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1
Q

Januvia

What type of drug?

Oral or SubQ?

Does in need dose adjustments?

A

Sitagliptin

Oral

DPP-4 inhibitor

Increases insulin release, decreases glucagon secretion

CrCl: 30-49: dose in half to 50 mg daily CrCl< 30 give 25 mg daily

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2
Q

generic dpp-4 inhibitors end in?

WHat do they have a risk of?

A

gliptin

Risk of heart failure Saxa and alogliptin specifically

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3
Q

What dpp-4 inhibitor ending in gliptin does not need renal adjustments?

A

Linagliptin

Tradjenta

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4
Q

Warnings for DPP_4 inhibitos

A

Gliptins

Acute pancreatitis and Risk of Heart failure Saxa and alo

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5
Q

What GLP-1 agonist is approved to reduce the risk of cardiovascular events in pt with TsDM and ASCVD

A

Liraglutide

Victoza

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6
Q

What two classis of DM agens have warnings for pancreatitis?

A

DPP-4 and GPP-1 Inhibitors

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7
Q

Goals for DM in pregnancy

A

Fasting <=95

1 hour post: <=140

2 hour post: <=120

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8
Q

A pt that is >=40 withoout ASCVD and DM

A

Moderate intensity statin

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9
Q

Rule of 500 calculation for rapid acting

A

500/total daily dose of insulin= grams of carbs covered by 1 unit rapid acting

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10
Q

Rule of 450 for regular indulin

A

450/total daily insulin

Grams covered by 1 unit

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11
Q

Rule of 1800 correction factor for rapid acting

A

Correction factor for 1 unit of total daily insulin

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12
Q

Insulin pens where no needle is included 4 types

A
  1. Flexpen: Novolog products
  2. Kwikpen: Humalog, humilin, Basaglar
  3. Flextouch, Levemir, Fiasp, Tresiba
  4. Solostar: Lantus, admelog, Toujeo
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13
Q

GLP-1 agonists that do not have needle 3

A
  1. Victoza
  2. Byetta
  3. Adlyxin
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14
Q

Pramilinide that does not have a needle

A

SymlinPen

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15
Q

5 drugs that can lower blood glucose

A
  1. Linezolid
  2. Lorcaserin (Belviq)
  3. Pentamidine
  4. Beta blockers
  5. Quinolones
  6. BB and quinolones can also cause hyperglycemia
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16
Q

Hyperglycemic crisis treatment

4 things

A
  1. Fluids
    1. Start with NS when BG reaches 250 mg/dL change to D5W 1/2NS
  2. Regular insulin Infusion (insulin of choice)
    1. 0.15 units/kg bolus then start continuous infusion at a rate of 0.1 units/kg/hr
  3. Prevent hypokalemia
    1. Monitor and keep 4-5
  4. Treat acidosis if pH is <7 give sodium bicarb as needed
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17
Q

What 5 drugs have the biggest decrease in A1C?

A
  1. Insulin biggest
  2. Metformin
  3. SUs
  4. TZDs
  5. GLP-1 agonists
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18
Q

Greatest hypoglycemic risk? 4

A
  1. Insulin most
  2. SUs
  3. Meglinitides
  4. pramlintide (with insulin)
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19
Q

Most likely to cause wt gain 4

A
  1. Insulin
  2. SUs
  3. Meglinitides
  4. TZDs
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20
Q

Drugs most likely to cause wt loss? 3

A
  1. SGLT2
  2. GLP-1 agonists
  3. Pramlintide
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21
Q

Cardiac benefit drugs? DM plus CVD event 3

A
  1. Empagliflozin
  2. Liraglutide
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22
Q

Cheapest DM meds 3

A

Metformin, SUs, TZDs

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23
Q

Injectable formulations 3

A
  1. Insulin
  2. GLP
  3. Pramlinitide
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24
Q

What drugs should be avoided in pts with HF? 3

A
  1. TZDs
  2. Alogliptin
  3. Saxagliptin
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25
Q

What drugs should you NOT use if a patient has PAD, DM foot, ulcers, peripheral neuropathy

A

Canagliflozin

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26
Q

If a patient has gsatroporesis or GI disorder what two dont you use?

A
  • GLP-agonists
  • Pramlitinide
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27
Q

Sulfa allergy What should be avoided?

A

SUs

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28
Q

G6PD def 1

29
Q

Lactic Acidosis

30
Q

Hepatotoxicity 2

A

TZDs, alogliptin

31
Q

Hypotension/dehydration? 1

32
Q

K abnormalitites?

A

Canagliflozin (hyper

Insulin hypo

33
Q

Pancreatitis 2

A

DPP-4 and GLP-1

34
Q

Hypersensitivity RXNs 3

A

SU, DPP-4, insulin

35
Q

Ketoacidosis 1

A

SGLT2: can occur when BG <250

36
Q

Cancer 3

A

Pioglitazone

Dapagliflozin (bladder)

GLP-1 (thyroid cancer)

37
Q

This drug should be given with meals is contraindacted with a eGFR < 30

and the ER formulation can leave a ghost tablet

What boxed warnings: 3

COntraindications: 2

Warnings: 2
SEs: 5

Monitoring 1

Notes; 1

A
  • Metformin
  • Boxed: Lactic acidosis with hypoxic states, renal impairment, intravascular iodinated contrast media
  • Contra: eGFR <30 and metabolic acidosis
  • Warnings: GFR 30-45, Vit B12 Def
  • SEs: N/V/D, flatuence, abdominal cramping
  • Monitor Renal function
  • Decreases A1C bu 1-2%
38
Q

What can increase the risk of lactic acidosis with metformin?

A

Alcohol

And iodinated contrast dye

39
Q

When should metformin be restarted after contrast dye use?

A

Stop before prodedure and restart 48 hours after if GFR is stable

40
Q

Should metformin be taken with or without food?

A

With food to limit GI upset

41
Q

When should meglitinides be taken?

A

Prandin: 15-30 minutes before meal

Starlix: 1-30 minutes before meals

42
Q

Amaryl

A

Glimepiride

43
Q

Glynase

A

Micronized glyburide

44
Q

Main SEs of SUs? 2

Warnings? 1

Contraindications

A

Wt gain and nausea

Contra: Sulfa-allergy

Warnings: Hypoglycemic

45
Q

What should never be used in combination?

A

SUs meglinides, and Insulin should not be used together

46
Q

When should SUs be taken?

A

With breakfast

Glipizide IR should be taken 30 minutes before meals

47
Q

What do TZDs end in?

48
Q

What are the two TZDs? Brand and Generic

A

Pioglitazone: Actos

Rosiglitazone: Avandia

49
Q

What TZD has increased risk of MI and is black boxed with it?

A

Rosiglitazone: Avandia

50
Q

All TZDs have a black box for what?

A

Cause or exacerbation of HF

51
Q

TZDs are contraindicated in what?

A

NYHA Class III/IV HF

52
Q

What are warnings of TZDs? 4

A
  1. Hepatic failure
  2. Edema (including macular)
  3. Risk of fracctures
  4. Urinary bladder tumors with Pioglitazone (Actos)
    1. Do not use in pts with active bladder cancer
53
Q

2 main SEs of glitazones

A
  1. Peripheral edema
  2. Wt gain
54
Q

What two things should be monitored with glitazones?

A

LFTs, s/sx of HF

55
Q

TZDs are substrates of what CYP enzyme?

A

2C8 caution with inducers rifampin

And inhibitors: gemfibrozil

56
Q

What can TZds cause?

A

Fluid retention

57
Q

What is the MOA of TZDs?

A

PPAR agonists: increase insulin sensitivity

58
Q

What do SGLT-2 Inhibitors end in?

59
Q

What SGLT2 inhibitor is approved to reduce risk of cardiovascular mortality in pts with DM2 and ASCVD?

A

Jardiance

Empagliflozin

60
Q

Main SEs of SGLT2

A

Gliflozin

Wt loss

Increase urination and thirst

61
Q

What is a contraindication of SGLT2s?

62
Q

Goals for pregnancy in DM

A

Fasting <=95

1 hour post meal<=140 mg/dL

2 hours post <=120

63
Q

What can be used in patients with predm? What are the pts that can see benefit from this? 3 things

A

Metformin

  1. BMI >=35
  2. Age <60
  3. Gestational DM history
64
Q

When should antiplatelet therapy be considered for DM patients?

A
  1. Aspirin should be considered for primary prevention in patients with T1 or 2 DM with increased risk of ASCVD
  2. Men and women >=50, who have DM and one additional ASCVD risk factor
65
Q

What is recommended in pregnant patients with DM to reduce the risk of preeclampsia?

66
Q

What drug has cancer risk in patients with bladder cancer?

A

Dapagliflozin

67
Q

What drugs have risk of thyroid cancer?

A

GLP-1 Agonists

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