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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
What drugs should you NOT use if a patient has PAD, DM foot, ulcers, peripheral neuropathy
Canagliflozin
26
If a patient has gsatroporesis or GI disorder what two dont you use?
* GLP-agonists * Pramlitinide
27
Sulfa allergy What should be avoided?
SUs
28
G6PD def 1
SUs
29
Lactic Acidosis
Metformin
30
Hepatotoxicity 2
TZDs, alogliptin
31
Hypotension/dehydration? 1
SGLT2
32
K abnormalitites?
Canagliflozin (hyper Insulin hypo
33
Pancreatitis 2
DPP-4 and GLP-1
34
Hypersensitivity RXNs 3
SU, DPP-4, insulin
35
Ketoacidosis 1
SGLT2: can occur when BG \<250
36
Cancer 3
Pioglitazone Dapagliflozin (bladder) GLP-1 (thyroid cancer)
37
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
* 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
What can increase the risk of lactic acidosis with metformin?
Alcohol And iodinated contrast dye
39
When should metformin be restarted after contrast dye use?
Stop before prodedure and restart 48 hours after if GFR is stable
40
Should metformin be taken with or without food?
With food to limit GI upset
41
When should meglitinides be taken?
Prandin: 15-30 minutes before meal Starlix: 1-30 minutes before meals
42
Amaryl
Glimepiride
43
Glynase
Micronized glyburide
44
Main SEs of SUs? 2 Warnings? 1 Contraindications
Wt gain and nausea Contra: Sulfa-allergy Warnings: Hypoglycemic
45
What should never be used in combination?
SUs meglinides, and Insulin should not be used together
46
When should SUs be taken?
With breakfast Glipizide IR should be taken 30 minutes before meals
47
What do TZDs end in?
glitazone
48
What are the two TZDs? Brand and Generic
Pioglitazone: Actos Rosiglitazone: Avandia
49
What TZD has increased risk of MI and is black boxed with it?
Rosiglitazone: Avandia
50
All TZDs have a black box for what?
Cause or exacerbation of HF
51
TZDs are contraindicated in what?
NYHA Class III/IV HF
52
What are warnings of TZDs? 4
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
2 main SEs of glitazones
1. Peripheral edema 2. Wt gain
54
What two things should be monitored with glitazones?
LFTs, s/sx of HF
55
TZDs are substrates of what CYP enzyme?
2C8 caution with inducers rifampin And inhibitors: gemfibrozil
56
What can TZds cause?
Fluid retention
57
What is the MOA of TZDs?
PPAR agonists: increase insulin sensitivity
58
What do SGLT-2 Inhibitors end in?
Gliflozin
59
What SGLT2 inhibitor is approved to reduce risk of cardiovascular mortality in pts with DM2 and ASCVD?
Jardiance Empagliflozin
60
Main SEs of SGLT2
Gliflozin Wt loss Increase urination and thirst
61
What is a contraindication of SGLT2s?
eGFR\<30
62
Goals for pregnancy in DM
Fasting \<=95 1 hour post meal\<=140 mg/dL 2 hours post \<=120
63
What can be used in patients with predm? What are the pts that can see benefit from this? 3 things
Metformin 1. BMI \>=35 2. Age \<60 3. Gestational DM history
64
When should antiplatelet therapy be considered for DM patients?
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
What is recommended in pregnant patients with DM to reduce the risk of preeclampsia?
ASiprin
66
What drug has cancer risk in patients with bladder cancer?
Dapagliflozin
67
What drugs have risk of thyroid cancer?
GLP-1 Agonists
68

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