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Therapeutics: Diabetes & Womens Health > Diabetes week 2- drugs > Flashcards

Diabetes week 2- drugs Flashcards

1
Q

if a pt is <65 y/o, healthy and without CVD- which guideline do you use?

A

AACE (strict target)
A1C < 6.5%
Pre-PG <110 mg/dl
PPG <140 mg/dL

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2
Q

If a pt is >65 OR <65 with CVD- which guideline do you use?

A

ADA (loose target)

  • A1C <7.5%
  • Pre-PG 80-130 mg/dL
  • PPG < 180 mg/dL
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3
Q

Benefits of lifestyle changes

A
  • weight reduction
  • healthy diet
  • exercise
  • smoking cessation
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4
Q

Sulfonylureas MOA & site of action

A
  • stimulate insulin release from beta cells

- PANCREAS!

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5
Q

Sulfonylurea drugs

A
  • Glyburide
  • GLipizide
  • Glimepride
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6
Q

which 2 (of 3) sulfonylureas are on the beers list?

A

-Glyburide (DO NOT USE with crcl <50) & Glimepiride

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7
Q

Side effects of sulfonyurea

A
  • hypoglycemia
  • N/V
  • weight gain (can still use this in phat ppl)
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8
Q

Sulfonylureas drug interactions

A
  • alcohol - flushing & potentiation of hypoglycemia
  • displaced protein binding
  • dec renal excretion
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9
Q

what sulfonylurea can you use in the elderly?

A

Glipizide

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10
Q

Sulfonylurea counseling points

A
  • take first thing in the am
  • take with food/first meal of the day
  • avoid alcohol use
  • ask about hypoglycemia and weight gain with every refill
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11
Q

Meglitinides MOA & SOA

A
  • stimulates insulin release from beta cells ~short acting~

- PANCREAS!

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12
Q

Meglitinide agents (2)

A
  • Repaglinide

- Nateglinide

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13
Q

Repaglinide dosing

A

A1C <8 = .5 mg po before meals

A1C >8 = 1-2 mg po before meals

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14
Q

Nateglinide dosing

A

60-120mg PO before meals (if skipping a meal- dont take the med)

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15
Q

Meglitinide side effects

A
  • hypoglycemia

- GI disturbances

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16
Q

What can you NEVER use Repaglinide with?

A

NPH insulin (increases risk of MI)

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17
Q

Drug interactions with Nateglinide?

A
  • Mifepristone (do not use within 14 days)

- Pazopanib (increases levels)

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18
Q

Drug interactions with Repaglinide?

A
  • Mifepristone (do not use within 14 days)

- Gemfibrozil (increased repaglinide levels)

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19
Q

Meglitinide counseling points

A

administer BEFORE MEALS (15-30 mins prior)

  • skip a meal, skip a dose*
  • Ask about hypoglycemia and weight gain with every refill
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20
Q

Biguanides MOA and site of action

A

1- decrease glucose output from the liver
2- increase peripheral muscle glucose sensitivity
site of action: liver and peripheral muscle
(metformin)

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21
Q

What is metformin optimal dosing?

A

IR: 850-1000 BID
ER: 1000-2000 qd
–titrate SLOWLY

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22
Q

Metformin renal dosing

A
  • eGFR > 45 = none
  • eGRF 30-45: half dose, up to 1000mg/day
  • eGFR < 30 : D/C
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23
Q

Metformin drug interactions

A

radiopaque contrast dyes- stop 24 hours before and hold for 48 hours after
-lactic acidosis & cardio protection

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24
Q

Biguanides counseling points

A
  • take with food to decrease GI effects
  • start low, go slow
  • potential vitamin B12 deficiency (have pts check at least once a year)
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25
Q

Biguanide monitoring

A
  • renal function(eGFR)
  • GI intolerance
  • FBG/PPG
  • signs/symptoms of lactic acidosis(SOB, muscle cramping, tachycardia)
  • takes 6-8 weeks for peak effect
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26
Q

Thiazolidinediones (TZD) moa & SOA

A

1- increase peripheral muscle glucose sensitivity
2- decrease glucose output from the liver
SOA: muscle and adipose tissue

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27
Q

Thiazolidindione agent & dosing

A

-Pioglitazone 15-30mg PO qd MDD= 45 mg/day

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28
Q

Pioglitazone side effects

A
  • edema! (may worsen HF)
  • weight gain
  • hepatic toxicity
  • bladder cancer (check to see if they have a fam hx)
  • fractures
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29
Q

Drug interactions with Pioglitazone

A
  • oral contraceptives (can reduce efficacy)
  • progestins
  • pazopanib
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30
Q

Thiazolinedione Contraindications

A
  • Hypersensitivity/T1dm/DKA
  • ALT>2.5XULN
  • NYHA CLASS III-IV
  • CHF(symptomatic)
  • ACS
  • Active bladder cancer
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31
Q

Thiazolidinediones black box warning

A
  • congestive heart failure(Rosiglitazone/Pioglitazone)

- myocardial infarction(Rosiglitazone only)

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32
Q

Thiazolidinediones counseling points

A
  • take at the same time once a day

- ask about edema and weight gain each refill

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33
Q

Thiazolidinediones clinical pearls

A
  • pioglitazone has potential ASCVD benefit
  • increase HF risk
  • can cause bone fractures and bladder cancer
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34
Q

alpha-glucasidase inhibitors (AGI) MOA & SOA

A
  • decreases breakdown of sucrose & complex carbs in brush border of the small intestine
  • SOA: gut
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35
Q

AGI drugs/dosing

A
  • Acarbose: 25mg TID (mdd 50)
  • Miglitol: 25mg PO TID (mdd 100)
  • *these only benefit those who eat complex carbs**
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36
Q

AGI side effects (super intense)

A

GI!

  • abdominal pain
  • diarrhea
  • flatulence
  • bloating
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37
Q

AGI counseling points

A
  • start low, go slow
  • take with the first bite of each meal (skip a meal- skip the dose)
  • ask about GI upset and meal timing at every refill)
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38
Q

Gliptins/DPP4-i MOA

A
  • potentiate the effects of incretin hormones (already low in diabetes pts)
  • -> blocks incretin degradation & potentiates insulin release
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39
Q

Gliptins/DPP4-i SOA

A
  • suppresses glucagon secretion
  • slows gasteric emptying
  • reduces food intake
  • promotes B cell proliferation
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40
Q

Gliptin agents

A
  • Januvia (sitagliptin) 100mg daily
  • Tradjenta (linagliptin) 5mg daily
  • Onglyza (saxagliptin) 5 mg daily
  • Nesina (alogliptin) 25mg daily
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41
Q

Only Gliptin that does not need renal dosing

A

Linagliptin: 5mg daily

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42
Q

Gliptin/DPP4-i side effects

A
  • **nasopharyngitis
  • **URI
  • pancreatitis (something to look out for/avoid)
  • heart failure (saxagliptin & alogliptin- avoid)
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43
Q

Gliptins/DPP4-i precautions

A
  • do NOT use with GLP-1 RA
  • impair renal function
  • history of pancreatitis
  • impaired hepatic function
  • heart failure (saxagliptin & alogliptin- avoid)
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44
Q

SGLT2 inhibitors MOA & SOA

A

-by inhibiting SGLT2, reabsorption of filtered glucose is reduced & the renal threshold for glucose is lowered (increases urinary glucose excretion)
SOA: proximal renal tubules

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45
Q

SGLT-2 agents(THEY ALL REQUIRED RENAL DOSING)

A
  • canagliflozin 100-300mg PO daily
  • dapagliflozin 5-10mg PO daily
  • empagliflozin 10-25mg po daily
  • ertuglifloozin 5-15mg po daily
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46
Q

what are SGLT2s contraindicated with?

A

eGFR <30 mL/min

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47
Q

SGLT2 side effects

A
  • Genital mycotic infections(females>males)
  • UTIs
  • increased urination
  • hypotension
  • weight loss
  • ketoacidosis-stay hydrated
  • lower limb amputation& bone fractures(canagliflozin)
  • bladder cancer (dapagliflozin)
  • hyperkalemia (canagliflozin)
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48
Q

SGLT2 drug interactions

A

-watch for hypotension if pt is on ACEi, ARB, diuretics

49
Q

which SGLT2s work super well in blacks & have CV effects?

A

-canagliflozin & empagliflozin

50
Q

which SGLT2i does not have any renal approved indication?

A

empagliflozin

51
Q

GLP1 role in the liver

A

decreases glucose production

52
Q

GLP1 role in the brain

A

reduces food intake

53
Q

GLP1 role in the heart

A
  • increases cardiac function

- decreases CV risk, fatty acid metabolism etc

54
Q

GLP1 role in the pancreas

A

-increases beta cell function

55
Q

GLP1 role in the muscles

A

-increases insulin sensitivity

56
Q

GLP1 role in the stomach

A

-decreases gastric emptying

57
Q

GLP1 MOA

A
  • suppreses glucagon secretion
  • slows gastric emptying
  • promotes b-cell proliferation
58
Q

GLP-1 daily dosing injectables drugs

A
  • exenatide IR (Byetta) 5mcg BID titrate up
  • liraglutide. (Victoza) 0.6mg daily titrate up
  • Lixisenatide (Adylxin) 10mcg daily titrate up
59
Q

only ORAL GLP-1 drug

A

semaglutide (rybelsus) 3mg po daily

60
Q

GLP-1 weekly dosing injectable drugs

A
  • exenatide ER (Bydureon) 2mg once weekly
  • exenatide ER (Bydureon BCise) 2mg once weekly
  • Dulaglutide (Trulicity) 0.75mg once weekly titrate up
  • semaglutide (ozempic). 0.25mg weekly titrate up
61
Q

GLP-1 side effects

A
  • mainly GI
  • N/V
  • Diarrhea
  • GERD, dyspepsia
62
Q

which GLP-1s have no cardio or renal indications?

A
  • eventide
  • lixisenatide
  • semaglutide PO
63
Q

GLP-1 Contraindications

A

black box warning -risk of thyroid c-cell tumor

  • Severe GI disease(colitis,chron’s , obstruction, IBD, UC, Gastroparesis)
  • Hypoglycemia
  • Pancreatitis
  • Renal Impairment(ESRD OR CrCl<30ml/min)
64
Q

GLP-1 counseling points

A
  • do not over eat- eat small meals

- prior to initial use, store in fridge

65
Q

Rybelsus only counseling point

A

-take 30 min before eating first meal - AT THE 30 MIN TIME

66
Q

Ultra rapid acting insulin

A
  • insulin aspart (Fiasp) (can be mixed with NPH)

- Insulin lispro (Lyumjev) U-100& U-200 (can be mixed with NPH)

67
Q

Rapid acting insulin

A

-Insulin lispro (HumaLog) U-100 and U-200 /(Admelog)
-Insulin aspart (NovoLog)
-Insulin glulisine (Apidra)
(They all can be mixed with NPH)

68
Q

Short acting regular insulin

A

-Humulin-R & Novolin-R (these are the drugs that are use in hospital and can be given IV)

69
Q

Intermediate acting NPH insulin

A

Humulin- NPH & Novolin- NPH

  • zinc and protamine make it last longer
  • frosting = loss of potency
70
Q

Long lasting insulin

A
  • insulin glargine(Lantus,Semglee,Basaglar) (Toujeo U-300)
  • Insulin detemir(Levemir)
  • Insulin degludec(Tresiba U-100 and U-200)
  • *do not dilute, do not mix**
71
Q

Insulin glargine MOA

A

(lantus, toujeo, basaglar, semglee)

-forms a precipitate under the skin and breaks down to get to the cells

72
Q

Insulin detemir MOA

A

(levemir)

-injected at the same pH- goes in and attaches to albumin –> goes to target tissue

73
Q

Insulin degludec MOA

A

(tresiba)
3-5 days steady state
-forms multi-hexamers and is broken down to monomers, binds to albumin and is take to target sites
(great for truck driver and night shifts)

74
Q

Afrezza

A
  • mealtime insulin (only bolus)
  • potenial for cough as AE
  • BBW->Acute Bronchospasm
75
Q

insulin side effects

A
  • HYPOGLYCEMIA!
  • lipophypertrophy (repeated injection sites)
  • Allergy extremely rare
76
Q

AACE basal dosing

A

A1C <8% : 0.1- 0.2 U/kg

A1C >8%: 0.2-0.3

77
Q

AACE bolus dosing (pt on a basal)

A

-ONE bolus a day, 10% of basal dose

must be on SGLT2i first

78
Q

AACE basal bolus dosing

A
  • start bolus before each meal
  • not on basal: 0.3-0.5 U/kg 50/50
  • if on basal: use 50% of basal dose & divide by 3 for each meal
79
Q

ADA basal dosing

A

0.1-0.2 U/ kg/ day

80
Q

ADA bolus dosing

A
  • start with 1 injection a day at largest meal

- 10% of basal dose

81
Q

Sulfonylurea Precautions

A
  • Sulfonamide allergy
  • impaired liver function
  • impaired renal function
  • elderly
  • thyroid dx
  • adrenal insufficiency
  • malnutrition
82
Q

Sulfonylurea Contraindications

A
  • Hypersensitivity
  • DKA
  • CrCl< 50(glyburide only)
  • pregnancy-near term( glyburide/glipizide only)
  • T1DM
83
Q

Sulfonylurea: Monitoring

A

-Hypoglycemia
-A1C
-Weight gain
-Sin sensitivity
time to full effect: 4-6 weeks

84
Q

Meglitinides:Precautions

A
  • Severe renal disease
  • Impaired liver function
  • Use with insulin
85
Q

Meglitinides: Contraindications

A
  • Hypersensitivity
  • T1DM
  • DKA
86
Q

Meglitinides:Monitoring

A

*Post prandial glucose
-Hypoglycemia
-A1c
-Weight gain
Time to peak effect: 4-6 weeks

87
Q

Biguanides (Metformin): Precautions

A
  • Elderly
  • Excesive alcohol use
  • CHF requiring drug therapy
88
Q

Biguanides (Metformin): Contraindications

A
  • Hypersensitivity
  • Renal disease/dysfunction
  • Metabolic acidosis
  • DKA
  • Lactic acidosis
  • Iodinated contrast
  • Impaired liver function
  • Hypoxemia
  • Dehydration
  • Sepsis
  • Surgery
89
Q

Thiazolinedione Precautions

A
  • CHF NYHA class I-II
  • Edema
  • MI(Rosiglitazone)
  • Impaired liver function
  • insulin/SU use
  • Bladder cancer history
  • Females(TZD in generally induce ovulations)
  • Fracture Risk
90
Q

alpha-glucosidase inhibitors contraindications/Precautions

A

-Hypersensitivity
-DKA
-Cirrhosis
-Irritable Bowel Syndrome(IBS)
-Crohn’s disease
-Colonic ulceration
-Intestinal obstruction
-SCr>2.0
Precautions
-Impaired Renal function

91
Q

Gliptins/DPP4-i counseling points

A
  • Take once a day;same time each day
  • Can be taken with or without food
  • *Ask about: Nasopharyngitis and URI at every refill
92
Q

Gliptins/DPP4-i Monitoring

A

-FBG/PPG
-A1C
-URI symptoms
-GI intolerance
Time to peak effect: 6-8 weeks

93
Q

SGLT-2i Contraindications

A
  • Dialysis
  • Renal Failure(eGFR<30ml/min)
  • ESRD
94
Q

SGLT-2i Precautions

A
  • Hypotension
  • Genital mycotic infections
  • UTI
  • AKI
  • Ketoacidosis
  • Hyperkalemia
  • Bladder Cancer
  • Amputations
95
Q

what is the brand name of Glyburide? (3)

A

Diabeta, Micronase, Glynase Prestabs

96
Q

What is the brand name of Glipizide? (2)

A

Glucotrol and Glucotrol XL

97
Q

What is the brand name for Glimepiride?

A

Amaryl

98
Q

brand name for Repaglinide

A

Prandin

99
Q

brand name for Nateglinide

A

Starlix

100
Q

brand name for rosiglitazone

A

Avandia

101
Q

brand name for Pioglitazone

A

actos

102
Q

brand name for Acarbose

A

Precose

103
Q

brand name for miglitol

A

Glyset

104
Q

brand name for Januvia

A

sitaglipitin

105
Q

brand name for Tradjenta

A

linagliptin

106
Q

brand name for Onglyza

A

saxagliptin

107
Q

brand name for Nesina

A

alogliptin

108
Q

brand name for canagliflozin

A

Invokana

109
Q

brand name for dapagliflozin

A

Farxiga

110
Q

brand name for empagliflozin

A

Jardiance

111
Q

brand name for ertugliflozin

A

Steglatro

112
Q

brand name for exenatide IR

A

Byetta

113
Q

brand name for exenatide ER

A

Bydureon or theres one called Bydureon BCise

114
Q

brand name for liraglutide

A

Victoza

115
Q

brand name for dulaglutide

A

Trulicity

116
Q

brand name for lixisenatide

A

Adlyxin

117
Q

brand name for semaglutide (SQ)

A

Ozempic

118
Q

brand name for semaglutide (PO)

A

Rybelsus

119
Q

brand name for pramlintide

A

Symlin

Therapeutics: Diabetes & Womens Health (2 decks)

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