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P2 E3 Shea > DM2- Oral Meds COPY > Flashcards

DM2- Oral Meds COPY 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
Which group of meds is considered an alternative to basal insulin in patients with **\< 9% A1c**, **obesity, no** **symptomatic hyperglycemia**
GLP-1
26
27
What is the ending for **_DPP-4_** inhibitors
**_"Gliptans"_** (Sitagliptin, saxagliptin, linagliptin, alogliptin)
28
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**
DPP-4
29
What 2 side effects warrant discontinuation of DPP-4 meds
1. Urticaria 2. Facial edema
30
What is the ending for **SGLT-2** inhibitors?
**"gli**_flozins_**"** (canagliflozin, dapagliflozin, empagliflozin)
31
What is the MOA of SGLT-2?
Inhibition of SGLT-2 **lowers the _renal_ tubular threshold for glucose reabsorption**
32
**Glucosuria** caused by **SGLT-2i** occurs when
at **lower plasma glucose** concentrations
33
Concomittent use of **diuretics** with **SGLT-2** inhibitors may cause what 2 things?
1. Orthostatic hypotension 2. Electrolyte abnormalities
34
SGLT-2 inhibitors have increased risk of which 2 things in women due to **glucosuria**?
1. UTIs 2. vagintis (this wasn't on the slide- said in class)
35
What are the two **a-glucosidase inhibitors**?
1. Acarbose 2. Miglitol
36
Which 2 meds cause **breakdown of sucrose and complex carbohydrates** in the **small intestine**, **prolonging carbohydrate absorption**
**Acarbose** and **Miglitol** | (a-glucosidase inhibitors)
37
What is the net effect of a-Glucosidase inhibitors (Acarbose and Miglitol)?
**reduction in postprandial glucose** (40-50mg/dL) with relatively **unchanged FBG**
38
What are the 4 side effects of **Acarbose** and Miglitol (a-Glucosidase inhibitors)
1. Flatulence 2. Bloating 3. Abdominal discomfort 4. Diarrhea
39
Acarbose and Miglitol: * Treat hypoglycemia with what
**glucose** (dextrose) products or **glucagon**
40
Which group of meds might **reduce LDL** cholesterol by 12-16% but this is not seen when combined with Metformin
Bile acid sequestrants (Colesevelam)
41
Which group of meds? * MOA not fully known but may involve **improved hepatic insulin sensitivity** and **decreased hepatic glucose output**
Dopamine Agonists
42
Which 4 meds have the greatest A1c lowering potential? (\> 1.5%)
* **_Metformin_** (1.5-2.0%) * **_TZD_** (1.5%) * **_SGLT-2_** (0.91-1.16%) * Sulfonylurea (1.5-2.0%)
43
What are 5 interventions decrease mortality/complications a/w T2DM?
_In decreasing order of benefit:_ * Smoking cessation * BP control * Metformin therapy * Lipid reduction * Glycemic control (no effect on mortality or clinically relevant complications)
44
Which intervention extends life by 3 years for men and by 2 years for women
Lipid reduction
45
According to ACE guidelines, what is the BP goal for a pt w/ DM and HTN
SBP: \< 130 DBP: \< 80
46
GLP-1 are not recommended for GFR below what
\< 30
47
What are the 3 microvascular complications a/w DM
1. Retinopathy 2. Neuropathy 3. Nephropathy
48
What can **Phentermine** be used for in DM? (idk if this will be on there but who knows)
DM w/ obesity (BMI \>25)
49
Which 2 meds are good for ppl w/ ASCVD risk
GLP-1 or SGLT2
50
Which 2 meds cause weight loss
GLP or SGLT2i
51
Which med is good for pt w/ **HF** or **CKD**?
**_SGLT2i_** If cant take SGLT2 (GFR \<30) then can use GLP-1
52
What med do you start if you have a **symptomatic** DM patient with **A1c \> 9.0?**
Insulin +/- other agents
53
What are the 3 macrovascular compliactions of DM?
1. Coronary heart disease/stroke 2. HTN 3. Peripheral vascular disease
54
Which hormone: * Suppresses glucagon release * slow gastric emptying * decreases food intake
Amylin
55
Which hormone: * Decreases release of insulin and glucagon * decreases GI tract motility and hormone release * Decreases GH secretion
Somatostatin
56
Which hormone? * Increases B cell mass and insulin secretion * delays gastric emptying * decreases food intake and glucagon secretion
GLP-1
57
Which hormone: * Promotes glycogenolysis and gluconeogenesis in liver
Glucagon
58
Which hormone: * Promotes uptake of glucose, amino acids and fatty acids from blood into cells for storage as glycogen, protein and triglyceride
insulin
59
Type 1 or 2 DM? B cell destruction--\> **insulin deficiency**
type 1
60
Type 1 or 2 DM? Progressive loss ob B cell insulin secretion, frequently on the background of **insulin resistance**
Type 2
61
T1DM or T2DM? * polyuria, polydispsia, polyphagia * **weight loss** * lethargy accompanied by hyperglycemia
Type 1
62
Type 1 or 2 DM * Lethargy * polyuria * **nocturia** * polydipsia * Most pts **overweight or obese**
Type 2
63
**Fasting blood sugar** measures effectiveness of what
**_basal insulin_** or agents which decrease hepatic gluconeogenesis overnight ("leaky liver")
64
2 hour post prandial blood sugar measures effectiveness of what
blous insulin or agents given to increase levels of insulin helps determine needed food intake changes
65
How do you treat diabetic diarrhea (commonly nocturnal)
Doxy or Metronidazole x10-14d
66
How do you tx gastroparesis in DM
Metoclopramide
67
1st line tx for diabetic nephropathy
ACE or ARBs
68
What med decreases sxs of peripheral vascular dz (complication of DM)
Cilostazol
69
Which 2 groups of meds decrease glucose absorption
1. a-glucosidase inhibitors 2. Amylin mimetics
70
Which group of meds increase glucose excretion
SGLT2i
71
Which 2 meds increase glucose utilization
1. Thiazolidinediones 2. Insulin
72
73
Which 4 meds **increase insulin secretion**
1. Sulphonylureas 2. Meglitinides 3. GLP-1 4. DPP-4
74
Which 2 meds **decrease glucose production**
1. Biguanides (Metformin) 2. Insulin
75
Which group of meds is contraindicated if GFR \<30
**SGLT2i** | (Dapagliflozin and Empagiflozosin)
76
Which 3 meds cause weight GAIN
1. TZD 2. Sulfonylureas 3. Insulin
77
Which 2 meds are weight NEUTRAL
Metformin DPP-4
78
Which 2 meds cause weight LOSS
1. GLP-1 2. SGLT2i
79
Which med has a potential for **B12 deficiency**
Metformin
80
Which group of meds has a **black box warning: risk of _ampution_**
SGLT2i- Canagliflozin
81
Which group of meds has **black box: risk of thyroid C-cell tumors**
GLP-1
82
Black box warnings: CHF
TZD

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