Didactics: Pharmacotherapy Pearls

Question 1

What is the 5-year life expectancy of heart failure?

Answer 1

50%

Question 2

Hyperglycemia usually becomes symptomatic at what A1c?

Answer 2

9%

Question 3

The ____________ trial showed that metformin has the best clinical outcomes (including cardiovascular vascular risk).

Answer 3

UKPDS

Question 4

Review the renal dosage adjustment for metformin.

Answer 4

• eGFR less than 30: do not give metformin
• 30-45: use half maximum dose
• 45-60: increase monitoring of renal labs
• 60 and above: no adjustment required

Question 5

The ____________ formula gives eGFR.

Answer 5

Cockcroft-Gault

Question 6

How should metformin be initiated?

Answer 6

GI upset is common with metformin, so start low and progress slowly: 
•500 mg QD for one week
•500 mg BID for one week
•1000 mg AM, 500 mg PM for one week
•1000 mg BID for one week

Question 7

How much can metformin, insulin, and GLP-1 agonists decrease A1c%?

Answer 7

• Metformin: 1.8%
• Insulin: 2.0%
• GLP-1 agonists: 1.5%

Question 8

Victoza is also called?

Answer 8

Liraglutide

Question 9

The GLP-1 agonists have what advantages and disadvantages?

Answer 9

Cons:
• Expensive (because they’re new),though insurers typically pay for them
•Subcutaneous injections

Pros:
•Weight loss
•Cannot cause hypoglycemia

Question 10

List the pros and cons of sulfonylureas.

Answer 10

Pros:
•Oral agent
• Inexpensive

Cons:
•Can cause hypoglycemia
•Can cause weight gain
• Might increase CVD risk (based on some new, inconclusive trials)

Question 11

Which of the basal insulins lasts longer?

Answer 11

Glargine

“LAntus LAsts!”

Question 12

Compare the pros and cons of DPP-4 inhibitors versus GLP-1 agonists.

Answer 12

• GLP-1 agonists cause weight loss, while DPP-4 inhibitors don’t.
• DPP-4 inhibitors are oral, while GLP-1 agonists are injections.