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Clin Mgt 2 DM & Psych > DM > Flashcards

DM Flashcards

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1
Q

name 3 conditiond DM puts you at an INC risk for

A
  • 8X increased risk acute MI
  • 3X increased risk of CV death
  • 6.7X increased risk of stroke
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2
Q

T2DM first line

CI in what pt populaton?

A

Metformin

GFR <30

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3
Q

sulfonurea w/ Highest hypoglycemia

A

glyburide

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4
Q

adverse effect of Meglitinides

A

Hypoglycemia

Weight gain

repaglinide (Prandin)

nateglinide (Starlix)

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5
Q

what DM med Beneficial in the treatment of prediabetes ??

A

Alpha-glucosidase inhibitors—> acarbose

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6
Q

list Alpha-glucosidase inhibitors & adverse effct

A

Acarbose (Precose)

Miglitol (Glyset) (same dose)

(e.g., flatulence, diarrhea)

Low risk of hypoglycemia

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7
Q

what class of meds Slows progression of deterioration of B-cell function

A

Thiazolidinediones

Pioglitazone (Actos)

Rosiglitazone (Avandia) no inc CVD risk

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8
Q

what DM med:
may improve lipid profile (lowers triglycerides) &

CV benefit

A

Pioglitazone (Actos)

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9
Q

what class of med can cause New or worsening HF(

A

DPP-4 saxagliptin and alogliptin

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10
Q

what DPP -4 does not need to be renally dosed

A

Linagliptin (Tradjenta

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11
Q

name DPP4 inhibitos

A

Sitagliptin (Januvia)

Linagliptin (Tradjenta) ** - not renally dosed

Saxagliptin (Onglyza)

Alogliptin (Nesina)

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12
Q

name GLP-1 RAs

A

Exenatide (Byetta)

Liraglutide (Victoza)

Exenatide ER (Bydureon)

Dulaglutide (Trulicity)

Lixisenatide (Adlyxin)

Semaglutide (Ozempic) (Rybelsus

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13
Q

wnat class of meds is assoc w/ Yeast infections

A

SGLT-2 inhibitors

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14
Q

lsist SGL-2 i

A

Canagliflozin (Invokana)

Dapagliflozin (Farxiga)

Empagliflozi n (Jardiance)

Ertugliflozin (Steglatro)

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15
Q

DM med reccommended for CVD

A

SGLT-2is—- “liflozin”

  • empagliflozin
  • canagliflozin
  • dapagliflozin)

OR

GLP-1RAs – “glutid”

  • Liraglutid
  • semaglutid
  • dulaglutide
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16
Q

DM med recc for HF

first line

second line

A

FIRST LINE – SGLT2i – lifolzin

  • empagliflozin
  • dapagliflozin

If cannot take use GLP-1RAs w/ CV benefit “glutide”

  • Liraglutide
  • Semaglutide
  • dulaglutide
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17
Q

DM w/ CKD w/ albuminuria

A

SGLT2i w/ primary evidence in reducing CKD progression (Ertugliflozin)

  • AVOID - canagliflozin, dapagliflozin, empagliflozin)

SGLT2i w/ evidence in reducing CVD progression

  • empagliflozin
  • canagliflozin
  • dapagliflozin

IF SGLT2i not tolerated or CI:

GLP-1 RA w/ proven CVD benefit

  • Liraglutid
  • semaglutid
  • dulaglutide
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18
Q

DM w/ CKD w/o albuminuria

A

SGLT-2is

  • empagliflozin
  • canagliflozin
  • dapagliflozin

OR

GLP-1RAs

  • Liraglutid
  • semaglutid
  • dulaglutide
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19
Q

DM minimize hypoglycemia

A

DPP-4i—–can add - SGLT2i OR TZD

  • NO DPP & GLP-1 RA!!!
  1. Degludec/glargine U300 <
  2. glargine U100/detemir <
  3. NPH insulin

GLP-1 RA — Add - SGLT2i OR TZD

SGLT2i —- Add - GLP-1 RA, DPP-4i, TZD

TZD —–Add –SGLT2i, DPP-4i, GLP-1 RA

20
Q

what class of DM med cause hypoglycemia

name meds in tbis class

A

Sulfonylureas

  • glyburide
  • glimepiride
  • glipizide
21
Q

Minimize Weight Gain/ weight Loss

A

GLP-1RAs – dulaglutide + Add SGLT2i

OR

SGLT2i —- Add GLP-1 PAs

  1. Semaglutide >
  2. liraglutide >
  3. dulaglutide* >
  4. exenatide >
  5. lixisenitid

Quad therapy or above not tolerated:

DPP-4i

Not tolerated or CI bc pt on GLP-1 RA —> + SU, TZD, basal insulin

22
Q

med to minimze cost

A

SU – can add TZD

TZD can add SU

Choose later generation SU to lower risk of hypoglycemia.

Glimepiride has shown similar CV safety to DPP-4i6

Basal insulin

23
Q

list Thiazolidinediones

A

Pioglitazone (Actos)

Rosiglitazone (Avandia) no inc CVD risk

24
Q

what 2 classes should you never combine

A

NO DPP & GLP-1 RA!!!

25
Q

fill in

Goal A1c -

Goal FBG –

Goal PP BS -

A

Goal A1c - <7

Goal FBG – 80-130

Goal PP BS - <130

26
Q

what is first injectable consideed for T2DM

A

GLP-1RA

27
Q

when is insulin considered in T2DM

A

•Consider insulin as first injectable if

  • catabolism
  • symptoms of hyperglycemia
  • A1C > 10% o
  • BG are very high (> 300)
  • suspect T1DM (EARLY INSULIN USE)
28
Q

list rapid acting insulin

A
  • Aspart (Novolog)
  • Glulisine (Apidra)
  • Lispro (Humalog)
  • Inhaled (Afrezza)
29
Q

short acting insulin

A
  • Humulin- R
  • Novolin – R
30
Q

long acting insulin

A
  • Glargine U100 (Lantus, Basaglar, Semglee)
  • Detemir (Levemir)
31
Q

ultra long acting

A
  • Deglutide (Tresiba)
  • Glargine U-300 (Toujeo)
32
Q

premixed insulin

A
  • Humulin 70/30
  • Monolin 70/30
33
Q

primary actions og insulin

A

­INC Glucose disposal

DEC Gluconeogenesis

INC Suppress ketogenesis

34
Q

•Contraindicated in patients at risk of medullary thyroid cancer

A

GLP-1- receptors agonist (RAs)

  • •Exenatide* (Byetta)
  • •Exenatide ER (Bydureon)
  • •Liraglutide* (Victoza)
  • •Lixisensatide (Adlyxin)
  • •Dulaglutide (Trulicity)
  • •Semaglutide (Ozempic, Rybelsus)
35
Q

­ INC insulin sensitivity in muscles & fat

A

Thiazolidinediones (Glitazones)

36
Q

MOI SGLT-2 inhibitors

A

INC renal excretion of glucose (glucosuria)

DEC plasma glucose level

37
Q

MOI metformin

A

DEC gluconeogenesis

INC insulin sensitivity in peripheral tissue

DEC intestinal absorption of glucose

38
Q

MOI GLP-RAs

A

INC exogenous GLP-1

INC ­ insulin secretion

DEC glucagon secretion

DEC gastric emptying

INC­ satiety

39
Q

wjat class causes hypoglycemia and weight gain

A

Sulfonylureas

  • Glyburide (Glynase)
  • Glipizide (Glucotrol)
  • Glimepiride (Amaryl)
40
Q

what class causes you to loseweight and has CV benefit

A

GLP-1- receptors agonist (RAs)

  • Exenatide* (Byetta)
  • Exenatide ER (Bydureon)
  • Liraglutide* (Victoza)
  • Lixisensatide (Adlyxin)
  • Dulaglutide (Trulicity)
  • Semaglutide (Ozempic, Rybelsus)
41
Q

•If A1C above goal

A
  • Add GLP-1RA if not already taking (lower basal dose) or
  • Add prandial insulin; one dose with largest meal
42
Q

•If above A1C target

A
  • Stepwise approach (2 then 3 injections- meal time)
  • Go to full basal bolus
  • Consider NPH bid and rapid acting/sort acting with 2 meals
  • Consider Premixed insulin regimen
43
Q

stepwise approach to staring insulin

A
  1. start w/ GLP first –>GLP CI then basal insulin
  2. add basal anology or bedtime NPH
  3. Add Prandial insulin or if on bedtime NPH then swicth to 2x a day dosing
  4. Add prandial insulin
  5. stepwise injectios of prandial insulin –> full basal bolus regimine

seld-mixed split insulin (NPH & short/rapid acting)

2x daily premixed insulin

44
Q

what is important about basal insulin

A

Basal insulin - only duration is important –

•want LONG duration of acting

45
Q

differentiate b/w DM 1 & 2

basal/bolus

basal only

A

Type 1: Basal / bolus (prandial)

Type 2: Basal only

46
Q

list MOI of

  • Repaglinide (Pandin)
  • Nateglinide (Starlix)
A

INC insulin secretion

Clin Mgt 2 DM & Psych (3 decks)

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