Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

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

Benefits of lifestyle changes

A
  • weight reduction
  • healthy diet
  • exercise
  • smoking cessation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sulfonylureas MOA & site of action

A
  • stimulate insulin release from beta cells

- PANCREAS!

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

Sulfonylurea drugs

A
  • Glyburide
  • GLipizide
  • Glimepride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Side effects of sulfonyurea

A
  • hypoglycemia
  • N/V
  • weight gain (can still use this in phat ppl)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sulfonylureas drug interactions

A
  • alcohol - flushing & potentiation of hypoglycemia
  • displaced protein binding
  • dec renal excretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what sulfonylurea can you use in the elderly?

A

Glipizide

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

Meglitinides MOA & SOA

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

- PANCREAS!

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

Meglitinide agents (2)

A
  • Repaglinide

- Nateglinide

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

Repaglinide dosing

A

A1C <8 = .5 mg po before meals

A1C >8 = 1-2 mg po before meals

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

Nateglinide dosing

A

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

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

Meglitinide side effects

A
  • hypoglycemia

- GI disturbances

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

What can you NEVER use Repaglinide with?

A

NPH insulin (increases risk of MI)

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

Drug interactions with Nateglinide?

A
  • Mifepristone (do not use within 14 days)

- Pazopanib (increases levels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Drug interactions with Repaglinide?

A
  • Mifepristone (do not use within 14 days)

- Gemfibrozil (increased repaglinide levels)

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is metformin optimal dosing?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Metformin renal dosing

A
  • eGFR > 45 = none
  • eGRF 30-45: half dose, up to 1000mg/day
  • eGFR < 30 : D/C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Metformin drug interactions

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Biguanide monitoring
- renal function(eGFR) - GI intolerance - FBG/PPG - signs/symptoms of lactic acidosis(SOB, muscle cramping, tachycardia) - takes 6-8 weeks for peak effect
26
Thiazolidinediones (TZD) moa & SOA
1- increase peripheral muscle glucose sensitivity 2- decrease glucose output from the liver SOA: muscle and adipose tissue
27
Thiazolidindione agent & dosing
-Pioglitazone 15-30mg PO qd MDD= 45 mg/day
28
Pioglitazone side effects
- edema! (may worsen HF) - weight gain - hepatic toxicity - bladder cancer (check to see if they have a fam hx) - fractures
29
Drug interactions with Pioglitazone
- oral contraceptives (can reduce efficacy) - progestins - pazopanib
30
Thiazolinedione Contraindications
- Hypersensitivity/T1dm/DKA - ALT>2.5XULN - NYHA CLASS III-IV - CHF(symptomatic) - ACS - Active bladder cancer
31
Thiazolidinediones black box warning
- congestive heart failure(Rosiglitazone/Pioglitazone) | - myocardial infarction(Rosiglitazone only)
32
Thiazolidinediones counseling points
- take at the same time once a day | - ask about edema and weight gain each refill
33
Thiazolidinediones clinical pearls
- pioglitazone has potential ASCVD benefit - increase HF risk - can cause bone fractures and bladder cancer
34
alpha-glucasidase inhibitors (AGI) MOA & SOA
- decreases breakdown of sucrose & complex carbs in brush border of the small intestine - SOA: gut
35
AGI drugs/dosing
- Acarbose: 25mg TID (mdd 50) - Miglitol: 25mg PO TID (mdd 100) * *these only benefit those who eat complex carbs**
36
AGI side effects (super intense)
GI! - abdominal pain - diarrhea - flatulence - bloating
37
AGI counseling points
- 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)
38
Gliptins/DPP4-i MOA
- potentiate the effects of incretin hormones (already low in diabetes pts) - -> blocks incretin degradation & potentiates insulin release
39
Gliptins/DPP4-i SOA
- suppresses glucagon secretion - slows gasteric emptying - reduces food intake - promotes B cell proliferation
40
Gliptin agents
- Januvia (sitagliptin) 100mg daily - Tradjenta (linagliptin) 5mg daily - Onglyza (saxagliptin) 5 mg daily - Nesina (alogliptin) 25mg daily
41
Only Gliptin that does not need renal dosing
Linagliptin: 5mg daily
42
Gliptin/DPP4-i side effects
- **nasopharyngitis - **URI - pancreatitis (something to look out for/avoid) - heart failure (saxagliptin & alogliptin- avoid)
43
Gliptins/DPP4-i precautions
- do NOT use with GLP-1 RA - impair renal function - history of pancreatitis - impaired hepatic function - heart failure (saxagliptin & alogliptin- avoid)
44
SGLT2 inhibitors MOA & SOA
-by inhibiting SGLT2, reabsorption of filtered glucose is reduced & the renal threshold for glucose is lowered (increases urinary glucose excretion) SOA: proximal renal tubules
45
SGLT-2 agents(THEY ALL REQUIRED RENAL DOSING)
- canagliflozin 100-300mg PO daily - dapagliflozin 5-10mg PO daily - empagliflozin 10-25mg po daily - ertuglifloozin 5-15mg po daily
46
what are SGLT2s contraindicated with?
eGFR <30 mL/min
47
SGLT2 side effects
- 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)
48
SGLT2 drug interactions
-watch for hypotension if pt is on ACEi, ARB, diuretics
49
which SGLT2s work super well in blacks & have CV effects?
-canagliflozin & empagliflozin
50
which SGLT2i does not have any renal approved indication?
empagliflozin
51
GLP1 role in the liver
decreases glucose production
52
GLP1 role in the brain
reduces food intake
53
GLP1 role in the heart
- increases cardiac function | - decreases CV risk, fatty acid metabolism etc
54
GLP1 role in the pancreas
-increases beta cell function
55
GLP1 role in the muscles
-increases insulin sensitivity
56
GLP1 role in the stomach
-decreases gastric emptying
57
GLP1 MOA
- suppreses glucagon secretion - slows gastric emptying - promotes b-cell proliferation
58
GLP-1 daily dosing injectables drugs
- exenatide IR (Byetta) 5mcg BID titrate up - liraglutide. (Victoza) 0.6mg daily titrate up - Lixisenatide (Adylxin) 10mcg daily titrate up
59
only ORAL GLP-1 drug
semaglutide (rybelsus) 3mg po daily
60
GLP-1 weekly dosing injectable drugs
- 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
GLP-1 side effects
- mainly GI - N/V - Diarrhea - GERD, dyspepsia
62
which GLP-1s have no cardio or renal indications?
- eventide - lixisenatide - semaglutide PO
63
GLP-1 Contraindications
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
GLP-1 counseling points
- do not over eat- eat small meals | - prior to initial use, store in fridge
65
Rybelsus only counseling point
-take 30 min before eating first meal - AT THE 30 MIN TIME
66
Ultra rapid acting insulin
- insulin aspart (Fiasp) (can be mixed with NPH) | - Insulin lispro (Lyumjev) U-100& U-200 (can be mixed with NPH)
67
Rapid acting insulin
-Insulin lispro (HumaLog) U-100 and U-200 /(Admelog) -Insulin aspart (NovoLog) -Insulin glulisine (Apidra) (They all can be mixed with NPH)
68
Short acting regular insulin
-Humulin-R & Novolin-R (these are the drugs that are use in hospital and can be given IV)
69
Intermediate acting NPH insulin
Humulin- NPH & Novolin- NPH - zinc and protamine make it last longer - frosting = loss of potency
70
Long lasting insulin
- 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
Insulin glargine MOA
(lantus, toujeo, basaglar, semglee) | -forms a precipitate under the skin and breaks down to get to the cells
72
Insulin detemir MOA
(levemir) | -injected at the same pH- goes in and attaches to albumin --> goes to target tissue
73
Insulin degludec MOA
(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
Afrezza
- mealtime insulin (only bolus) - potenial for cough as AE - BBW->Acute Bronchospasm
75
insulin side effects
- HYPOGLYCEMIA! - lipophypertrophy (repeated injection sites) - Allergy extremely rare
76
AACE basal dosing
A1C <8% : 0.1- 0.2 U/kg | A1C >8%: 0.2-0.3
77
AACE bolus dosing (pt on a basal)
-ONE bolus a day, 10% of basal dose | must be on SGLT2i first
78
AACE basal bolus dosing
- 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
ADA basal dosing
0.1-0.2 U/ kg/ day
80
ADA bolus dosing
* start with 1 injection a day at largest meal | - 10% of basal dose
81
Sulfonylurea Precautions
- Sulfonamide allergy - impaired liver function - impaired renal function - elderly - thyroid dx - adrenal insufficiency - malnutrition
82
Sulfonylurea Contraindications
- Hypersensitivity - DKA - CrCl< 50(glyburide only) - pregnancy-near term( glyburide/glipizide only) - T1DM
83
Sulfonylurea: Monitoring
-Hypoglycemia -A1C -Weight gain -Sin sensitivity time to full effect: 4-6 weeks
84
Meglitinides:Precautions
- Severe renal disease - Impaired liver function - Use with insulin
85
Meglitinides: Contraindications
- Hypersensitivity - T1DM - DKA
86
Meglitinides:Monitoring
*Post prandial glucose -Hypoglycemia -A1c -Weight gain Time to peak effect: 4-6 weeks
87
Biguanides (Metformin): Precautions
- Elderly - Excesive alcohol use - CHF requiring drug therapy
88
Biguanides (Metformin): Contraindications
- Hypersensitivity - Renal disease/dysfunction - Metabolic acidosis - DKA - Lactic acidosis - Iodinated contrast - Impaired liver function - Hypoxemia - Dehydration - Sepsis - Surgery
89
Thiazolinedione Precautions
- 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
alpha-glucosidase inhibitors contraindications/Precautions
-Hypersensitivity -DKA -Cirrhosis -Irritable Bowel Syndrome(IBS) -Crohn's disease -Colonic ulceration -Intestinal obstruction -SCr>2.0 Precautions -Impaired Renal function
91
Gliptins/DPP4-i counseling points
- Take once a day;same time each day - Can be taken with or without food * *Ask about: Nasopharyngitis and URI at every refill
92
Gliptins/DPP4-i Monitoring
-FBG/PPG -A1C -URI symptoms -GI intolerance Time to peak effect: 6-8 weeks
93
SGLT-2i Contraindications
- Dialysis - Renal Failure(eGFR<30ml/min) - ESRD
94
SGLT-2i Precautions
- Hypotension - Genital mycotic infections - UTI - AKI - Ketoacidosis - Hyperkalemia - Bladder Cancer - Amputations
95
what is the brand name of Glyburide? (3)
Diabeta, Micronase, Glynase Prestabs
96
What is the brand name of Glipizide? (2)
Glucotrol and Glucotrol XL
97
What is the brand name for Glimepiride?
Amaryl
98
brand name for Repaglinide
Prandin
99
brand name for Nateglinide
Starlix
100
brand name for rosiglitazone
Avandia
101
brand name for Pioglitazone
actos
102
brand name for Acarbose
Precose
103
brand name for miglitol
Glyset
104
brand name for Januvia
sitaglipitin
105
brand name for Tradjenta
linagliptin
106
brand name for Onglyza
saxagliptin
107
brand name for Nesina
alogliptin
108
brand name for canagliflozin
Invokana
109
brand name for dapagliflozin
Farxiga
110
brand name for empagliflozin
Jardiance
111
brand name for ertugliflozin
Steglatro
112
brand name for exenatide IR
Byetta
113
brand name for exenatide ER
Bydureon or theres one called Bydureon BCise
114
brand name for liraglutide
Victoza
115
brand name for dulaglutide
Trulicity
116
brand name for lixisenatide
Adlyxin
117
brand name for semaglutide (SQ)
Ozempic
118
brand name for semaglutide (PO)
Rybelsus
119
brand name for pramlintide
Symlin

Therapeutics: Diabetes & Womens Health (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions