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Year 1: Patho/Pharm > Diabetes PHARM > Flashcards

Diabetes PHARM Flashcards

1
Q

Metformin
Indications

A

Type 2 DM (non-insulin dependent) A1C > 6.5%

Safe in pregnancy and childhood (A1C > 9%)

PCOS to increase fertility
(insulin insensitivity, increases insulin = increase androgens = decrease fertility)

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1
Q

Metformin
MOA

A
  1. GI: Decrease GI absorption of glucose
  2. Muscle/Fat: Increase insulin sensitivity in periphery
  3. Liver: Prevents liver from synthesizing glucose (gluconeogenesis, glycogenolysis)
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2
Q

Metformin
SE/AE

A
  1. GI: N/V/D/anorexia
    - start low, go slow
  2. Macrocytic anemia (absorption vitamin B12 and folic acid inhibited)
    - pre-disposed to anemia
  3. Lactic acidosis
    - prevent mitochondria from oxidizing lactic acid
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3
Q

Metformin
Pros/Cons

A

Pros
- Cardioprotective: decrease MI
- Weight neutral
- Low risk hypoglycemia

Cons
- Toxicity (not metabolized, excreted by kidney)
- liver disease
- lactic acidosis

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4
Q

Metformin
Contraindications

A
  1. Kidney disease and nephrotoxic medications
    - high risk toxicity
    - D/C contrast dyes
  2. Liver disease
    - high risk toxicity and lactic acidosis
  3. Risk or history of lactic acidosis
    - Liver disease
    - alcoholism
    - hypoxia
    - sepsis
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5
Q

PRN medications
Metformin

A
  • Vitamin B12
  • Folic Acid
  • drink water to flush out
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6
Q

Patient Education
Metformin

A
  1. Take PRNs
    - vitamin B12
    - Folic acid
    - monitor S&S anemia
  2. Inform MD before contrast dyes
  3. Monitor for S&S lactic acidosis
    - hyperventilation
    - malaise
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7
Q

Metformin
Drug class

A

Biguanide

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8
Q

Sulfonylureas
Examples

A

Glyburide
Glimepiride
Glipizide

Insulin secretagogue

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9
Q

Sulfonylureas
Indication

A

Type 2 DM
non-insulin dependent

*Insulin secretagogues

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10
Q

Sulfonylureas
MOA

A
  1. increase insulin secretion
    - Blocks K ATPase islet cell
    - Depolarization
    - influx of calcium
    - release of insulin

*Insulin secretagogue

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11
Q

Sulfonylureas
SE/AE

A
  1. Hypoglycemia
    - increases release of insulin regardless of BG
    - *Glyburide >
  2. Hypoglycemic shock
  3. Weight gain
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12
Q

Sulfonylureas
Con

A

Weight gain
- increases insulin release
- anabolic hormone

Hypoglycemia
* do not combine with meglitinides or insulin

Cardio- neutral

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13
Q

Sulfonylureas
Contraindications

A

Liver or kidney disease
- accumulation drug to toxic levels

Hypoglycemia

Pregnancy and breast feeding

Insulin

Rx. Meglitinides (same mechanism, hypoglycemia)

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14
Q

Meglitinide
Examples

A

RepaGLINIDE
NateGLINIDE

Insulin secretagogues

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15
Q

Meglitinide
Indication

A

Lower post-prandial glucose
Taken TID with meals

Type 2 DM (non insulin dependent)

*insulin secretagogue

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16
Q

Meglitinide
MOA

A

*Same as sulfonylureases (faster acting, must be taken with meals)

  1. Increase insulin secretion
    - Block K ATPase
    - depolarization
    - influx calcium
    - release insulin
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17
Q

Meglitinide
SE/AE

A

Hypoglycemia and hypoglycemic shock
- must be dosed with meals

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18
Q

Meglitinide
Pros/Cons

A

Cons
- weight gain
- hypoglycemia
- cardio neutral

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19
Q

Meglitinide
Contraindications

A
  1. liver and kidney disease
    - accumulate to toxic levels
  2. pregnancy and breast feeding
  3. Rx. Sulfonylureas (glyburide, glimepiride, glipizide) = hypoglycemia
    * or insulin
  4. Empty stomach
  5. insulin dependence (will not work)
20
Q

Thiazolidinediones
Indicaiton

A

Type 2 DM (non-insulin dependent)

21
Q

Thiazolidinediones
Examples

A

RosiGLITAZONE

PioGLITAZONE

22
Q

Thiazolidinediones
SE/AE

A

Rosiglitazide - causes MI

Pioglitazide - Causes congestive heart failure (edema), and fractures

hypoglycemia

liver disease (monitor LFTs 3-6m)

bladder cancer

ovulation and unwanted pregnancies (PRN contraception)

macular degeneration

fractures (PRN vitamin D, calcium, excercise)

Dyslipidemia (high LDL, high HDL, low TG)

23
Q

Thiazolidinediones
Contraindications and Patient educaiton

A
  • liver disease and kidney disease
  • Monitor S&S liver failure, LFT monitoring
  • bladder cancer (personal or family history)
  • dyslipidemia
  • osteoporosis
  • PRN Calcium, vitamin D, exercise
  • macular degeneration (personal, family history)
  • history MI or heart failure
  • monitor S&S FVO
  • insulin
24
Q

thiazolidinediones
MOA

A

Activation peroxisome proliferator activated receptor gamma (PPAR gamma) –> transcription insulin responsive genes

  1. increase insulin sensitivity MSK/fat
  2. decrease liver production of glucose
25
Q

Acarbose
Indication

A

Type 2 DM
Adjunct medication

26
Q

Acarbose
MOA

A

Delays carbohydrate digestion and prevents post-prandial glucose spike

  • inhibits alpha glucosidase
  • cannot break down disaccharides into monosaccharides for absorption
27
Q

Acarbose
SE

A

GI:
Fermentation of disaccharides
Abdominal distention, bloating, gas, cramping, diarrhea

Anemia
- prevents absorption of iron

Liver damage
- LFT monitoring required

Inhibits treatments of hypoglycemia
- do not use disaccharide (use monosaccharide)

28
Q

Acarbose
Contraindications

A

Irritable bowel symdrome (IBS)

Irritable bowel disease (IBD)

Liver disease

Anemia

29
Q

Patient Education
Acarbose

A

Monitor for S&S anemia
- iron supplement

Monitor for S&S liver disease
- LFT blood monitoring Q3months

30
Q

Dipeptidyl peptidase 4 Inhibitors (DPP4)
Indication

A

Type 2 DM
Second line
combined with metformin therapy

Adjunct
- metformin
- sulfonylureas (glyburide, glimepiride, glipizide)
- thiazolidinediones (rosiglitazone, pioglitazone)

31
Q

Dipeptidyl peptidase 4 inhibitors
Examples

A

SaxaGLIPTIN
AloGLIPTIN
linaGIPTIN
sitaGLIPTIN

*incretin mimetics

32
Q

Dipeptidyl Peptidase 4 (DPP4) inhibitor
MOA

A

Block dipeptidyl peptidase 4 (DPP4), blocks degredation of incretin

Incretin stimulates
1. Insulin release
2. inhibits glucagon release
3. slows gastric emptying
4. inhibits appetite

33
Q

Dipeptidyl peptidase 4 (DPP4) inhibitor
SE/AE

A

Saxagliptin - heart failure

weight gain

Upper respiratory tract infections
- nasopharyngitis

Pancreatitis

Hypersensitivity reactions
- angioedema, anaphylaxis, SJS

34
Q

Dipeptidyl peptidase inhibitor (DPP4)
contraindications

A

Personal or family history
Pancreatitis

Patient Education
- Monitor S&S URT infection
- Monitor S&S pancreatitis

Heart failure
- saxagliptin

35
Q

Glucagon Like Peptide 1 Agonist (GLP1 agonist)
Indications

A

Type 2 DM (non insulin dependent)

36
Q

Glucagon like peptide 1 receptor agonist (GLP1 receptor agonist)
MOA

A

Incretin mimetic
*same MOA as DPP4 inhibitors

Increase activity of GLP1
1. increase insulin secretion
2. inhibit glucagon secretion
3. slow gastric emptying
4. decrease hunger

37
Q

GLP 1 receptor agonist
SE/AE

A

hypoglycemia (combination)

N/V/D

Antibodies against drug decrease action

Hypersensitivity - angioedema, anaphylaxis

Thyroid cancer, multiple endocrine neoplasia syndrome (MENS2)

Pancreatitis

Kidney failure

Retinopathy with large drop in A1C

Teratogenic

38
Q

GLP1 receptor agonists
Pros/Cons

A

Pros
- cardioprotective
- Reduce MACE in individuals with ASCVD and > 60 years
- weight loss

Cons
- subcutaneous injection
- antibodies against drug
- hypersensitivities
- renal failure
- retinopathy
- thyroid / endocrine cancer
- pancreatitis
- teratogenic

39
Q

Glucagon like peptide 1 receptor agonist (GLP 1)
Examples

A

LiraGLUTIDE
SEmaGLUTIDE
DulaGLUTIDE
ExenaTIDE

TirzepaTIDE (GIP and GLP1 receptor agonist)

40
Q

Contraindications
GLP-1 receptor agonists

A

Dehydration
- increase renal failure

Personal or family history
- thyroid cancer
- pancreatitis
- kidney disease
- retinopathy

Teratogenic
- pregnancy and breastfeeding

Hypersensitivity reactions

41
Q

Sodium Glucose Co-Transporter 2 (SGLT2) inhibitor
Indication

A
  1. HTN
  2. T2DM
42
Q

Sodium Glucose Co-transporter 2 (SGLT2) inhibitor
MOA

A

blocks sodium/glucose re-absorption by the kidney tubules (90%)

43
Q

Sodium Glucose Co-Transporter 2 (SGLT2) inhibitor
SE/AE

A
  1. osmotic diuresis
    - dehydration
    - polyuria
    - polydipsia
    - orthostatic hypotension (fall risk)
  2. Hyponatremia
  3. Glucosuria = UTI
    - infections
  4. Bladder cancer (Dapagliflozin)
44
Q

Sodium Glucose Co-Transporter 2 inhibitor
Contraindications

A

Kidney failure (GFR < 30mL/min)

Bladder cancer

UTI infections

45
Q

Benefits
SGLT2 inhibitors

A

Reduced MACE, HF, nephropathy in patients with ASCVD

weight loss

46
Q

Sodium Glucose Co-Transporter 2 Inhibitors (SGLT2)
Examples

A

CanaGLIFLOZIN
DapaGLIFLOZIN
EmpaGLIFLOZIN

47
Q

Cardioprotective
Anti-hyperglycemics

A

Metformin
- prevents MI

GLP1 receptor agonists
(semaglutide, liraglutide)
- prevent MACE in > 60 years with ASCVD

SGLT2 antagonists
- prevent HF
- prevent MACE
- nephroprotective

Year 1: Patho/Pharm (39 decks)

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