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P2 E3 Shea > DM2- Oral Meds > Flashcards

DM2- Oral Meds Flashcards

1
Q

What is the Somogyi effect and what 2 things cause it?

A

Hyperglycemia in the morning due to:

  1. Too little food the night before
  2. Too much insulin the night before
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2
Q

Infections and corticosteroids cause hypo or hyperglycemia?

A

Hyperglycemia

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3
Q

Hyperglycemia or hypoglycemia?

  • Shaking
  • tachycardia
  • sweating
  • anxiety
  • dizziness
  • hunger
  • impaired vision
  • weakness, fatigue
  • HA
  • Irritable
A

Hypoglycemia

(this is life threatening)

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4
Q

Hyperglycemia or hypoglycemia?

  • Thirst
  • Dry skin
  • frequent urination
  • Hunger
  • blurred vision
  • Drowsiness
  • Nausea
A

Hyperglycemia

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5
Q

If you aren’t sure if the patient is hypo or hyperglycemic should you give them glucose or no?

A

Yes! Hypoglycemia can kill them!

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6
Q

What is first line tx for T2DM

A

Metformin

+

Lifestyle changes

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7
Q

POPCORN

What type of medication is Metformin

A

Biguanide

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8
Q

MOA of Metformin?

A

Enhances insulin sensitivity of hepatic and peripheral (muscle) tissues, allowing for increased glucose uptake

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9
Q

When starting your patient on Metformin, when should you advise them to first take it

A

With the largest meal of the day

(to avoid GI upset)

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10
Q

What is the common ending associated with the Thiazolidinediones?

A

“-glitazones”

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11
Q

What are the 2 Thiazolidinediones

A
  1. Pioglitazone
  2. Rosiglitazone
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12
Q

MOA of Thiazolidinediones (“-glitazones”)

A

Enhances insulin sensitivity in muscle, liver and fat tissues indirectly

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13
Q

What are the 2 ADEs of Thiazolidinediones

A
  1. Fluid retention
  2. Fat accumulation- weight gain
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14
Q

What is the special ADE of Pioglitazone

A

may decrease triglycerides

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15
Q

T/F: Thiazolidinediones is great for people with CVD

A

FALSE

This group of meds is NOT for patients with CVD

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16
Q

What are the 2 Sulfonylureas

A
  1. Glipizide
  2. Glimepiride
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17
Q

What are the 2 Metaglinides? What is the common ending?

A

“-glinides”

  • Regaglinide
  • Nateglinide
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18
Q

What are the 2 side effects of Sulfonylureas and Metaglinides?

A
  1. Weight gain
  2. Significant Hypoglycemia
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19
Q

Although Sulfonylureas and Metaglinides are 3rd line, why might you prescribe these?

A

Low cost- it might be what the patient can afford

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20
Q

Which group of meds are second line monotherapy or added to Metformin regimen?

A

GLP-1 receptor agonists (“-glutide”, “-natide”)

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21
Q

The following meds are part of which group of DM meds?

  • Exenatide
  • Liraglutide
  • Albiglutide
  • Dulaglutide
  • Semaglutide
  • Lixisenatide
A

GLP-1 receptor agonists (incretins)

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22
Q

What is the MOA of GLP-1? (3)

A
  • Enhance insulin secretion
  • Suppresses inappropriately high postprandial _glucagon secretion**_
  • Decreases hepatic glucose production
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23
Q

Which group of meds?

  • Increases satiety
  • slows gastric emptying
    *
A

GLP-1

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24
Q

Does GLP-1 cause weight loss or gain?

A

weight loss

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25
Q

Which group of meds is considered an alternative to basal insulin in patients with < 9% A1c, obesity, no symptomatic hyperglycemia

A

GLP-1

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26
Q
A
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27
Q

What is the ending for DPP-4 inhibitors

A

“Gliptans”

(Sitagliptin, saxagliptin, linagliptin, alogliptin)

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28
Q

which group of meds:

Prolong the half life** of endogenously produced **GLP-1** and **GIP, which:

  • Reduces inappropriately elevated postprandial glucagon
  • improves B cell response to hyperglycemia
A

DPP-4

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29
Q

What 2 side effects warrant discontinuation of DPP-4 meds

A
  1. Urticaria
  2. Facial edema
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30
Q

What is the ending for SGLT-2 inhibitors?

A

“gliflozins“

(canagliflozin, dapagliflozin, empagliflozin)

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31
Q

What is the MOA of SGLT-2?

A

Inhibition of SGLT-2 lowers the renal tubular threshold for glucose reabsorption

32
Q

Glucosuria caused by SGLT-2i occurs when

A

at lower plasma glucose concentrations

33
Q

Concomittent use of diuretics with SGLT-2 inhibitors may cause what 2 things?

A
  1. Orthostatic hypotension
  2. Electrolyte abnormalities
34
Q

SGLT-2 inhibitors have increased risk of which 2 things in women due to glucosuria?

A
  1. UTIs
  2. vagintis

(this wasn’t on the slide- said in class)

35
Q

What are the two a-glucosidase inhibitors?

A
  1. Acarbose
  2. Miglitol
36
Q

Which 2 meds cause breakdown of sucrose and complex carbohydrates in the small intestine, prolonging carbohydrate absorption

A

Acarbose and Miglitol

(a-glucosidase inhibitors)

37
Q

What is the net effect of a-Glucosidase inhibitors (Acarbose and Miglitol)?

A

reduction in postprandial glucose (40-50mg/dL) with relatively unchanged FBG

38
Q

What are the 4 side effects of Acarbose and Miglitol (a-Glucosidase inhibitors)

A
  1. Flatulence
  2. Bloating
  3. Abdominal discomfort
  4. Diarrhea
39
Q

Acarbose and Miglitol:

  • Treat hypoglycemia with what
A

glucose (dextrose) products or glucagon

40
Q

Which group of meds might reduce LDL cholesterol by 12-16% but this is not seen when combined with Metformin

A

Bile acid sequestrants (Colesevelam)

41
Q

Which group of meds?

  • MOA not fully known but may involve improved hepatic insulin sensitivity and decreased hepatic glucose output
A

Dopamine Agonists

42
Q

Which 4 meds have the greatest A1c lowering potential? (> 1.5%)

A
  • Metformin (1.5-2.0%)
  • TZD (1.5%)
  • SGLT-2 (0.91-1.16%)
  • Sulfonylurea (1.5-2.0%)
43
Q

What are 5 interventions decrease mortality/complications a/w T2DM?

A

In decreasing order of benefit:

  • Smoking cessation
  • BP control
  • Metformin therapy
  • Lipid reduction
  • Glycemic control (no effect on mortality or clinically relevant complications)
44
Q

Which intervention extends life by 3 years for men and by 2 years for women

A

Lipid reduction

45
Q

According to ACE guidelines, what is the BP goal for a pt w/ DM and HTN

A

SBP: < 130

DBP: < 80

46
Q

GLP-1 are not recommended for GFR below what

A

< 30

47
Q

What are the 3 microvascular complications a/w DM

A
  1. Retinopathy
  2. Neuropathy
  3. Nephropathy
48
Q

What can Phentermine be used for in DM?

(idk if this will be on there but who knows)

A

DM w/ obesity (BMI >25)

49
Q

Which 2 meds are good for ppl w/ ASCVD risk

A

GLP-1 or SGLT2

50
Q

Which 2 meds cause weight loss

A

GLP or SGLT2i

51
Q

Which med is good for pt w/ HF or CKD?

A

SGLT2i

If cant take SGLT2 (GFR <30) then can use GLP-1

52
Q

What med do you start if you have a symptomatic DM patient with A1c > 9.0?

A

Insulin

+/- other agents

53
Q

What are the 3 macrovascular compliactions of DM?

A
  1. Coronary heart disease/stroke
  2. HTN
  3. Peripheral vascular disease
54
Q

Which hormone:

  • Suppresses glucagon release
  • slow gastric emptying
    • decreases food intake
A

Amylin

55
Q

Which hormone:

  • Decreases release of insulin and glucagon
  • decreases GI tract motility and hormone release
  • Decreases GH secretion
A

Somatostatin

56
Q

Which hormone?

  • Increases B cell mass and insulin secretion
  • delays gastric emptying
  • decreases food intake and glucagon secretion
A

GLP-1

57
Q

Which hormone:

  • Promotes glycogenolysis and gluconeogenesis in liver
A

Glucagon

58
Q

Which hormone:

  • Promotes uptake of glucose, amino acids and fatty acids from blood into cells for storage as glycogen, protein and triglyceride
A

insulin

59
Q

Type 1 or 2 DM?

B cell destruction–> insulin deficiency

A

type 1

60
Q

Type 1 or 2 DM?

Progressive loss ob B cell insulin secretion, frequently on the background of insulin resistance

A

Type 2

61
Q

T1DM or T2DM?

  • polyuria, polydispsia, polyphagia
  • weight loss
  • lethargy accompanied by hyperglycemia
A

Type 1

62
Q

Type 1 or 2 DM

  • Lethargy
  • polyuria
  • nocturia
  • polydipsia
  • Most pts overweight or obese
A

Type 2

63
Q

Fasting blood sugar measures effectiveness of what

A

basal insulin or agents which decrease hepatic gluconeogenesis overnight (“leaky liver”)

64
Q

2 hour post prandial blood sugar measures effectiveness of what

A

blous insulin or agents given to increase levels of insulin

helps determine needed food intake changes

65
Q

How do you treat diabetic diarrhea (commonly nocturnal)

A

Doxy or Metronidazole x10-14d

66
Q

How do you tx gastroparesis in DM

A

Metoclopramide

67
Q

1st line tx for diabetic nephropathy

A

ACE or ARBs

68
Q

What med decreases sxs of peripheral vascular dz (complication of DM)

A

Cilostazol

69
Q

Which 2 groups of meds decrease glucose absorption

A
  1. a-glucosidase inhibitors
  2. Amylin mimetics
70
Q

Which group of meds increase glucose excretion

A

SGLT2i

71
Q

Which 2 meds increase glucose utilization

A
  1. Thiazolidinediones
  2. Insulin
72
Q
A
73
Q

Which 4 meds increase insulin secretion

A
  1. Sulphonylureas
  2. Meglitinides
  3. GLP-1
  4. DPP-4
74
Q

Which 2 meds decrease glucose production

A
  1. Biguanides (Metformin)
  2. Insulin
75
Q

Which group of meds is contraindicated if GFR <30

A

SGLT2i

(Dapagliflozin and Empagiflozosin)

P2 E3 Shea (9 decks)

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