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PHAR 152 > Diabetes - Part 5 > Flashcards

Diabetes - Part 5 Flashcards

1
Q

What are the SGLT2 inhibitors?

A

Dapagliflozin
Canagliflozin
Empagliflozin

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2
Q

What is the MOA of SGLT2 inhibitors?

A

SGLT2 us a high capacity transporter that is responsible for glucose reabsorption (90%) from the glomerular filtrate, & is over expressed in those with T2DM
These drugs inhibit SGLT2, thereby decreasing the reabsorption of glucose and increasing urinary glucose excretion

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3
Q

What is the efficacy of SGLT2 inhibitors?

A

Decrease A1C by 0.5-0.8% in clinical trials as add-on agent
Works on both FPG and PPG
Fast acting
Require functioning nephrons to work

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4
Q

What effect on weight do SGLT2 inhibitors have?

A

~2-3kg avg weight loss
Plateaus at 26 weeks; is sustained

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5
Q

What is the dosing for SGLT2 inhibitors?

A

Oral OD medications
Start at low dose
Results are not dose dependent

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6
Q

What is the renal dosing for SGLT2 inhibitors?

A

At eGFR ,45, no longer effective for BG (but beneficial for cardio renal protection)

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7
Q

What initially happens when starting a SGLT2 inhibitor?

A

Decrease in kidney function - about 5ml/min in eGFR
- will be reversed if drug is discontinued

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8
Q

What are the adverse effects of SGLT2 inhibitors?

A

Most common: increase urination, increase thirst, mycotic gentian infections
Less common/rare: UTIs, DKA

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9
Q

What are the precautions for SGLT2 inhibitors?

A

Dehydration potential: use cautiously in patients at risk for volume depletion effects
DKA risk: rare but sever if it occurs

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10
Q

What drug interactions do SGLT2 inhibitors have?

A

Use with diuretics may increase risk of hypovolemia and hypotension

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11
Q

Are SGLT2i cardioprotective?

A

Yes they are, they showed reduction in hospitalization for HF

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12
Q

Which SGLT2i is covered under the Sask formulary for treatment of class II and III HF?

A

Dapa

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13
Q

What are the premixed insulins for T2?

A

Premixed regular insulin - NPH (cloudy)
Premixed insulin analogues (cloudy)

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14
Q

What are the premixed regular insulins - NPH?

A

Humulin 30/70 and novolin ge 30/70 - 30% regular/70% NPH
Novolin ge 40/60 - regular/NPH
Novolin ge 50/50 - regular/NPH

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15
Q

What are the premixed insulin analogues?

A

Novomix 30 - 30% insulin aspart/70% insulin aspart protamine crystals
Humalog Mix25 - 25% insulin lispro/75% insulin lispro protamine
Humalog Mix50 - 50% insulin lispro/50% insulin lispro protamine

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16
Q

What long before each meal should each type of premixed insulin be administered?

A

Premix regular - 30-45 minutes before starting a meal
Premix analogues - up to 15 minutes before or after a meal

17
Q

What are the barriers to insulin from patients?

A

More complexity
Sense of failure
Fear of hypo
Needle phobia
Fear/denial of disease progression

18
Q

What are the barriers to insulin from HCPs?

A

More complexity
Fear of hypo
Patients cognitive ability to handle it

19
Q

What are the insulin option for T2?

A
  1. Basal insulin + anti hyperglycemic medications
    - usually initiated as 10U at bedtime
  2. Basal and Bolus insulin
  3. Biphasic (premixed) insulin
20
Q

Which insulin initiation option is preferred and why?

A

Basal only because:
- simplicity
- minimization of weight gain and hypo
- keeping oral meds on board helps with insulin sensitization

21
Q

What are the options for if basal insulin/oral/sc pharmacotherapy is not working?

A

Evaluate / add other antihyperglycemics (DPP4i, GLP1RA, SGLT2i)
Basal insulin / GLP1RA combo products
Basal/Bolus

22
Q

What is the traditional treatment strategy for T2?

A

Lifestyle -> Metformin -> other oral agents -> insulin

23
Q

What are the A1C targets pre- and during pregnancy?

A

Pre-pregnancy: </=7.0% (ideally </= 6.5% if safe)
During pregnancy: </=6.5% (ideally </=6.1% if possible

24
Q

What medications should be used in preconception for pregnancy?

A

Add folic acid 1mg/d
Discontinue ACEi / ARB and statin therapy
For T1: insulin
For T2: can continue Metformin, glyburide, or insulin

25
Q

What is the DOC in pregnant women with diabetes?

A

Insulin
Then Metformin and then glyburide may be considered

26
Q

What is the first line treatment for GDM?

A

Diet and exercise

27
Q

What is the second line treatment for GDM?

A

Insulin
Alternative: Metformin and glyburide

28
Q

What is the A1C target for children?

A

<7 or 7.5% for all <18yo

29
Q

What should FPG be in children?

A

4-8 mmol/l

30
Q

What should the 2hr PPG be in children?

A

5-10 mmol/l

31
Q

What should we limit the use of for T2 in elderly?

A

SUs, TZDs
Choose DPP4is over SUs

PHAR 152 (10 decks)

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