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FA17 Endocrine > Diabetes Pharm > Flashcards

Diabetes Pharm Flashcards

1
Q

Drugs with little/no risk of HYPOGLYCEMIA (5)

A

Metformin

GLP-1 RA

SGLT2-I

DPP4-I

TZD

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2
Q

Drugs with HIGH risk of HYPOGLYCEMIA

A

Sulfonuryea

Insulin

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3
Q

Drugs causing weight gain?

A

Sulfunayrea

Insulin

TZD

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4
Q

Drugs causing weight loss

A

Metformin i

GLP-1 RA

SGLT2-I

DPP4-I

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5
Q

Metformin (glucophage)

MOA

A

Limits haptic production of glucophage

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6
Q

Metformin (Glucophage)

Indications + off label

A

Treatment of T2DM

Off-label: Pre diabetes prevention, PCOS

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7
Q

Metformin (Glucophage)

Effectiveness/Advantages

A

reduces A1C by 1.5-2%

Modest weight loss or weight stabilization

Low risk of hypoglycemia

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8
Q

Metformin (Glucophage)

S.E.

A

GI most common (allergies)

Diarrhea, N/V
Metallic taste
Minimized by gradual dose titration or XR formulations

Also can be done used in IV contrast (hold 48hrs before to 48hrs later)

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9
Q

Metformin

BBW

A

Elevated lactate and anion acidosis

Increased risk in renal impairment
Hypoperfusion
Hypoxia

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10
Q

Glucophage CI

A

Metformin

CKD 
Heart Failure
ALcohol use
Surgery 
Significant chronic liver disease

Can cause b12 deficiency

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11
Q

Sulfonylureas

MOA

A

Stimulate pancreatic beta cells to secrete more insulin REGARDLESS of glucose levels

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12
Q

Sulfonylureas

Drug list

A

glyburide (Micronase, Diabeta)

Glipizide (Glucotrol)

Glimepiride (Amaryl)

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13
Q

Sulfonylureas

SE/Adverse outcomes

A

Can cause weight gain

Can cause hypoglycemia

Increase in all cause mortality (may even increase CVD)

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14
Q

Sulfonylurea

Effectiveness

A

Reduces A1c by 1-2%

Effectiveness decreases over time as b-cell mass declines

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15
Q

Sulfonylurea

C/i

A

Sulfa allergic patients (avoid in those with SJS/TEN rxns)

G6PD def.

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16
Q

Sulfonylurea indications

A

Used often 2nd line therapy for T2DM

Falling out of favor

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17
Q

GLP-1 analogs

MOA + possible benefit

A

Stimulating glucose dependent insulin release from pancreatic islets

Slows gastric emptying, inhibits inappropriate post meal glucagon release and reduce food intake

MAY Also stimulate beta cell recovery

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18
Q

Drug list

GLP-1 analogs

A

Exenetide (Byetta, Bydureon) - daily, weekly

Liraglutide (Victoza) - daily

Albiglutide (Tanzeum) - weekly

Dulaglutide (Trulicity) -weekly

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19
Q

GLP-1 RA

Indications

A

Used 1st Lin in pts with T2DM

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20
Q

GLP-1 Analogs

Effectiveness

A

Lower A1c by 1%

21
Q

GLP-1 Analogs

ADRs

A

GI effects (cause nausea, v/d)

pancreatitis

Injection site reactions

Thyroid C cell tumors

22
Q

CI of GLP-1 Analogs

A

Stage V CKD

Also use caution in CKD stage IV

23
Q

DPP-IV inhibitors

MOA

A

Inhibits the breakdown and prolongs action of endogenous incretin hormones

24
Q

Drug list DPP-IV inhibitors

A

Stigalipitin (Januvia)

Sazeglipitin (Onglyza)

Linagliptin (Tradjenta)

Alogliptin (Nesina)

25
Q

Linagliptin

Special note

A

Tradjenta

No need to dose adjust for liver or kidney disease

26
Q

DPP-IV inhibitors

Benefits

A

Weight neutral

27
Q

DPP-IV inhibitors

ADRs/

A

Less effective than GLP -1

Pancreatitis

Alterations in immunity

HA, dizziness

Hepatic inflammation

Skin lesions

MSK

Increase HF

28
Q

DPP-IV inhibitors

Place in therapy

A

Can be first line, or more often used as add on

Lower A1c by 0.6-0.8%

29
Q

SGLT2 - Inhibitors

MOA

A

Blocks reabsorption of glucose in the kidney and causes glucose removal in the urine

Limited by amnt of glucose filtered and osmotic diuresis

30
Q

SGLT2 - Inhibitors

Benefits

A

Should not cause hypoglycemia

Promotes weight loss and lower blood pressure

31
Q

SGLT2 - Inhibitors

Effectiveness

A

First line monotherapy

Lowers A1c by 0.5-0.7% (moderately effective)

32
Q

SGLT2 - Inhibitors

Drug list

A

Canagliflozin (Invokana)

Dapagliflozin (Farxiga)

Empaglifozin (Jardiance)

33
Q

SGLT2 - Inhibitors

ADRs

A

Increased risk of infection + delays recognition of DKA (this is a problem bc infxn can cause DKA)

Can contribute to orthostatic hypotension + bone loss (will fall often, and break a hip)

May cause AKI, has to be dose adjusted in CKD

Increased risk of lower extremity amputation (canagliflozin)

34
Q

SGLT2 - Inhibitors

Special benefit of Empagliflozin

A

Lowers CV mortality !!

35
Q

TZD/Glitazones

Drug choices

A

Pioglitazone (Actos)

Rosiglitazone (Avandia)

36
Q

TZD/Glitazones

Effectiveness

A

Lower A1C by 0.5-1.4%

37
Q

TZD/Glitazones

SE (many!)

A

Believed to be causing MI at one time (associated with higher risk of HF)

Lipid effects (Ros- increase LDL)

Piog- increased risk of HF

causes weight gain

Can cause bladder cancer

Increase risk of osteoporosis

38
Q

TZD/Glitazones C/I

A

Patients w/NYHA class III or IV heart failure

39
Q

Drugs in Meglitinides class

A

Repaglinide (Prandin)

Nateglinide (Starlix)

40
Q

Meglitinides

Place in therapy

A

Diabetic patients who have allergies to sulfonylureas

Considerably more expensive with no real added benefit so really not used

41
Q

Meglitinides

SE

A

May lead to CV events

Caution in liver dz

Risk of weight gain

CI in CKD

42
Q

Alpha-glucosidase Inhibitors

MOA

A

Inhibits upper GI enzymes, so ingested polysaccharides are not converted to monosaccharides so decreased absorption in small intestine

Limits postprandial glucose excursions

43
Q

Alpha-glucosidase Inhibitors

Drug lists

A

Acarbose (Precose)

Miglitol (Glyset)

44
Q

Why are Alpha-glucosidase Inhibitors not used often

A

Can cause flatulence and diarrhea

Reduced efficacy (0.5-0.9%), high expense, and poor tolerance

45
Q

Rapid acting insulin

A

Absorbed more quickly than regular following injection

Onset of action is 5-10 min, peak 45-75 min, duration 2-4 hrs

Carbs should be ingested first, take 20 min before meal

46
Q

Types of rapid acting insulin

brand + generic

A

Insulin lispro (Humalog)

Insulin aspart (Novolog)

Insulin glulisine (Apidra)

47
Q

Regular insulin - short acting

Pharmacokinetics

A

Onset of 30 minutes

Peaks at 2.5-5 hrs

Duration is 4-12 hrs

48
Q

Regular insulin - short acting

Therapy use

A

Can be given as basal bonus for mealtime coverage (being replaced)

Main use is IV tx of DKA

FA17 Endocrine (10 decks)

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