Diabetes Mellitus (AE/Contraindications/Monitoring)

Question 0

Name all monitoring parameters for the sulfonylureas?

Answer 0

Sulfonylureas: Glimepiride (Amaryl), Glipizide (Glucotrol), Glyburide (Diabeta, Micronase), Micronized Glyburide (Glynase)

Monitor:

1. BS
2. HgA1c
3. renal function
4. S/S of AE (hypoglycemia, weight gain, GI distress, etc.)

Question 1

What AE are associated with Glimepiride?

Answer 1

Glimepiride (Amaryl) Adverse Effects:

1. hypoglycemia
2. GI distress
3. weight gain
4. photosensitivity
5. disulfuram reaction (mostly occurs with Chlorpropamide 1st gen sulfonylureas)

Question 3

Metformin is contraindicated in patients with what condition(s)?

Answer 3

Metformin is CONTRAINDICATED:

1. renal insufficiency (SCr >1.4 female, >1.5male)
2. active liver disease
3. HF patients
4. previous Hx of LA
5. active alcoholic
6. IV contrast media (stop before procedure, start 1-2 days after finished)

Question 4

What are the 3 main AE associated with Metformin?

Answer 4

Adverse Effects:

1. GI (30%)
2. LA
3. Vit B12 deficiency

Question 5

Actos and Avandia are contraindicated in patients with what condition(s)?

Answer 5

Pioglitazone (Actos) and Rosiglitazone (Avandia) are CONTRAINDICATED:

1. HF
2. acute liver disease

Question 6

What parameters should be monitored for a patient taking Pioglitazone?

Answer 6

Monitor:

1. BS
2. HgA1c
3. LFT

Question 7

What are the major AE associated with the Thiazolidinidiones?

Answer 7

Thiazolidinidiones: Pioglitazone (Actos), Rosiglitazone (Avandia) Adverse Effect:

1. hematological anemias
2. LE edema
3. osteoporosis
4. GI
5. liver failure

Question 8

What are the major monitoring parameters for Miglitol?

Answer 8

Miglitol (Glyset) Monitor:

1. LFT
2. glycemic control
3. HgA1c

Question 9

Alpha-glucosidase inhibitors are contraindicated in patients with what condition(s)?

Answer 9

Alpha-glucosidase inhibitors: Acarbose (Precose), Miglitol (Glyset)

Contraindicated
1. Active obstructive or IBD and ulceration of colon

Question 10

What are the monitoring parameters for Starlix?

Answer 10

Meglitinide: Nateglinide (Starlix)

Monitor:
1. glycemic control
2. HgA1c
That it!!

Question 11

Meglitinides can cause what AE?

Answer 11

Meglitinides: Repaglinide (Prandin), Nateglinide (Starlix)

Adverse Effects:

1. hypoglycemia
2. HA

Question 12

What are the major AE of Pramlintide?

Answer 12

Amylin Analogue: Pramlintide (Symlin)

Adverse Effects:

1. Nausea
2. Hypoglycemia

Question 13

Name all monitoring parameters for Incretin Analogues?

Answer 13

Incretin Analogue: Exenatide (Byetta) Exenatide XR (Byduron), Liraglutide (Victoza)

Monitor:

1. glycemic control
2. HgA1c

Question 14

What AE might you expect from Liraglutide?

Answer 14

Liraglutide (Victoza)

Adverse Effects:

1. hypoglycemia
2. nausea
3. pancreatitis

Question 15

What AE might you expect from Onglyza and Januvia?

Answer 15

DPP-IV inhibitors: Saxagliptin (Onglyza), Alogliptin (Nesina)

Adverse Effects:

1. Hypoglycemia
2. Nausea
3. Diarrhea
4. Acute pancreatitis

Question 16

Name the SGLT-2 Inhibitors (brand and generic) and list the AE associated with them?

Answer 16

SGLT-2 Inhibitors: Canagliflozin (Invokana), Dapagliflozin (Farxiga)

Adverse Effects:

1. genital fungal infections
2. hypoglycemia
3. hypotension
4. increased LDL
5. bladder cancer

Question 17

Name the one DA agonist (brand and generic), give the dose, and list the AE associated with it?

Answer 17

DA agonist: Bromocriptine (Cycloset) 0.8mg po daily

Adverse Effects:

1. hypoglycemia (only if combined with another hypoglycemic agent)
2. constipation
3. dizziness
4. fatigue

Question 18

What are the 3 AE associated with Colesevelam?

Answer 18

Bile Acid Sequestrant: Colesevelam (Welchol)

Adverse Effects:

1. constipation
2. increased TG
3. GI distress

Question 19

Name all monitoring parameters for Glucophage?

Answer 19

Monitoring Parameters:

1. BS
2. Renal function
3. LFT
4. HgA1c