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Pharm > DM medications > Flashcards

DM medications Flashcards

1
Q

Diabetes is a disease in which the body in unable to produce insulin or the body’s response to insulin is impaired
The result is increased levels of

A

glucose in the body and urine

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2
Q

Type I Diabetes

A

Autoimmune B-cell destruction- body cannot produce endogenous insulin

Onset occurs < 30 years of age

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3
Q

Type II Diabetes

A

Progressive loss of B-cell insulin secretion resulting in insulin resistance

Usual onset > 45 years of age

Predominant in African American community

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4
Q

Gestational Diabetes

A

Occurs in the 2nd or 3rd trimester of pregnancy

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5
Q

Complications of Diabetes: Retinopathy (patho and treatment)

A

Diabetic retinopathy is caused by damage to the blood vessels in the tissue at the back of the eye (retina). Early symptoms include floaters, blurriness, dark areas of vision, and difficulty perceiving colors. Blindness can occur.

Mild cases may be treated with careful diabetes management. Advanced cases may require laser treatment or surgery.

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6
Q

Complications of Diabetes: Neuropathy

A

Peripheral neuropathy is the most common type of nerve damage in diabetes that typically affects the feet and legs and sometimes affects the hands and arms

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7
Q

Complications of Diabetes: Albuminuria treatment

A

add ACE inhibitor or ARB

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8
Q

Complications of Diabetes: Macrovascular

A

Coronary artery disease (CAD)
Stroke
Initiate statin therapy

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9
Q

Risk Factors for Diabetes

A

Family history
Populations at greatest risk
African Americans, Latino, Native/ Asian Americans, Pacific Islanders
Cardiovascular disease
Hypertension
HDL <35 mg/dL and /or triglycerides >250 mg/dL
Women with polycystic ovarian syndrome (PCOS)
Obesity

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10
Q

Hyperglycemia- Signs and Symptoms

A 
polyuria
polydipsia
blurred vision
fatigue
xerostomia
headache
trouble concentrating
abnormal pain
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11
Q

Screening for Diabetes: Testing should begin at age

A

45 for all patients

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12
Q

Screening for Diabetes: Besides people 45 years old, who else should be screened

A

Adults with BMI > 25 kg/m2 or BMI > 23 kg/m2 in Asian Americans

and who have >1 additional DM risk factor

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13
Q

Screening for Diabetes: Repeat screening

A

Repeat screening every year if determined to be prediabetic

Repeat screening every 3 years

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14
Q

___ ___ disease is the leading cause of death in T2DM

A

Atherosclerotic cardiovascular disease (ASCVD)

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15
Q

conditions associated with clinically significant atherosclerosis

A

TIA, hospitalized unstable angina, amputation, CHF (NYHA class II-III), >50% stenosis of any artery, CKD (GFR <60mL/min)

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16
Q

DM Medication that is good when they also have ASCD

A

liraglutide, which is a GLP-1 receptor agonists. Several GLP-1 receptor agonists are good for ASCD. SGLT2 Inhibitors are also used.

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17
Q

DM medication that is good when they have heart failure

A

SGLT2 inhibitor which include

Empagliflozin and canagliflozin

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18
Q

DM medication that is good when they have Chronic kidney disease +/- CVD

A

SGLT2 inhibitor which include Empagliflozin and canagliflozin

GLP1RA may be used if SGLT2 is not tolerated, but must use with caution in ESRD

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19
Q

Monotherapy considerations

A

Monotherapy can be considered if A1C < 9%

Metformin + lifestyle modifications

If A1C is not in target after three months, assess medication compliance and consider dual therapy

20
Q

Considerations for dual therapy

A

Dual Therapy can be considered if A1C > 9%

add an agent proven to reduce major CV events and /or CV mortality

If A1C is not in target after three months, assess medication compliance and consider triple therapy

21
Q

Combination injectable therapy can be considered if:

A

A1C >10%
blood glucose > 300 mg/dL
symptomatic

22
Q

ORAL MEDICATIONS

A 
BIGUANIDES 
SULFONYLUREAS 
MEGLITINIDES 
ALPHA-GLUCOSIDASE INHIBITORS 
BAS 
GLITAZONES 
DPP4 INHIBITORS 
SGLT2 INHIBITORS
23
Q

INJECTABLES

A 
GLP-1 AGONISTS 
INSULIN THERAPY (TYPE 1 DIABETES)
24
Q

BIGUANIDES are aka

A

metformin

25
Q

metformin: place in therapy

A

1st line, alone of in combination

26
Q

metformin: mechanism of action

A

decreases hepatic glucose production
decrease glucose absorption in intestines
Increases insulin sensitivity

27
Q

metformin: common ADRs

A

GI upset, vitamin B12 deficiency, lactic acidosis

28
Q

metformin: Black box warning

A

Lactic acidosis

29
Q

metformin: AC1 reduction

A

1-2%

30
Q

metformin: monitoring

A

monitor blood glucose, vitamin B12, A1C, eGFR

31
Q

metformin: impact on weight

A

you can lose or stay the same

32
Q

metformin: benefits

A

doesn’t cause hypoglycemia, cheap, helps PCOS and heart

33
Q

metformin: administration

A

take with food

34
Q

SULFONYLUREAS are a group that includes

A

glipizide, glyburied, glimepride

35
Q

SULFONYLUREAS (glipizide, glyburied, glimepride): place in therapy

A

used in combination

36
Q

SULFONYLUREAS (glipizide, glyburied, glimepride): effect on weight

A

gain

37
Q

SULFONYLUREAS (glipizide, glyburied, glimepride): miscilaneous

A

can cause hypoglycemia

take it 30 minutes before meal, but make sure you definitely eat that meal

38
Q

MEGLITINIDES include

A

nateglinide

repaglinide

39
Q

MEGLITINIDES (nateglinide, repaglinide): place in therapy

A

use in combination; works on postprandial glucose

40
Q

MEGLITINIDES (nateglinide, repaglinide): A1C reduction

A

0.5 to 1.5%

41
Q

MEGLITINIDES (nateglinide, repaglinide): effect on weight

A

gain

42
Q

MEGLITINIDES (nateglinide, repaglinide): miscellaneous

A

less hypogly and less weight gain than sulfonylureas
Always that a little while before eating
safe in the elderly

43
Q

Thiazolidinediones include

A

Pioglitazone

Rosiglitazone

44
Q

Thiazolidinediones (Pioglitazone, Rosiglitazone): place in therapy

A

combination

45
Q

Thiazolidinediones (Pioglitazone, Rosiglitazone): black box warning

A

Can cause or worsen heart failure

MI (Rosiglitazone)

46
Q

Thiazolidinediones (Pioglitazone, Rosiglitazone): misc

A

Rosiglitazone is restricted because it can cause heart failure

Pharm (23 decks)

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