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Endocrinology Exam 1 > DM Medications > Flashcards

DM Medications Flashcards

1
Q

Pramlinitide (Symlin®) MOA

A

↓ glucagon secretion
↑ Satiety (↓ appetite)
↓ gastric emptying
Excretion: Most all in the urine

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2
Q

Pramlinitide (Symlin®) side effects

A

Nausea (28-48% )
Anorexia (9-17%)
HA (13%)
Vomiting (8-11% )
Abdominal pain
Fatigue
Arthralgias

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3
Q

Pramilmitide BBW

A

increased risk of insulin-induced severe
hypoglycemia, particularly in patients with type 1
diabetes

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4
Q

Pramlinitide (Symlin®) practice PEARLS

A

Give any oral drugs requiring rapid
GI absorption 1 hr before injection
or 2 hrs after meal

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5
Q

Metformin (Glucophage®) MOA

A

↓ intestinal absorption of glucose
↓ hepatic gluconeogenesis
↑ insulin sensitivity in peripheral tissues
Excretion: 90% in the urine, 10% feces

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6
Q

Additional benefit of Metformin

A

↓ serum LDL
↑ fatty acid oxidation
Does not ↑ insulin secretion,
hypoglycemia, or weight gain

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7
Q

Contraindications of Metformin

A
  • Acute or chronic metabolic acidosis including diabetic ketoacidosis
  • Hypersensitivity to metformin
  • Severe renal impairment: eGFR below 30 mL/min/1.73 m(2)
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8
Q

Metformin (Glucophage®) side effects

A

Diarrhea (10-53%)
Nausea/vomiting (7-26%)
Flatulence (12%)

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9
Q

Monitoring & Follow-up for metformin

A

Creatinine at baseline, then annually

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10
Q

Metformin practice PEARLS

A

Start low & titrate up, Push through the nausea

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11
Q

DPP-4 inhibitors

A

Sitagliptin (Januvia®)
Saxagliptin (Onglyza®)
Linagliptin (Tradjenta®)
Alogliptin (Nesina®)

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12
Q

DPP-4 inhibitors MOA

A
  • DPP-4 enzyme brakes down GLP-1
    naturally
  • Inhibition allows GLP-1 longer action
  • Slows incretin metabolism
  • ↑ insulin synthesis & release
  • ↓ glucagon levels
  • Excretion: 75% urine, 22% feces
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13
Q

Common side effects of DPP-4 Inhibitors

A
  • URI (5%)
  • HA (1-6%)
  • Hypoglycemia (.5-12%)
  • UTI
  • Vomiting
  • Abdominal pain
  • Gastroenteritis
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14
Q

Practice PEARLS for DPP-4 inhibitors

A
  • Report severe abdominal pain &
    discontinue
  • Report severe joint pain
  • Report stress, such as fever,
    trauma, infection, or surgery,
    that may require medication
    dosage adjustments
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15
Q

GLP-1 Agonists

A

Exenatide (Byetta®) (Twice daily)
Exenatide (Bydureon®) (weekly)
Liraglutide (Victoza®, Saxenda®) (Daily)
Dulaglutide (Trulicity®) (weekly)
Semaglutide (Ozempic®, Wegovy) (weekly)
Semaglutide (Rybelsus®) (oral daily)
Lixisenatide (Adlyxin®) (daily)

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16
Q

GLP-1 Agonists MOA

A

↑ Insulin secretion
↓ Glucagon secretion
Delays gastric emptying
↓ liver gluconeogenesis
↑ satiety
Excretion: Most all in the urine

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17
Q

Common side effects with GLP-1 Agonists

A

Nausea

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18
Q

Practice PEARLS for GLP-1 Agonists

A
  • Avoid dehydration
  • Report S/S of a thyroid tumor,
    cholelithiasis, or pancreatitis
  • Monitor for hypoglycemia
    & report difficulties with
    glycemic control
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19
Q

Tirzepatide (Mounjaro®) is a _____

A

New Class: GLP-1 RA, GIP

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20
Q

How is Tirzepatide different from the original GLP-1 agonists?

A
  • Superior to 1-mg semaglutide for ↓
    HbA1c & body weight in DMII

Tirzepatide acts in two ways
GLP-1 RA
Glucose-dependent insulinotropic polypeptide (GIP)
- Incretin hormone
↑ insulin release in response to
↑ blood glucose
↑ glucagon levels when blood glucose is normal to low

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21
Q

What is GIP?

A

Glucose-dependent insulinotropic polypeptid: incretin hormone; induces insulin secretion in
response to duodenal hyperosmolarity of glucose

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22
Q

Common side effects of Tirzepatide (Mounjaro®)

A

Nausea

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23
Q

Practice PEARLS for GLP-1 RA, GIP

A
  • Avoid dehydration
  • Report S/S of a thyroid tumor, cholelithiasis, or pancreatitis
  • Monitor for hypoglycemia & report difficulties with
    glycemic control
24
Q

SGLT-2 Inhibitors

A

Canagliflozin (Invokana®)
Dapagliflozin (Farxiga®)
Empagliflozin (Jardiance®)
Ertuglifozin (Steglatro®)

25
Q

SGLT-2 Inhibitors MOA

A

↓ glucose reabsorption in
the kidney
↑ insulin sensitivity
↓ gluconeogenesis in the liver
↑ insulin release from �-cells
Excretion: 33% urine, 60% feces

26
Q

Common side effects of SGLT-2 Inhibitors

A

Genital mycotic infection* (4-11%, > in females)

27
Q

Sulfonylureas

A

Glimepiride (Amaryl®)
Glyburide (DiaBeta®)
Glipizide (Glucotrol®)

28
Q

Sulfonylureas MOA

A

Stimulates islet � cells to release insulin
Blocks the ATP sensitive K+ pump, → action
potential to open voltage Ca++ channels → release
insulin vesicles
Excretion: 80% urine, 10% feces

29
Q

Common side effects of Sulfonylureas

A

Hypoglycemia (4-20%)

30
Q

Practice PEARLS of Sulfonylureas

A

Avoid prescribing together with insulin

31
Q

Thiazolidinediones (TZDs)

A

Pioglitazone (Actos®)
Rosiglitazone (Avandia®)

32
Q

TZDs MOA

A

↑ insulin receptor sensitivity
↑ energy storage in fat & muscle
↓ glucose production
Stimulate fat, muscle, & liver cells
to ↑ insulin receptors
Excretion: 15-64% urine, 23% feces

33
Q

TZDs Common side effects

A

Fluid retention (5-15%)

34
Q

TZDs BBW

A

May cause or worsen congestive heart failure (CHF).

35
Q

TZDs Practice PEARLS

A

Report S/S of CHF

36
Q

Make a chart of all slides 57-67 in DM Medications slides

A

:)

37
Q

Insulin is required for survival in ___

A

DM I

38
Q

____ regimens & ____ should be used for most pts with DM1

A

Physiologic (Basal-Bolus) & insulin analogs

39
Q

Total Daily Insulin (TDI) dose based on weight typical range

A

Range: 0.4 — 0.5 units/kg per day

40
Q

Insulin Daily dosing - basal and prandial

A

Basal 40% — 50% TDI
- Given as single injection of basal
analog (QHS) OR
injections of NPH BID

Prandial: 50% — 60% of TDI in divided doses
15 min before each meal
Actual prandial insulin dose determined by carbohydrate content & experience with SMBG testing.

41
Q

T/F all patients respond the same to insulin

A

F
Any 2 people with DM I can have
different insulin-to-carbohydrate ratios

42
Q

The starting insulin-to-carbohydrate
ratio for a person is ____

A

estimated
- Then, adjust the actual dose by
analyzing blood glucose readings
pre- & post meals
- Starting insulin-to-carb ratio is
estimated using the 450/500 Rule
- Only for people with Type I DM

43
Q

500 Rule

A

Grams of carbohydrate covered by 1 unit of rapid acting insulin

Divide 500 by the total daily dose of insulin
* Quotient = # grams of carbohydrate that are
managed by 1 unit of Rapid Acting insulin

44
Q

450 Rule

A

Grams of carbohydrate covered by 1 unit of regular insulin
* Divide 450 by the total daily dose of insulin
* Quotient = # grams of carbohydrate that are
managed by 1 unit of Regular insulin

45
Q

1800 Rule

A

Estimates serum glucose point drop in mg/dL per unit of rapid acting insulin
* Divide 1800 by the TDI
* Quotient = mg of serum glucose/dL
that are approximately managed by
1 unit of rapid acting insulin

46
Q

1500 Rule

A

Estimates serum glucose point drop in mg/dL per unit of regular insulin
* Divide 1500 by the TDI
* Quotient = mg of serum glucose/dL
that are approximately managed by
insulin

47
Q

When should you inject Regular U-100 insulin?

A

Inject 30-45 min before a meal
* Injection with or after a meal could
increase risk for hypoglycemia

48
Q

Rapid Acting insulin administration considerations

A
  • Administer 0-15 min before meals
  • ↓ risk of postprandial
    hypoglycemia compared to regular
    insulin
49
Q

Role of Rapid-acting (Analogs) insulin

A

Covers needs for meals eaten at the same time as the injection, & often used with basal insulin.

50
Q

Role of NPH U-100 immediate acting insulin

A
  • Covers needs for about half a
    day or over night.
  • Often combined with shortacting insulin (pre-mixed)
51
Q

Basal (long-acting) insulin Role

A

Covers needs for ~1 day Often combined with other
insulin types if needed for tighter control.
Basal insulin forms microprecipitate in fatty tissue & is gradually released

52
Q

Pre-mixed insulin

A

Pre-mixed: Mixture of long intermediate-acting insulin with short rapid-acting insulin

53
Q

Pre-mixed insulin role

A

Generally used 2 – 3 times a day, before mealtime.

54
Q

The most common adverse effect (27%) of inhaled insulin was ___

A

cough

55
Q

CSII is

A

Continuous subcutaneous insulin infusion

56
Q

MDI vs CSII therapy

A
  • Significant ↑ glycemic control
  • Greater ↓ HbA1c & ↓ insulin
    requirements lower in DM I
  • Severe hypoglycemia risk ↓
57
Q

Insulin Administration locations

A

Abdomen →Fastest
Arms
Legs
Buttock →Slowest
injection sites should be rotated

Endocrinology Exam 1 (8 decks)

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