Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm Endocrine > Diabetes - Oral > Flashcards

Diabetes - Oral Flashcards

1
Q

DPP-4 Inhibitors: Names and MOA

A

-gliptins

Sitagliptin
Saxagliptin
Linagliptin
Alogliptin

Prolong GLP1, increasing insulin, decreasing glucagon, improved satiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DPP-4 Inhibitors: Indications

A

2nd line, 1st line if no metformin
Less hypoglycemia
Weight neutral
A1C: 0.7-1.0%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DPP-4 Inhibitors: Side Effects

A

Headache
Nasopharyngitis
Pancreatitis??

Saxagliptin: Strong 3A4 inhibitor
All require renal adjustment except linagliptin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bile Acid Sequestrant

A 
Colesevelam 
Minimal A1C Reduction, Lowers LDL
3rd line tx
6 tabs Qday or 3tabs BID
Prevents absorption of: Synthroid, OCP, phenytoin, warfarin, digoxin
Malabsorption ADEK
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SGLT2 Inhibitors: Names and MOA

A

-flozin

Canagliflozin
Dapagliflozin
Empagliflozin
Ertugliflozin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SGLT2 Inhibitors: Indication

A 
Weight loss
Slight BP reduction
May increase LDL
Don't use in renal dysfxn
Expensive 
Add-on to metformin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SGLT2 Inhibitors: Side Effects

A

Genital fungal (yeast)
UTI
Polyuria
Hypotension

Canagliflozin: May increase stroke risk
Dapagliflozin: May increase bladder cancer risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Thiazolinideiones (TZDs): Name and MOA

A

-glitazone

Pioglitazone
Rosiglitazone: risk of MI, minimal use

Nuclear modifier: Stimulates PPAR-gamma, increasing insulin sensitivity, decreasing plasma fatty acids.

Up to 12 weeks max effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

TZDs: Side Effects and Indications

A

Lower A1C 1.0-1.5%

Fluid retention, edema. NO HEART FAILURE.
Hepatotoxicity.
Promotes ovulation.
Increases risk of upper/lower limb fracture
Increases risk of bladder cancer
Weight gain
Low hypoglycemia risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Alpha Glucosidase Inhibitors

A

Acarbose
Miglitol

TID w/ meals (containing carbohydrates), can skip if no carbs. Delays absorption.
3rd Line
Lower effectiveness 0.3-1.0%
SEs: gas, abd discomfort, diarrhea
Contraindication: IBD, Short Bowel, Creatinine >2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Metformin!

A

Biguanide. Max 2550 IR or 2000 XR.
1st line for everything? Reduces A1C 1.5-2% AVOID in liver or renal dz (cr < 30)
Weight neutral, low hypoglycemia risk, inexpensive.

WITHHOLD for surgery or contrast. Check renal fxn 48 hours after, can then restart.

SEs: Lactic acidosis. B12 absorption. GI, N/D.

MOA unclear: Increases insulin sensitivity, decreases hepatic glucose prod, improves lipids!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Non-Sulfonylurea Secretagogues AKA Meglitinides

A

-glitinides, -glinides

Nateglinide
Repaglinide (more effective)

MOA: Increase insulin by blocking ATP-sensitive K Channels. Shorter onset and duration that sulfonylureas.

Lower A1C 0.8-1.0%. Take 15-30min before meal.

Weight neutral, hypoglycemia.
2nd Line, 1st line of no metformin
No sulfa allergy
Use in combination, but NOT with sulfonylureas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sulfonylureas: Med Names

A

1st gen: (not preferred)
Chlorpropamide (avoid in renal impairment or elderly)
Tolazamide
Tolbutamide (no renal adjustment needed)

2nd Gen: (2nd line tx after metformin)
Glyburide (not preferred, more weight gain and hypoglycemia)
Glipizide
Glimeprimide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sulfonylureas: MOAs and Side effects

A 
2C9 Metabolism, first class of antihyperglycemics in US
Block ATP sensitive K channels to increase insulin secretion

Lower A1C 1.0-1.5%

HYPOGLYCEMIA + weight gain. Reduced efficacy over time. Start slow (esp elderly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dopamine Receptor Agonist

A

(Bromocriptine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Rapid Acting Insulins: Names

A

Aspart (Novolog)
Lispro (Humalog)
Glulisine (Apidra)

Analogs!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Rapid Acting Insulins: Onset, Peak, Duration

A

Onset: 10-30 Min
Peak: 1 hour to 3 (aspart), 4.3 (Humalog), 1.5 (glulusine)
Duration: 3-5 (aspart, glulisine), 4-6 (Humalog)

18
Q

Short Acting Human

A

Regular (Humulin, Novolin)

Onset: 0.5-1 hr. Peak 2-3 hours. Duration 3-6 hours.

19
Q

Intermediate Acting Human

A

NPH; cloudy

Onset: 1-2 hours, peak 6-14 hours, duration 16-24 hours

20
Q

Long Acting

A

Detemir (Levemir): Onset 1-2, Peak 6-8, Duration 24

Glargine (Lantus): Onset 1, Peak 2-20, Duration 24

21
Q

Premixed: (Longer/Shorter)

A

Analogs:
Novolog, Novolin Mix (70/30)
Humalog 75/25, 50/50

Human:
Humulin, Novolin 70/30
Humalin 5050

22
Q

Correction Factor

A

How much will one unit of insulin drop blood sugar?

Rapid: 1700/TDD
Regular: 1500/TDD

23
Q

Insulin : Carbs Ratio

A

How many grams of carbs will one unit of insulin cover?

Rapid: 500/TDD
Regular: 450/TDD

24
Q

When to add insulin?

A

A1C > 9% and symptomatic
A1C >7.5% after 3mo of triple therapy

If A1C > 8.5%; multidose insulin. If 7.5-8.5; once-daily.
Simplest: Add basal or premixed

25
Q

GLP1 Receptor Agonist w/ BBW for medullary thyroid carcinoma?

A

Semaglutide

26
Q

Contraindication for pramlintide?

A

Gastroparesis

27
Q

Dosing for pramlintide?

A

Type 1: 15(start)-60(max) mcg SubQ before meals (TID)

Type 2: 60-120mcg TID SQ

28
Q

How much insulin to start?

A

Basal: 10 units, or 0.15u/kg/day (up to 0.3 if severe); titrate q2-3 days

29
Q

Insulin sliding scale?

A

Start at 150 at 2u for normal sensitivity; increase by 2u per 50.

Highly insulin sensitivity: 50% of normal

High insulin resistance: 150% of normal

30
Q

Pre-meal insulin?

A

50% of TDD / 3 daily doses

31
Q

Diabetes goals:

A

<6.5: no serious illness, low hypoglycemic risk

>6.5: serious illness, risk for hypoglycemia, low life expectancy

32
Q

Diabetes Dx:

A

Fasting (8 hrs): >126
OGTT: >200 after 2hours
A1C > 6.5
Random Plasma >200

33
Q

Impaired glucose tolerance dx:

A

Fasting: 100-125
OGT: 140-199 after 2 hours
A1C: 5.7-6.4

34
Q

Screening:

A

Age 45 w/o risk factors, repeat q3. More frequent if overweight + risk factor.

35
Q

Pre/post prandial goals:

A

Pre: 80-130
Post: <180

36
Q

Pregnant A1C goal:

A

less than 6% if no hypoglycemia

37
Q

May target A1C less than 6.5:

A

Long life expectancy
DM2 with lifestyle/metformin only
No significant CV disease

38
Q

May target A1C less than 8:

A 
h/o severe hypoglycemia
Poor life expectancy
Advanced vascular complications, extensive co-morbidities
Long standing DM
Multiple agents tried
39
Q

GLP1 Receptor Agonists given 1/week

A

Exenatide XR (Bydureon)
Dulaglutide (Trulicity)
Albiglutide: brand dc’d
Semaglutide: not preferred d/t inc thyroid caner risk

40
Q

Can be used for DM1:

A

Pramlintide; may reduce insulin by 50%

Pharm Endocrine (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions