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Diabetes Mellitus > DM Pharmacology Part II > Flashcards

DM Pharmacology Part II Flashcards

1
Q

Patients with liver/renal disease, age over 65, hypoxic states and use excessive EtOH who take metformin should be monitored for?

A

lactic acidosis

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2
Q

medications that predispose you to hypoglycemia

A 
combinind antidiabetics 
aspirin
beta blockers
fluoroquinolones
fenugreek
MAO inhibitors 
psyllium 
ACE inhibitors
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3
Q

Effect of metformin in PCOS

A

can help with conception

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4
Q

why do you have to frequently dose glinides?

A

short half life

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5
Q

Two types of Thiazolidinedione drugs

A

pioglitazone → MC

rosiglitazone

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6
Q

black box warning for GLP1 agonist

A

thyroid cancer in rat studies

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7
Q

what drug do you want to avoid interacting with acarbose?

A

digoxin

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8
Q

this receptor regulated gene transcription associated with proteins which interact in carb and lipid metabolism

A

peroxisome proliferator-activated receptor gamma (PPAR-y)

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9
Q

if the patient has ASCVD or needs weight loss you should consider

A

GLP1 agonist

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10
Q

MOA for thiazolidinediones

A

increases insulin sensitivity by stimulating PPAR-y

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11
Q

MOA of a-glucosidase inhibitors

A

decreases prostprandial hyperglycemia with delayed intestinal carbohydrate absorption

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12
Q

pro of nateglinide

A

doesn’t need renal dosing → good for patient with renal insufficiency

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13
Q

what drug can you prescribe to a prediabetic patient?

A

a-glucosidase

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14
Q

what is the incretin effect?

A

INtestinal seCRETion of INsulin→ oral glucose ingestion results in greater insuline response in comparion to IV glucose administration

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15
Q

two types of insulin secretagogues

A

sulfonylurea (SUR) and meglitindes

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16
Q

effects of GLP1 on the pancease

A

increases insulin release

decrease glucagon release

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17
Q

adverse effects for SGLT2 inhibitors

A 
potential for DKA 
potential for leg and foot amputations 
yeast infections 
increased fracture risk
hypotension
hyperkalemia 
bladder cancer
UTIs
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18
Q

T2DM with HF or CKD → first line? Second line?

A

metformin

metformin + GLP1RA or SGLT2i

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19
Q

T2DM with established ASCVD → first line

A

metformin

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20
Q

GLP1 agonist that is the best at lowering glucose and has benefit of weight loss

A

semaglutide

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21
Q

Adverse effects in GLP1 agonists

A

GI → D/N
gallbladder disease
hypoglycemia

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22
Q

Patient is on GLP1 agonist and experiences severe abdominal pain that radiates to the back, they also are experiencing nausea and vomiting → work them up for?

A

pancreatitis

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23
Q

4 types of DPP-4 inhibitors

A

alogliptin
linagliptin
saxagliptin
sitagliptin

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24
Q

MOA of SUR

A

block ATP sensitive potassium channels in pancreatic B cell membrane → increase insulin secretion

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25
Q

which DPP-4 would you give to a patient with renal failure since there are no adjustments required?

A

linagliptin

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26
Q

Besides decreasing glucose levels how else is SGLT2 benefitial?

A

decreases SBP
decreases body weight
decreases urinary albumin excretion

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27
Q

you should avoid DPP-4 inhibitor in patient already on

A

GLP1 agonist

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28
Q

Black box warning for TZD

A

congestive heart failure

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29
Q

adverse effect to be on the lookout for with exenatide

A

injection site reactions

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30
Q

If the eGFR falls below 45 in a patient who just started Metformin, what is the next step you should take?

A

consider risk/benefit for treatment

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31
Q

Actions of GLP1

A 
neuroprotective
appetite suppression
decreased gastric emptying
increased insulin secretion 
decreased glucagon secretion
increased B cell proliferation
increased glucose uptake/storage in muscle and adipose
decreased glucose production by liver 
cardioprotective
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32
Q

T2dM with established ASCVD → second line

A

metformin + GLP 1RA or SGLT2i

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33
Q

what heart failure signs do you want to monitor for in starting and increase TZD dose?

A

excessive rapid weight gain
dyspnea
edema

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34
Q

According to ADA, the recommended glycemic management for T2DM with establish ASCVD is

A

SGLT2 inhibitor or GLP1 agonist

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35
Q

If a patient has eGFR between 30-45, can they take metformin?

A

not recommended

36
Q

Patient on metformin should stop their meds before receiving contrast media if their eGFR is between

A

30-60

37
Q

What do you do with a patient on metformin whose eGFR falls below 30?

A

discontinue therapy

38
Q

4 types of SGLT2 inhibitors

A

canagliflozin
dapagliflozin
empagliflozin
etrugliflozin

39
Q

3 pros of metformin

A

highly efficacious
low risk of hypoglycemia
weight neutral

40
Q

this transporters main role is glucose/galactose reabsorption in the small intestines

A

SGLT1

41
Q

Where do SGLT1 mainly act?

Where do SGLT2 mainly act?

A

SGLT1 → gut

SGLT2 → renal

42
Q

How should a patient take Nateglinide?

A

with food → more effective

43
Q

Pregnancy category for a-glucosidase inhibitors

A

B

44
Q

What do you want dose adjust SGLT2 inhibitors for?

A

renal impairment

45
Q

when prescribing metformin, you can go ahead and inititate the required dose for the patient?

A

no → must titrate up

46
Q

Adverse effects in meglitinides

A

hypoglycemia
weight gain
diarrhea

47
Q

MOA of dipeptidyl peptidase enzyme inhibitor

A

protects GLP1 from inactivation →
increases glucose depended insulin secretion
decreases glucagon secretion

48
Q

biggest adverse effect for SUR and some others

A

weight gain

nausea and vomiting, hypoglycemia, CV events, hyponatremia

49
Q

metformin is pregnancy category __

A

B

50
Q

biggest side effect with Metformin

A

diarrhea → seen less with XR

51
Q

MOA of SGLT2 inhibitors

A

increases urinary glucose excretion

52
Q

Three 2nd generation SUR that are most often used

A

glyburide
glipizide
glimipride

53
Q

two types of Meglitinides (nonsulfonylurea secretagogues)

A

nateglinide

repaglinide

54
Q

MOA of Meglitinides

A

similar to SUR → block ATP Na/K channels on pancreatic B cells → enhances insulin secretion

55
Q

examples of GLP1 agonists

A

dulaglutide
exanatide
liraglutide
lixisenatide

56
Q

Adverse effects of TZD

A 
fluid retention → edema and HF
increased risk of MI
bone fracture risk
bladder cancer 
hepatotoxicity
57
Q

pro of second generation SUR

A

low cost and highly effective

58
Q

this enzyme converts complex startes (oligosaccharides, disaccharides) to simple start (monosaccharides)

A

alpha-glucosidase

59
Q

T2DM without ASCVD or CKD: what do you add on if you need to manage weight loss?

A

GLP 1 RA

SGLT2 i

60
Q

GLP1 agonist with best cardiovascular benefit

A

liraglutide

61
Q

incretin hormones are responsible for ___% of postprandial insulin release

A

60%

62
Q

adverse effects of DPP-4 inhibitors (gliptins)

A 
angioedema 
heart failure 
hepatic failure
joint pain
renal impairment
acute pancreatitis 
hyperlipidemia
63
Q

first line in treating T2DM

A

metformin

64
Q

what gylcemic lowering drug should be avoided in a patient with heart failure?

A

TZD

65
Q

When you should start to consider dose adjusting for renal function for SUR?

A

CrCl < 50

66
Q

metformin is at risk for lowering what level?

A

B12

67
Q

Pro of using meglitinide over SUR

A

patients with sulfa allergy

68
Q

this transporter facilitates renal glucose reabsorption

A

SGLT2

69
Q

2 incretin hormones

A

gastric inhibitory peptide (GIP)

glucagon-like peptide (GLP1)

70
Q

while Beta Blockers can decrease signs of hypoglycemia, they will not decrease what?

A

sweating

71
Q

Is SUR effective in T1DM?

A

no → need functioning pancreatic B cells

72
Q

Who are TZD contraindicated in?

A

heart failure patients

73
Q

side effects of SGLT1 inhibitors

A

diarrhea and dehydration

74
Q

3 MOA of GLP1 agonists

A

increases glucose dependent insulin secretion
decreases glucagon secretion
slows gastric emptying

75
Q

Con of linagliptin that may cause lots of DDI

A

long half life → > 100 hours

76
Q

T2DM without ASCVD or CKD: add on if cost is concern for patient?

A

SU

TZD

77
Q

biggest adverse effects of a-glucosidase inhibitors

A

flatulence → MC
diarrhea
abdominal pain

78
Q

what levels do you check before prescribing TZD?

A

LFTs

79
Q

effects of GLP1 on the hypthalamus

A

decreases appetite

80
Q

MOA for TZD at the liver, muscle, and adipose tissue

A

decreases hepatic glucose production

increases glucose uptake in muscles

81
Q

T2DM without ASCVD or CKD: what do you add on if you need to address hypoglycemia?

A

DPP-4 I
GLP 1 RA
SGLT2i
TZD

82
Q

2 MOA of Metformin

A

decreases hepatic glucose production

increases glucose uptake in muscles

83
Q

effects of GLP1 on the stomach

A

delays gastric emptying

84
Q

Black box warning for canagliflozin

A

increased risk of lower limb amputation in patients with T2DM and established CVD

85
Q

two types of a-glucosidase inhibitors used

A

acarbose

miglitol

Diabetes Mellitus (4 decks)

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