DM drugs Flashcards
Side Effects:
UTIs
Hypotension
SGLT2 inhibitors
Semaglutide (Ozempic)
Empagliflozin (Jardiance)
Canagliflozin (Invokana)
Side Effects:
Weight loss
Appetite suppression
Pancreatitis
GLP1 agonist
Liraglutide (Victoza) / Exenatide
Side Effects:
Weight Gain
Fluid Retention/ HTN/ HF
Thiazolidinediones
Pioglitazone
Side Effects:
Diarrhea/ GI
Lactic Acidosis
Biguanides Metformin (Vit. B12 deficiency)
Side Effects:
Weight Gain
Hypoglycemia
Insulin Secretagogues
increase urine glucose excretion
SGLT2 inhibitors
Semaglutide
Empagliflozin
3 most used drugs for glycemic management
Metformin (1st line)
GLP1 agonist –> Liraglutide/ Exenatide
SGLT2 inhibitors –> Semaglutide/ Empagliflozin
Preferred anti-platelet therapy for DM
Low dose Asprin
Preferred BP control therapy for DM
ACE-i (Lisinopril) or ARBs (Losartan)
3 Lifestyle recommendations for DM management?
Smoking Cessation
Reduce Fat intake (Diet)
Exercise Regularly
Preferred Lipid-lowering therapy for DM
Statin (Atorvastatin/Pravastatin)
Glycemic control can help somewhat reduce what complications?
Microvascular
Retinopathy/ Nephropathy
Effect of exercise on insulin and glucose
Exercise increases glucose uptake by muscle cells
insulin is not regulated/ lowered thus impaired endogenous glucose synthesis results in hypoglycemia (low blood levels of glucose)
Long-standing diabetes impairs the release of ____ resulting in no hypoglycemic awareness resulting in no correctional behavioral response (like eating) and no hepatic glucose production.
Epinephrine
This drug is contraindicated in pts w/
Renal insufficiency (GFR <30)
Hepatic insufficiency
CHF
Metformin
A glycemic goal of A1c ___ is adequate for most patients.
7-8%
Statin therapy and _____ improve cardiovascular and all-cause mortality in type 2 diabetics
smoking cessation
primary treatment goals
Pt is has been taking Sulfonylurea (Glipizide) for glycemic control for 10 years and is suddenly experiencing rising A1c levels despite no changes. Reason?
Beta cell burnout
5-15 years it stops Sulfonylureas stop helping the patient control sugar levels.
Switch to another med like SGLT2i or GLP1-angonist
List 2 long acting Insulins to manage fasting glucose levels
Glargine (Lantus)
Detemir (once a day)
Best HTN control for Black patients w/o DM
CCB
Best HTN control for pts w/o DM
Chlorithalidone (Thiazide Diuretic)
These medications decrease mortality in DM patients with CVD
GLP-1
Screening for diabetes should commence at age __ for overweight and obese patients (USPSTF) or universally at age __ (ADA) and continue every __ years thereafter.
40-70
45
3
BP should be lowered to less than ___
based on JNC-8
or less than ___
based on ACC/AHA guidelines.
140/90 (ideal)
130/80
(4) meds that convey a benefit for all-cause mortality, independent of glucose control.
Metformin
Liraglutide (Victoza)
Exenatide (Byutta)
Empagliflozin (Jardiance)
In type 2 diabetes, self glucose monitoring does not improve hemoglobin A1c levels or reduce complications, but does result in more symptomatic ____.
hypoglycemic events
___ & ___ together are effective in preventing type 2 diabetes in patients with impaired glucose tolerance, and in patients who are overweight or obese.
Lifestyle
behavior modifications
DM drug therapy should target (3) based on the patient’s age and co-morbidities
blood pressure control (ACE-i)
lipid lowering agent (Statin)
reasonable blood sugar control (Metformin)
Diabetics age ____ with a previous cardiovascular disease should receive aspirin.
50-70
If non-insulin therapy does not achieve glycemic goals, ___ should be initiated.
insulin
(NPH- intermediate acting)
(Glargine- long acting)
postprandial glucose goal is ___ for an A1c of 7%
80-130
