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Summer FDTN Exam 2 > Diabetes meds > Flashcards

Diabetes meds Flashcards

1
Q

How does metformin work

A

inhibits gluconeogenesis= less hepatic glucose output
Increases insulin mediated glucose utilization in peripheral tissues
Yields 1-2% drop in A1c!
Weight neutral!

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2
Q

Side effects of Metformin are

A

GI s/e (diarrhea during titration)
Reduce intestine absorption of B12
IV contrast concerns; stop w/ IV contrast
CI if GFR <30

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3
Q

What are the Sulfonylureas

A

Glipizide
Glyburide
Glimepiride

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4
Q

How do Sulfonylureas work

A

stimulate insulin secretion from beta cells

yield 1-2% drop in A1c, but mildly less than metformin

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5
Q

Side effects of sulfonylureas are

A

high risk of hypoglycemia

weight gain

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6
Q

What are the GLP-1 agonists

A 
TIDE's 
Exenatide 
Liraglutide 
Dulaglutide 
Albiglutide 
Lixisenatide 
Semaglutide
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7
Q

What is the “incretin effect”

A

oral glucose > IV glucose at stimulating insulin secretion 2/2 GI peptides (GLP) released in response to a meal

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8
Q

How do GLP agonists work

A 
stimulate insulin release from beta cells 
slow gastric emptying 
inhibit post-meal glucagon secretion
Yields 0.5-1% drop in A1c 
*Usu add on Tx*
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9
Q

Side effects of GLP agonists are

A

weight loss

N/V/D (warn pt)

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10
Q

Which GLP agonists yield improved cardiac outcomes

A

Liraglutide

Semaglutide

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11
Q

What are the DPP4 inhibitors

A 
GLIPTAN's 
Sitagliptan 
Saxagliptin
Linagliptin 
Alogliptin
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12
Q

How do DPP4 inhibitors work

A 
DPP4 usually inactivates GLP-1 
Block DPP4= allow GLP-1 to stimulate insulin, inhibit glucagon, and slow gastric emptying 
Yield 0.5-0.8% drop in A1c 
*Usu add on Tx* 
Weight neutral!
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13
Q

What are the SGLT2 inhibitors

A

FLOZIN’s
Empagliflozin
Canagliflozin
Dapagliflozin

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14
Q

How do SGLT2 inhibitors work

A

Sodium glucose cotransporters are in the proximal tubule and cause reabsorption of 90% of glucose
Inhibit transporters= increase glucose urine excretion= reduced blood glucose
Yield 0.5-0.7% drop in A1c
Usu add on Tx

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15
Q

Side effects of SGLT2 inhibitors are

A

Weight loss
reduced BP
+/- CV mortality
Vulvovaginal candidiasis, UTI

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16
Q

What are the Thiazolidinediones (TZD)

A

*Pioglitazone

Rosiglitazone

17
Q

How do Thiazolidinediones work

A

Improve insulin action
increase insulin sensitivity in adipose, muscle, and liver
Yield 0.5-1.4% drop in A1c
Usu add on Tx

18
Q

ADE of Thiazolidinediones are

A 
fluid retention, HF 
weight gain 
bone fractures 
\+/- increase in MI w/ Rosiglitazone 
\+/- increase in bladder cancer w/ Pioglitazone
19
Q

Thiazolidinediones are contraindicated in

A 
Sx HF 
Class III-IV HF 
bladder cancer 
high fracture risk 
liver disease
20
Q

What are the Meglitinides

A

Nateglinide

Repaglinide

21
Q

How do Meglitinides work

A

Stimulate insulin secretion from beta cells
take WITH MEALS to reduce post-prandial hyperglycemia
Yield 0.5-1% drop in A1c
Usu add on Tx

22
Q

Side effects of Meglitinides are

A

risk of hypoglycemia

weight gain

23
Q

What are the alpha glucosidase inhibitors

A

Acarbose

Miglitol

24
Q

How do alpha glucosidase inhibitors work

A

decrease absorption of glucose (take WITH meals)
Yield 0.5-0.8% drop in A1c
Usu add on Tx
Weight neutral!

25
Q

What are the side effects of alpha glucosidase inhibitors

A

flatulence

diarrhea

26
Q

What are the insulin therapy options

A

Basal therapy
Intensive insulin therapy
*Used when PO meds no longer work

27
Q

Side effects of insulin therapy are

A

weight gain

hypoglycemia

28
Q

What are the basal insulin therapy meds (long acting, 24 hr)

A

NPH
Glargine
Detemir
Degludec

29
Q

what are the prandial insulin therapy meds

A

NPH short acting

Rapid acting: Lispro, aspart, glulisine

30
Q

How do you decide what meds to give based on A1c

A

A1c <9%: Monotherapy (metformin + life management)
A1c >9%: dual therapy
A1c >10% and BG 300+: combo injectable therapy

31
Q

When should you monitor/change monotherapy

A

Check A1c at 3 months.
If at target: monitor 1 3-6 months
If not target: assess meds and behavior, consider dual therapy

32
Q

When should you monitor/change dual therapy

A

Check A1c at 3 months.
At target: monitor q 3-6 months
Not at target: assess meds and behavior, consider triple therapy

33
Q

How do you choose a second agent in dual therapy

A

If w/ ASCVD: add agent that will reduce major adverse CV effects
If no ASCVD: add an agent considering drug specific events and pt factors

34
Q

How do you monitor triple therapy

A

Check A1c at 3 months.
At target: monitor A1c q 3-6 months
Not at target: assess meds and behavior, consider injectable therapy

35
Q

How do you start basal insulin therapy

A

at 10 units x day. increase by 1 unit daily and monitor FPG until target FPG is reached

36
Q

If A1c is not controlled on Metformin + initial basal insulin therapy

A
  • Add rapid acting insulin injection before largest meal
  • Add GLP-1
  • Change to premixed insulin BID before breakfast and dinner
37
Q

An important consideration when choosing insulin therapy for a patient is

A

Cost!

insulin therapy is getting more expensive

Summer FDTN Exam 2 (11 decks)

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