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Pharm > DM treatment > Flashcards

DM treatment Flashcards

1
Q

what medication is a biguinaide?

A

metformin

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2
Q

what is the MOA of metformin?

A

biguinide

  • insulin sensitizer of hepatic and muscle tissues to increase glucose uptake
  • lower hepatic glucose production
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3
Q

is metformin associated with hypoglycemia?

A

no

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4
Q

what is the max effective dose of metformin?

A

2000mg

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5
Q

what are the ADE of metformin?

A

N/D/V
metallic taste
interferes with B12 absorption
Lactic acidosis when used with contrast dye

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6
Q

what are the contraindications for metformin?

A

GFR <30

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7
Q

what are the dose adjustment for GFR when using metformin?

A

GFR <30: stop therapy

GFR <45: do not initiate therapy

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8
Q

what medications are thiazolinidones?

A

-glitazones
pioglitazone
rosiglitazone

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9
Q

what is the MOA pioglitazone?

A

thiazolinidiones

  • activates PPAR-y to increase insulin sensitivity
  • increase glucose uptake in muscles and adipose tissue
  • decrease glucose output by liver
  • increase fatty acid uptake
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10
Q

is pioglitazone associated with hypoglycemia?

A

no

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11
Q

what are the ADE of pioglitazone?

A

insulin sensitizer

  • edema
  • HF exacerbation
  • increased LFTs
  • increased risk of bone fracture
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12
Q

what are the contraindications for pioglitazone?

A
  • NYHA Class III/IV HF
  • LFT >2.5x ULN
  • Hx of bladder cancer
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13
Q

what medications are sulfonylureas?

A

Gli- or Gly-

  • Glimepiride
  • Glipizide
  • Glyburide
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14
Q

what is the MOA of sulfonylureas?

A

Glimepiride, glipizide, glyburide
bind to sulfonylurea receptors on beta cells to increase insulin secretion
- squeeze out insulin

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15
Q

where is significant about Glipizide?

A

second generation sulfonylurea

  • associated with the most hypoglycemia in its class
  • metabolized int he liver to inactive metabolites
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16
Q

what is significant about Glimepiride?

A

2nd gen sulfonylurea

  • metabolized in liver to inactive components
  • best A1C benefit
  • less hypoglycemia, but weight gain
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17
Q

what is significant about glyburide?

A

2nd gen sulfonylurea

- metabolized in the liver to active metabolites

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18
Q

which of the 2nd gen sulfonylurea is a prodrug?

A

glyburide

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19
Q

what are the ADE of Glimepiride, glipizide, glyburide?

A

hypoglycemia
weight loss
pruritis
hemolytic anemia

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20
Q

what is the MOA of nateglinide and repaglinide?

A

bind to sulfonylyrea receptors on beta cells to increase insulin secretion

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21
Q
  • nateglinide and repaglinide
  • glimepiride, glipizide, glyburide
    both drug classes have the same MOA, what is the difference between the 2?
A
  • nateglinide and repaglinide have a shorter onset
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22
Q

what are the ADE of nateglinide and repaglinide?

A
  • hypoglycemia

- weight gain

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23
Q

what is the MOA of sitagliptin, linaglitin, and alogliptin?

A

Glucose dependent

  • increase insulin synthesis and release from beta cells
  • decrease glucagon secretion from alpha cells
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24
Q

out of these meds, which one has no renal adjustments? sitagliptin, linaglitin, and alogliptin

A

linaglitin

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25
Q

what is the ADE of sitagliptin, linaglitin, and alogliptin?

A
  • acute pancreatitis
  • H/A
  • severe joint pain
  • UTI
  • URI
  • hypersensitivity
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26
Q

what are the contraindications for sitagliptin, linaglitin, and alogliptin?

A
  • hypersensitivity
  • DKA
  • Saxgliptin worsens HF
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27
Q

what is the MOA of liragluTIDE, exenaTIDE, exenaTIDE?

A
  • decrease glucagon secretion

- improve satiety and decrease food intake

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28
Q

what are the ADE of liragluTIDE, exenaTIDE, exenaTIDE?

A
  • GI discomfort
  • acute pancreatitis
  • injection site reaction
  • thyroid carcinoma
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29
Q

what are the contraindications for liragluTIDE, exenaTIDE, exenaTIDE?

A
  • hx of thyroid cancer
  • MEN2
  • risk for thyroid C-cell tumor
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30
Q

what is the MOA of canaGLIFLOZIN, dapaGLIFLOZIN, empaGLIFLOZIN, ertuGLIFLOZIN?

A
  • increase glucose excretion by inhibiting Na+/glucose co-transporter 2 in the proximal convoluted tubule
  • lowers renal threshold for glucose
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31
Q

what is the ADE of canaGLIFLOZIN, dapaGLIFLOZIN, empaGLIFLOZIN, ertuGLIFLOZIN?

A
  • fungal UTI
  • genital mycotic infections
  • polyuria/dehydration
  • electrolyte imbalance
  • DKA
  • bone fracture
  • Fournier’s gangrene
32
Q

what are the contraindications for canaGLIFLOZIN, dapaGLIFLOZIN, empaGLIFLOZIN, ertuGLIFLOZIN?

A
  • severe renal impairment
  • end stage renal disease
  • dialysis
33
Q

what is the MOA of acarbose and miglitol?

A
  • inhibits alpha-glucosidase enzymes to slwo the rate of digestion = less glucose absorbed
34
Q

what are the ADE of acarbose and miglitol?

A
  • hypoglycemia
  • GI distress
  • increased LFTs
35
Q

what are the contraindications for acarbose and miglitol?

A
  • IBS
  • colonic ulcerations
  • intestinal obstruction
  • cirrhosis
36
Q

what is the MOA of pramlintide?

A
  • decrease glucagon production and slows gastric emptying
37
Q

what are the ADE of pramlintide?

A
  • hypoglycemia
  • N/V
  • lack of appetite
  • abdominal pain
38
Q

what are the contraindications for pramlintide?

A

gastroparesis

39
Q

what is the use of bile acaid sequestrants in DM treatment?

A

bind bile acids in intestines and increase bile acid production

40
Q

what are the contraindications for using bile acid sequestrants in treating DM?

A
  • TG >500
  • bowel obstruction
  • h/o pancreatitis
  • T1DM
  • DKA
41
Q

out of the T2DM drug classes, which medications are injections?

A
  • liragluTIDE, exenaTIDE, exenaTIDE
    (only oral option is semaglutide)
  • pramlintide
42
Q

out of the medication class GLP1 receptor agonist, which is an oral medication?

A

Semaglutide

43
Q

out of the Type II DM drug classes, which ones have a risk for hypoglycemia?

A
  • insulin
  • 2nd gen sulfonylurea: Glipizide has the highest hypoglycemia in its class
  • pamlintide
  • meglinitides: nateglinide and repaglinide
44
Q

what is the approrpaite initial therapy for type II DM?

A

metformin

45
Q

what is the add on therapy for a patient with type II DM and wants to lose weight?

A
  • insulin for those A1C >10% and BG >300
  • SLGT2i: -gliflozin
  • GLP1 agonist: -tide
46
Q

what is the add on therapy for type II DM who has ASCVD, CVD, HF?

A
  • SGLT2i: -gliflozin

- GLP1-receptor agonist: -tide

47
Q

what is the use of insulin in treating type II DM?

A
  • when A1C >10%
  • start with basal at 0.1-0.2 units/kg/day
  • consider adding prandial
  • continue metformin
48
Q

when fasting insulin in out of range, what insulin do you adjust?

A
  • basal insulin

- evening NPH insulin

49
Q

when post-breakfast/pre-lunch in out of range, what insulin do you adjust?

A
  • prebreakfast rapid insulin or

- short acting insulin

50
Q

when post-lunch/pre-dinner insulin in out of range, what insulin do you adjust?

A
  • prelunch rapid insulin or short acting insulin

- morning NPH insulin

51
Q

when bedtime insulin in out of range, what insulin do you adjust?

A
  • predinner rapid or short acting insulin
52
Q

what is the recommended rx therapy for T1DM?

A
  • multiple daily injections of prandial and basal insulin OR continous insulin
  • potential add-ons: pramlintide, metformin, GLP1 agonist, SGLT2i
53
Q

what is the ultra-rapid bolus insulin?

A

Fiasp

54
Q

what are the rapid acting insulins?

A

bolus

- Humalog, ademelob, novolog, apidra, afrezza (inhaled)

55
Q

what are the intermediate acting basal insulins?

A
  • humulin

- novolin R

56
Q

what are the long acting basal insulins?

A
  • lantus
  • toujeo
  • basaglar
  • levemir
57
Q

what are the ultra long acting basal insulins?

A
  • tresiba
58
Q

what is the treatment for a patient with DM and HTN?

A
  • ACEi/ARB
  • CCB
  • diuretic
59
Q

what is the treatment for a patient with DM and high lipids?

A

statin

60
Q

what is the use of anti-platelet therapy for patients with DM?

A
  • ASA for secondary prevention

- DAPT for ACS

61
Q

what is the management for a patient with DM and ASCVD?

A
  • canagliflozin
  • empagliflozin
  • dulaglutide
  • liraglutide
  • semaglutide
62
Q

what is the management for a patient with DM and HF?

A
  • dapagliflozin

- empaglifozin

63
Q

what medications should be avoided when treating patient with DM and HF?

A
  • thiazolidinediones (-glitazone)

- DPP4 inhibotors: saxagliptin and alogliptin

64
Q

what is the management for a patient with DM and CKD?

A
  • canagliflozin and daptagliflozin

- dulaglutide, liraglutide, semaglutide

65
Q

how do you switch basal insulins?

From NPH daily to glargine, detemir, and debludec?

A

1:1

66
Q

how do you switch from NPH 2x daily to glargine, detemir, or degludec?

A

80% total daily dose NPH -> glargine or detemir once daily

67
Q

how do you switch from premix insulin to glargine, detemir, and degludec?

A

80% of basal component to once daily

68
Q

how do you switch long acting insulin to glargine, detemir, or degludec?

A

1:1

69
Q

how do you calculate insulin to carbohydrate ratio (ICR)?

A

Rule of 500: people usually consume 500g carbs a day
500/total dose (TDD) of insulin
e.g. if you use 20 units of insulin, ICR is 1:25

70
Q

how do you calculate the correction factor?

A

Rule of 1800:
- for rapid acting insulin correction and to show how much it will lower blood sugar by
1800/TDD insulin
e.g if you take 30 units of rapid acting, 1800/30 = 60. Blood sugar will decrease by 60 mg/dL

71
Q

what is the correction dose?

A

(Current BG - Target BG)/correction factor

e. g. (220-120)/50
- need 2 units of rapid acting insulin

72
Q

for T1DM, how do you determine insulin?

A

50% basal, 50% prandial

73
Q

how do you calculate total daily insulin for T1DM?

A
  • 0.4-1 units/kg/day

- 0.5 units kg/day starting dose that is 50% prandial and 50% basal

74
Q

how do you initiate basal insulin therapy for a T2DM?

A

0.1 - 0.2 units/kg/day

75
Q

how do you initiate prandial insulin therapy for a T2DM?

A

4% of basal insulin dose

Pharm (2 decks)

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