Dx
Competes with CYP3A4 substrates
30
What does Actos require in order to work?
Insulin
31
Actos may stimulate...
Ovulation
32
Precose: class
Alpha-glucosidase inhibitor
33
Precose: MOA
Inhibits conversion of polysaccharides to monosaccharides
34
Precose: indication
T1DM, T2DM
35
Precose: side effects
GI upset
36
Precose: contraindication
IBD, IBS
37
How do you take Precose?
PO before each meal
38
Januvia: class
DPP-4 inhibitor
39
Januvia: MOA
DPP-4 inhibition reduces GLP-1 degredation
40
Januvia: indication
T2DM
41
Januvia: side effects
diarrhea, nasopharyngitis
42
You're old enough now. It's time we talked about...
Insulin
43
Rapid-acting insulin
Humalog
44
Humalog: onset/peak/duration
Onset: 5-15 min Peak: 1-1.5 hrs Duration: 3-5 hrs
45
Short-acting insulin
Humulin-R
46
Humulin-R: onset/peak/duration
Onset: 30-60 min Peak: 2-4 hrs Duration: 5-8 hrs
47
Intermediate-acting insulin
Humulin-N
48
Humulin-N: onset/peak/duration
Onset: 2-4 hours Peak: 4-10 hours Duration: 10-24 hours
49
Long-acting insulin
Lantus
50
Lantus: onset/peak/duration
Onset: 2-4 hours Peak: none Duration: 20-24 hours
51
Is it okay to mix other insulins with your Lantus in the same syringe?
No, no it isn't.
52
In what two concentrations is Lantus available?
100u/mL | 300u/mL
53
Afrezza: class
Oral inhalation rapid acting insulin
54
Afrezza: MOA
Inhaled insulin
55
Afrezza: indication
T1DM, T2DM | Use with a long-acting insulin
56
Afrezza: side effects
May decr FEV1
57
Afrezza: contraindication
Smoking w/in 6 months
58
Symlin: class
Amylin analog
59
Symlin: MOA
Decr gastric emptying, glucagon secretion, appetite
60
Symlin: indication
T1DM, T2DM | Use with a long-acting insulin
61
Symlin: side effects
anorexia, hypoglycemia
62
Symlin: contraindication
Gastroparesis
63
When do you take Symlin?
15 mins before meals
64
Can you mix Symlin with insulin?
No....I'm beginning to be concerned about your obsession with mixing things into your insulin....get a hobby already.
65
Byetta: class
Incretin mimetic: GLP-1
66
Byetta: MOA
Incr insulin secretion Decr glucagon secretion Slows gastric emptying Decr appetite
67
Byetta: indication
T2DM with Metformin, +/- Sulfonylurea
68
Byette: side effects
Necrotizing hemorrhagic pancreatitis
69
Oh, you have necrotizing hemorrhagic pancreatitis?
Come back when you've got real problems.
70
How do you take Byette?
SQ BID 60 mins before meals
71
T1/2 of Byette?
2.5 hours
72
Victoza: class
Incretin mimetic: GLP-1
73
Victoza: MOA
Incr insulin secretion Decr glucagon secretion Slows gastric emptying Decr appetite
74
Victoza: indication
T2DM with Metformin, +/- Sulfonylurea
75
Victoza: side effects
Necrotizing hemorrhagic pancreatitis AND HTN....okay now you have problems
76
How do you take Victoza?
With a side of necrotizing hemorrhagic pancreatitis plase
77
Okay, how do you really take Victoza?
SQ BID before meals
78
Victoza: t1/2
13 hours
79
Invokana: class
SGLT2 inhibitor
80
Invokana: MOA
Inhibits glucose resorption in proximal renal tubule
81
Invokana: indication
T2DM adjunct therapy
82
Invokan: side effects
Vulvovaginitis, UTI
83
Invokana: contraindications
GFR below 30
84
Invokana: Dx-Dx
Ace-I/ARBs Steroids K+ sparing diuretics SSRIs
85
Welchol: class
Bile acid sequesterant
86
Welchol: MOA
Unknown in DM
87
Welchol: indication
Adjunct to Metformin, Sulfonylureas, insulin in T2DM
88
Welchol: side effects
Constipation, abd pn, incr triglycerides
89
Welchol: contraindication
Bowel obstruction
90
Welchol: Dx-Dx
May inhibit absorption of other drugs
91
D/C Welchol if triglycerides exceed
500
92
Desmopression: class
Vasopressin receptor agonist
93
Desmopressin: MOA
Incr renal H2O resoprtion
94
Desmopressin: indication
Diabetes insipidus
95
Desmopressin: side effects
BP changes | decr plasma osmalality
96
Desmopressin: contraindication
Hyponatremia
97
Desmopressin: Dx-Dx
Lithium, SSRIs, NSAIDs, etoh
98
Okay, let's talk about A1c
Okay, let's.
99
What drug classes lower A1c by ~0.5-1.0%?
``` GLP-1 Meglitinide Alpha-glucosidase DPP-4 inhibitor Amylin analog SGLT2 inhibitor Bile acid sequestrant ```
100
What drug classes lower A1c ~1-1.5%?
Sulfonylurea Biguanide TZD
101
What drug class lowers A1c ~1.5-3.5%?
Insulin

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