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OU Practice Spring 2018 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

DM

A

disease in which the body’s ability to produce and/or respond to insulin is impaired

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2
Q

Type 1 DM

A
  • Absolute deficiency of insulin production
  • Onset is usually during childhood
  • Etiology is mostly autoimmune in nature
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3
Q

Type 2 DM

A
  • Relative deficiency of insulin production associated with tissue insulin resistance
  • Most common
  • Usually occurs during adulthood
  • Etiology mostly due to genetics / lifestyle
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4
Q

hypoglycemia symptoms (< 70)

A
  • Tremors
  • Tachycardia
  • Diaphoresis
  • Dizziness
  • Anxiousness
  • Increased appetite
  • Impaired vision
  • Weakness
  • Headache
  • Irritability
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5
Q

hyperglycemia symptoms (fasting > 130, non-fasting > 180)

A
  • Frequent urination (polyuria)
  • Extreme thirst (polydipsia)
  • Sweet / Fruity breath
  • Somnolence
  • Increased appetite
  • Blurred vision
  • Nausea / Vomiting
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6
Q

non-DM drugs that cause glucose dysregulation: increase blood glucose

A
  • Systemic corticosteroids
  • Protease inhibitors (ritonavir)
  • Oral contraceptives (estrogens)
  • Diuretics (furosemide, HCTZ)
  • Atypical antipsychotics (olanzapine, clozapine)
  • Beta-agonists
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7
Q

non-DM drugs that cause glucose dysregulation: decrease blood glucose

A
  • Alcohol
  • Pentamidine
  • Fluoroquinolones
  • Beta-blockers
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8
Q

Metformin

A
  • Glucophage®, Glucophage XR®, Glumetza®
  • DM II
  • Decreases hepatic glucose production and intestinal glucose absorption
  • Improves insulin sensitivity by increasing glucose uptake and utilization in skeletal muscle and adipose tissue
  • drug interaction w/ ranolazine (increase metformin) and alcohol (can cause hypoglycemia)
  • d/c if pt is getting contrast dye b/c it can increase risk of metabolic acidosis
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9
Q

Metformin adverse effects

A
  • GI upset: N/D; try to avoid by starting low go slow, take with food, ER formulation
  • Vit B-12 deficiency
  • Lactic acidosis
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10
Q

Metformin precautions

A
  • Black box warning: lactic acidosis
  • Hepatic impairment
  • Renal impairment (eGFR 30-45 mL/min/1.73m2)
  • CV disease
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11
Q

Metformin contraindications

A
  • eGFR < 30 mL/min/1.73m2

- acute or chronic metabolic acidosis

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12
Q

Metformin counseling

A
  • take with food
  • shell of ER formulation may be visible in stool
  • weight neutral
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13
Q

Metformin dosing

A
  • 500mg po BID initially

- titrate up to max 2550mg/day

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14
Q

Sulfonylureas

A
  • DM II
  • Stimulates insulin secretion from functioning beta cells in the pancreas
  • Increase insulin sensitivity and lower hepatic glucose production
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15
Q

Sulfonylureas adverse effects

A
  • Hypoglycemia

- Weight gain

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16
Q

Sulfonylureas precautions

A
  • Renal / hepatic impairment
  • Sulfa allergy
  • G6PD deficiency
  • Do not use concomitantly with meglitinide class
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17
Q

Sulfonylureas contraindications

A
  • Ketoacidosis

- DM I

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18
Q

Sulfonylureas counseling

A
  • Maintain consistent diet; Take with breakfast
  • Weight gain (glyburide the most)
  • Decrease efficacy over time
  • Can cause hypoglycemia
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19
Q

What are the drugs in the Sulfonylureas class?

A
  • Glipizide (Glucotrol®, Glucotrol XL®)
  • Glyburide (Diabeta®, Micronase®)
  • Glimepiride (Amaryl®)
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20
Q

Glipizide

A
  • Glucotrol®, Glucotrol XL®

- Take 30 min before meals

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21
Q

Metformin dosage forms

A
  • Tablets: 500mg, 850mg, 1000mg
  • Extended Release tab: 500mg, 750mg
  • Osmotic release tab: 500mg, 750mg
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22
Q

Glipizide dosage forms

A
  • Tablets: 5mg, 10mg

- Extended Release tablets: 2.5mg, 5mg, 10mg (avoid in pts with GI obstruction)

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23
Q

Glipizide dosing

A

5-20mg per day (once daily or BID)

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24
Q

Glyburide

A
  • Diabeta®
  • Micronase®
    -Take with breakfast / first meal
  • not recommended in
    patients with chronic kidney disease (CKD)
  • Concomitant use with bosentan
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25
Q

Glyburide dosing forms

A

Tablets: 1.25mg, 2.5mg, 5mg

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26
Q

Glyburide dosing

A

2.5-5mg by mouth once or twice daily

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27
Q

Glimepiride

A
  • Amaryl®

- Take with breakfast / first main meal

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28
Q

Glimepiride dosage forms

A

Tablets: 1mg, 2mg, 4mg

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29
Q

Glimepiride dosing

A

1-4mg by mouth daily

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30
Q

Meglitinides

A
  • DM II
  • lowers blood glucose levels by stimulating release of insulin
  • interacts with ATP sensitive potassium channel on beta cells in pancreas
  • short half life
  • effective on postprandial glucose level
  • can have variable meal schedule
  • reduced hypoglycemia compared to sulfonylurea
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31
Q

Meglitinides adverse effects

A
  • Hypoglycemia

- Weight gain

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32
Q

Meglitinides precautions

A
  • Do not use with sulfonylureas

- Use with caution in renal / hepatic impairment

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33
Q

Which drugs are in the Meglitinides class?

A
  • Repaglinide (Prandin®)

- Nateglinide (Starlix®)

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34
Q

Repaglinide

A
  • Prandin®
  • If meal is skipped, skip dose -Take 30 min or less before meal
  • Contraindicated with concurrent gemfibrozil therapy
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35
Q

Repaglinide dosage forms

A

Tablets 0.5mg, 1mg, 2mg

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36
Q

Repaglinide dosing

A

0.5mg by mouth TID with meals

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37
Q

Nateglinide

A
  • Starlix®
  • If meal is skipped,
    skip dose
    -Take 30 min or less before meal
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38
Q

Nateglinide dosage forms

A

Tablets: 60mg, 120mg

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39
Q

Nateglinide dosing

A

60-120mg by mouth TID with meals

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40
Q

Alpha-glucosidase inhibitors

A
  • Lowers postprandial glucose by competitive, reversible inhibition of pancreatic alpha-amylase and membrane bound intestinal alpha-glucoside hydrolysis
  • Inhibits hydrolysis of complex starches; decrease glucose absorption
  • Does not enhance insulin secretion
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41
Q

Alpha-glucosidase inhibitors adverse effects

A
  • GI: flatulence, diarrhea, abdominal pain

- Elevated AST / ALT

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42
Q

Alpha-glucosidase inhibitors contraindications

A
  • Ketoacidosis
  • Chronic intestinal diseases associated with marked disorders of digestion or absorption conditions that may deteriorate as a result of increased gas formation in the intestine (ex. IBD, bowel obstruction, colonic ulceration)
  • Precaution: SCr > 2mg/dL or CrCl < 25mL/min
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43
Q

What drugs are in the Alpha-glucosidase inhibitors class?

A
  • Acarbose (Precose®)

- Miglitol (Glyset®)

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44
Q

Acarbose

A
  • Precose®

- Take with first bite of food

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45
Q

Miglitol

A
  • Glyset®
  • Take with first bite of food
  • Contraindicated in
    patients with cirrhosis
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46
Q

Acarbose dosage forms

A

Tablets: 25mg, 50mg, 100mg

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47
Q

Acarbose dosing

A

25mg by mouth TID

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48
Q

Miglitol dosage forms

A

Tablets: 25mg, 50mg, 100mg

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49
Q

Miglitol dosing

A

25mg by mouth TID

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50
Q

GLP-1

A
  • DMII
  • increase insulin in presence of elevated glucose
    concentration
  • decrease glucagon secretion in glucose-dependent manner
  • delays gastric emptying
  • regulates appetite
51
Q

GLP-1 adverse effects

A
  • N/V/D
  • headache
  • Pancreatitis
52
Q

GLP-1 precautions

A
  • boxed warning: thyroid cancer

- Pancreatitis

53
Q

GLP-1 counseling

A
  • injection technique

- weight loss

54
Q

Liraglutide dosage forms

A
  • Victoza®

- Prefilled pen: 0.6mg, 1.2mg, 1.8mg

55
Q

Liraglutide dosing

A
  • Victoza®

- 1.8mg SQ once daily

56
Q

Exenatide

A
  • Byetta®, Bydureon®
  • Byetta: INR increase (monitor warfarin)
  • CI with CrCl <30ml/min (both)
  • Bydureon need to assemble
57
Q

Exenatide dosage forms

A
  • Byetta: Prefilled pen (5mcg, 10mcg)

- Bydureon: 2mg

58
Q

Exenatide dosing

A
  • Byetta: 5-10mcg SQ once daily

- Bydureon: 2mg SQ every week

59
Q

Albiglutide

A
  • Tanzeum®

- Must dissolve first (15min for 30mg, 30min for 50mg)

60
Q

Dulaglutide dosage forms

A
  • Trulicity®

- Prefilled pen: 0.75mg, 1.5mg

61
Q

Dulaglutide dosing

A
  • Trulicity®

- SQ every week

62
Q

DPP-4 inhibitors

A
  • DM II
  • inhibit break down of GLP-6
  • used in combination with other products
63
Q

DPP-4 inhibitors precautions

A
  • renal insufficiency

- use with agents that cause hypoglycemia

64
Q

DPP-4 inhibitors adverse effects

A
  • Nasopharyngitis
  • Pancreatitis
  • Arthralgia
  • Angioedema
  • Urticaria
65
Q

DPP-4 inhibitors counseling

A
  • may take with or without food

- weight neutral

66
Q

What drugs are in the DPP-4 inhibitors class?

A
  • Sitagliptin (Januvia®)
  • Linagliptin (Tradjenta®)
  • Saxagliptin (Onglyza®)
  • Alogliptin (Nesina®)
67
Q

Sitagliptin

A
  • Januvia®
  • renal adjustment
  • May increase digoxin levels
68
Q

Sitagliptin dosage forms

A

Tablets 25mg, 50mg, 100mg

69
Q

Sitagliptin dosing

A

100mg by mouth once daily

70
Q

Linagliptin

A
  • Tradjenta®

- CYP3A4 interactions

71
Q

Linagliptin dosage forms

A

5mg tablets

72
Q

Linagliptin dosing

A

5mg by mouth once daily

73
Q

Saxagliptin

A
  • Onglyza®
  • renal adjustment
  • CYP3A4 interactions
  • New/worsening heart failure
74
Q

Saxagliptin dosage forms

A

Tablets 2.5mg, 5mg

75
Q

Saxagliptin dosing

A

2.5mg or 5mg by mouth once daily

76
Q

Alogliptin

A
  • Nesina®
  • renal adjustment
  • New/worsening heart failure
77
Q

Alogliptin dosage forms

A

25mg tablets

78
Q

Alogliptin dosing

A

25mg by mouth once daily

79
Q

SGLT2 inhibitors

A
  • DM II
  • reduce renal threshold
  • reduce glucose reabsorption
  • increase loss ofcluose in urine
  • reduce plasma glucose levels
80
Q

SGLT2 inhibitors precautions

A
  • Ketoacidosis
  • Hypotension
  • Fractures
  • Hyperkalemia
  • Renal impairment
  • CONTRAINDICATED in pts with CrCl < 30mL/min
81
Q

SGLT2 inhibitors adverse effects

A
  • UTI / gential fungal infections
  • increased urination
  • increased LDL
  • dizziness
82
Q

SGLT2 inhibitors counseling

A
  • weight loss

- signs / symptoms of decreased blood pressure

83
Q

What drugs are in the SGLT2 inhibitors class?

A
  • Cangliflozin (Invokana®)
  • Dapagliflozin (Farxiga®)
  • Empagliflozin (Jardiance®)
84
Q

Cangliflozin

A
  • Invokana®
  • Take with first meal of the day
  • 3A4 substrate
  • Only use 300mg with eGFR ≥60ml/min/1.73 m2)
  • increased risk of leg and foot amputations
85
Q

Cangliflozin dosage forms

A

Tablets 100mg, 300mg

86
Q

Cangliflozin dosing

A

100mg by mouth once daily

87
Q

Dapagliflozin dosage forms

A
  • Farxiga®

- Tablets 5mg, 10mg

88
Q

Dapagliflozin dosing

A
  • Farxiga®

- 5mg by mouth once daily

89
Q

Empagliflozin

A
  • Jardiance®
  • decrease CV mortality and hospitalization due to HF in Type II DM with CVD
  • Dose adjust with eGFR < 45 mL/min/1.73 m2
90
Q

Empagliflozin dosage forms

A

Tablets 10mg, 25mg

91
Q

Empagliflozin dosing

A

10mg by mouth once daily

92
Q

Thiazolidinediones (TZDs)

A
  • DM II
  • increased sensitivity of skeletal muscle
  • decreasing fatty acid at adipose tissue -> less ketoacidosis
  • increase lipogenesis
  • has drug interactions; 2C9, 3A4
93
Q

Thiazolidinediones (TZDs) adverse effects

A
  • edema
  • macular degeneration
  • weight fain
  • muscle pain
  • headache
94
Q

Thiazolidinediones (TZDs) precautions

A
  • edema
  • macular degeneration
  • bladder cancer
  • fractures
95
Q

Thiazolidinediones (TZDs) contraindication

A

heart failure (initiation of therapy)

96
Q

What drugs are in the Thiazolidinediones (TZDs) class?

A
  • Pioglitazone (Actos®)

- Rosiglitazone (Avandia®)

97
Q

Pioglitazone

A
  • Actos®
  • Decreased triglycerides
  • May reduce CVD
98
Q

Pioglitazone dosage forms

A

Tablets 15mg, 30mg, 45mg

99
Q

Pioglitazone dosing

A

15mg by mouth once daily

100
Q

Rosiglitazone

A
  • Avandia®
  • Increased LDL
  • Do not initiate in patients with stable IHD.
101
Q

Rosiglitazone dosage forms

A

Tablets 4mg, 8mg

102
Q

Rosiglitazone dosing

A

4mg by mouth once daily

103
Q

Glyburide- Metformin brand name

A
  • Glucovance®

- Sulfonylurea + Metformin

104
Q

Sitagliptan-Metformin brand name

A
  • Janumet®, Janumet XR®

- DPP-4 Inhibitor + Metformin

105
Q

Linagliptan-Metformin brand name

A
  • Jentadueto®, Jentadueto XR®

- DPP-4 Inhibitor + Metformin

106
Q

Saxagliptan-Metformin brand name

A
  • Kombiglyze®, Kombiglyze XR®

- DPP-4 Inhibitor + Metformin

107
Q

Canagliflozin-Metformin brand name

A
  • Invokamet®

- SGLT-2 Inhibitor + Metformin

108
Q

Empagliflozin-Linagliptin brand name

A
  • Glyxambi®

- SGLT-2 Inhibitor + DPP-4 Inhibitor

109
Q

PioglitazoleGlimepiride brand name

A
  • Duetact®

- TZD + Sulfonylurea

110
Q

insulin adverse effects

A
  • hypoglycemia
  • injection site reaction
  • weight gain
111
Q

insulin precautions

A

hypoglycemia

112
Q

insulin patient counseling

A
  • watch for signs/symptoms of hypoglycemia
  • alternate injection technique
  • when to administer
  • expiration date
  • blood glucose testing
  • sliding scale if applicable
113
Q

adverse effects associated with hypoglycemia

A
  • precipitation of acute cerebrovascular disease
  • MI
  • neurocognitive dysfunction
  • retinal cell death / vision loss
  • counter regulatory response
  • hypoglycemia unawareness
  • decreased psychological well-being and quality of life
114
Q

Insulin Asapart

A
  • Novolog®, Novolog Flexpen®
  • rapid acting
  • give 5-10 minutes before meal
115
Q

Insulin Lispro

A
  • Humalog®, Humalog Kwikpen®
  • rapid acting
  • give within 15 min of meal or immediately after
116
Q

Insulin Glulisine

A
  • Apidra®, Apidra Solostar®
  • rapid acting
  • give within 15 min before or within 20 min after starting meal
117
Q

What are the rapid acting insulin?

A
  • apart
  • lipro
  • glulisine
118
Q

Regular Insulin

A
  • Humulin R®, Novolin R®
  • intermediate acting
  • OTC
  • give 30 min prior to meal
  • Humulin R: Expires 28 days after opening
  • Novolin R: Expires 42 days after opening
119
Q

NPH

A
  • Humulin N, Novolin N
  • intermediate acting
  • OTC
  • cloudy appearance
  • Humulin N: Vials expires 28 days after opening, Pens 14 days
  • Novolin N: Expires 42 days after opening
120
Q

What are the intermediate acting insulin?

A
  • regular

- NPH

121
Q

Insulin Degludec

A
  • Tresiba Flextouch®
  • basal / long acting
  • dosed once daily, can be dosed anytime (not within 8 hours of last dose)
  • Expires 56 days after opening
122
Q

Insulin Detemir

A
  • Levemir®, Levemir Flextouch®
  • basal / long acting
  • can be given once or twice daily
    (12 hours apart)
  • Expires 42 days after opening
123
Q

Insulin Glargine

A
  • Lantus (U100®) vial and Solostar, Toujeo® (U-300) Solostar
  • basal / long acting
  • acidic pH -cloudy appearance
  • Toujeo® is more concentrated than Lantus®
  • Expires 28 days after opening
124
Q

What are the basal / long acting insulin?

A
  • Degludec
  • Detemir
  • Glargine

OU Practice Spring 2018 (9 decks)

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