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602 E1 > E1 > Flashcards

E1 Flashcards

1
Q

What BG is considered hyperglycemia?

A

BG > 250mg/dl

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2
Q

What are the S/Sx of hypoglycemia?

A

sweaty, tachycardia, pallor, hangry

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3
Q

How to tx hypoglycemia?

A

Tx with Rule of 15:

  1. check BG
  2. 15g carb load of OJ/soda/candy
  3. wait 15min, then recheck BG
  4. substantial snack w protein, carb, fat
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4
Q

How do you treat severe hypoglycemia?

A

impaired mentation –> paramedics + recombinant glucagon

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5
Q

What are the S/Sx of hyperglycemia?

A

visual changes, polyuria, nocturia, long-term weight loss

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6
Q

How do you tx hyperglycemia?

A

Home mgmt: monitor BG, insulin, rest, water, exercise

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7
Q

What is severe hyperglycemia?

A

DKA –> T1DM, hrs-days

HHS –> T2DM, days-weeks, higher mortality

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8
Q

What are microvascular complications?

A

retinopathy, nephropathy, neuropathy

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9
Q

What are macrovascular complications?

A

cerebrovascular disease, heart disease (CAD leading cause of death), Peripheral vascular disease

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10
Q

What are the ADA guidelines to treat HTN?

A

no preference unless albuminuria –> ACEi/ARB

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11
Q

What are the AAE guidelines to treat HTN?

A

prefer ACEi/ARB

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12
Q

What are the ACC/AHA guidelines to treat HTN?

A

no preference unless:

  • CKD –> ACE
  • HF –> avoid nonDHP CCBs
  • African American –> Thiazides or CCB if monotherapy
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13
Q

What are the ADA guidelines to tx cholesterol?

A

under 40y/o:

  • ASCVD > 10% –> high intensity statin (+/- ezetimibe, PCSK9i)

over 40y/o:

  • ASCVD < 20% –> mod. statin
  • ASCVD > 20% –> high intensity statin (+/- ezetimibe, PCSK9i)
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14
Q

What are the ACC/AHA guidelines to tx cholesterol?

A

all DM its should have mod. intensity statin

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15
Q

What do the ADA guidelines say about ASA in primary prevention?

A

may in pt with high CVD risk (50+, smoker, HTN, LDL > 100, CKD)

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16
Q

What do the AACE guidelines say about ASA in primary prevention?

A

when ASCVD > 10%

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17
Q

How do you treat obesity in DM pts?

A
  • diet, exercise, behavioral therapy to 5% weight loss
  • BMI >= 27 –> consider weight loss meds/therapy
  • BMI >= 35 –> consider bariatric surgery
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18
Q

How do the guidelines address smoking cessation?

A

AVOID tobacco products, even e-cigs

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19
Q

What do the guidelines say about immunizations?

A
  • influenza annually
  • HepB
  • Pneumococcus: 19-64y/o: PPSV23, 65+: PCV13 then PPSV23 booster 1yr later
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20
Q

What do the guidelines say to treat retinopathy?

A
  • optimize BG, BP, lipid control to dec. risk and slow progression
  • annual eye exams –> T1DM within 5yrs post-DM onset, T2DM at the time of diagnosis
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21
Q

What do the guidelines say about nephropathy?

A
  • risk factors: BG, HTN, proteinuria (ACE/ARB), dyslipidemia (statins)
  • annually asses urinary albumin (proteinuria) and eGFR
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22
Q

What do the guidelines say about neuropathy?

A
  • tx options for Sx but not progression (Lyrica, duloxetine)

- annual comprehensive foot exams

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23
Q

How do you tx microvascular complications?

A

by controlling blood sugars

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24
Q

What does DCCT trial show?

A

T1DM; largest study ever conducted

  • intensive insulin therapy reduces A1C and T1DM microvascular complications –> EDIC
  • relative risk of microvascular complication is highly affected by A1C
  • CV benefit won’t be realized until ~10yrs from when you started intensive therapy
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25
Q

What does UKPDS trial show?

A

T2DM; trial we talk about when we consider metformin CV benefit

  • intensive therapy (+metformin, SU) reduced microvascular events –> 10yr follow up: need for meticulous glucose control to improve microvasc. complications & long-term macrovasc. comps., necessary to control BG, A1C & BP
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26
Q

what does ACCORD trial show?

A

T2DM; study that makes us want to individualize goals for pts

  • super intensive therapy (AIC< 6%) led to higher risk of death & MI, esp. if A1C >= 8.5, hx of neuropathy, hx of ASA use
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27
Q

What does ADVANCE trial show?

A

T2DM

  • corroborated with UKPDS 10yr follow up with a dec. in micro and macrovascular complications with intensive therapy
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28
Q

What does VADT trial show?

A

T2DM (white, older men)

  • lower threshold to start insulin therapy dec. major microvascular complications; severe hypoglycemia in last 90 days is strong predictor of mortality
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29
Q

What class of drugs don’t have CVD mortality benefits?

A

DPP4i

only SGLT2 and GLP-1 do

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30
Q

What guidelines (outpt) would you use for someone <65 y/o without clinical ASCVD event?

A

Strict Guidelines: AACE

  • AIC <= 6.5%
  • FBG < 110mg/dl
  • PPG < 140mg/dl
  • want to prevent long-term complications
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31
Q

What guidelines (outpt) would you use for someone >= 65y/o OR any age with a clinical ASCVD event?

A

Loose Guidelines: ADA

  • AIC < 7.5%
  • FBG 80-130mg/dL
  • PPG < 180mg/dl
  • want to avoid hypoglycemia
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32
Q

What are the guidelines to treat a pediatric pt with T1DM?

A
  • BP: tx if consistently > 130/80mmHg
  • cholesterol: tx if LDL consistently > 130mg/dl
  • microvascular monitoring once >= 10y/o OR had DM for 5yrs
  • 60min aerobic exercise with strength training at least 3x/week
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33
Q

What are the guidelines to treat a pediatric pt with T2DM?

A
  • screening once >= 10y/o AND BMI >= 85th percentile
  • aim for 7-10% weight loss
  • 30-60mins of mod-vigorous physical activity 5x/week with strength training for 3
  • goal AIC < 7% (6.5% reasonable if you can avoid hypoglycemia)
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34
Q

What are the guidelines to treat a geriatric pt with DM?

A
  • functional, cognitively intact older adults can use goals developed for younger adults. otherwise…
  • A1C goals more lenient < 7.5%
  • AVOID HYPOGLYCEMIA
  • routinely consider de-escalating regimens
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35
Q

What do you do for sick day mgmt?

A

Sick day = infection, injury, surgery, trauma, invasive procedure, major life stress

  • continue long-acting (basal) insulin as normal
  • use rapid-acting (bolus) insulin only If eating
  • continue PO meds EXCEPT metformin, SGLT2i, GLP-1 –> d/t all PO meds if N/V/D
  • check OTC meds (sugar content)
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36
Q

What are some counseling points for sick day mgmt?

A

test BG Q2H

  • T1DM: check urine/blood ketones Q4H
  • monitor temp. and hydration status
  • tract Sx: N/V/D, thirst, urination
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37
Q

What is MNT?

A

medical nutrition therapy

  • MNT for all DM pts
  • portion control and healthy food choices: low carb, low processed foods
  • plate method
  • weight loss > 5%
  • individualized meal plans

alcohol consumption inc. hypoglycemia

  • no more than 1drink/day for females
  • no more than 2 drinks/day for males
  • preferably drinking with food
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38
Q

What are the target BG values for hypoglycemia and hyperglycemia for inpatient?

A
  • hyperglycemia: > 140mg/dl
  • hypoglycemia: < 70mg/dl
  • severe hypoglycemia: < 40mg/dl
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39
Q

What are the target BG value for FBG and PPG for inpatient?

A
  • FBG: < 140mg/dl
  • PPG: < 180mg/dl
  • if BG goes < 100mg/dl we should modify the pts regimen
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40
Q

What factors could affect a pts glucose control in the inpatient setting?

A
  • stress hyperglycemia: pts without DM (AIC < 6.5%) can experience inc. BG readings when ill
  • inpatient and pt specific risk factors for Hypo and Hyperglycemia
  • drug-induced alterations in BG
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41
Q

What are patient specific factors for hypoglycemia?

A
  • advanced age
  • dec. oral intake
  • chronic renal failure
  • liver disease
  • hx of frequent or severe hypoglycemia
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42
Q

What are inpatient factor for hypoglycemia?

A
  • Change in diet
  • medication use (BBs)
  • failure to adjust regimen based on BG patterns
  • poor coordination between testing and timing of insulin delivery
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43
Q

What are inpatient factors for hyperglycemia?

A
  • prolonged use of correctional insulin as monotherapy
  • TPN or enteral feeds
  • medication use
  • failure to adjust regimen based on BG patterns
  • poor coordination between testing and timing of insulin delivery
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44
Q

What drugs increase the risk of hypoglycemia?

A
  • BBs
  • fluoroquinolone ABX (-oxacin)
  • alcohol
  • pentamidine
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45
Q

What drugs increase the risk of hyperglycemia?

A
  • corticosteroids (-sone)
  • atypical antipsychotics (-zapine)
  • Fluoroquinolone ABX (-oxacin)
  • calcineurin inhibitors (cyclosporine, Tacrolimus)
  • protease inhibitors (-vir)
  • thiazide diuretics
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46
Q

What do you do if a pt comes in and they have a hx of T1DM or T2DM and A1C >= 6.5%?

A

treat them as diabetic (regular POC BG monitoring). no further tests needed

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47
Q

What do you do if a pt comes in with no hx of diabetes but BG > 140mg/dL?

A

send for A1C and begin POC BG testing while we wait (24-48hrs). Can’t confirm DM status without A1C, further tests needed.

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48
Q

What do you do if a pt comes in with no indication that they have been diagnosed with DM, but have a BG > 140mg/dL & A1C in the last 3 months is >= 6.5%?

A

treat them as diabetic (regular POC BG monitoring). no further tests needed.

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49
Q

What are the names of long-acting (basal) insulins?

A
  • Glargine (Lantus, toujeo, basaglar)

- determir (Levemir)

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50
Q

What are the names of rapid-acting (bolus) insulins?

A
  • aspart (novolog)

- lispro (Humalog, Admelog)

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51
Q

What insulin dosage do you use for an inpatient with T1DM?

A

TDD = 0.2-0.4U/kg/day

  • 50-60% basal, 40-50% nutritional
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52
Q

What insulin dosage do you use for an inpatient with T2DM but who has never had insulin?

A

TDD: 0.3-0.5U/kg/day

  • 50% basal, 50% nutritional
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53
Q

What insulin dosage do you use for an inpatient with T2DM who was on insulin before they came in?

A

reduce outpatient dose by 20-25%

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54
Q

If FBG > 140mg/dL how do we adjust insulin dosage?

A

inc. dose of basal insulin by 20%

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55
Q

If BG < 70mg/dl how do we adjust insulin dosage?

A

reduce basal dose by 20%

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56
Q

What is a counseling point for Linagliptan (tradjenta)?

A

URTI

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57
Q

What 2 classes of meds can you never use together?

A

DPP4i and GLP-1

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58
Q

What DPP4i does not require renal dose adjustments?

A

Linagliptan (Tradjenta)

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59
Q

What sulfonylurea is not on the BEERs list?

A

Glipizide

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60
Q

What medication has a DDI with radiopaque contrast dye?

A

metformin –> D/t 24h before, 48hr after imaging

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61
Q

Glyburide

A

SU: Diabeta, Micronase, Glynase

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62
Q

Glipizide

A

SU: Glucotrol, Glucotrol XL

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63
Q

glimepiride

A

SU: Amaryl

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64
Q

Is glyburide on BEERs list?

A

yes

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65
Q

Is glipizide on BEERs list?

A

no

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66
Q

Is glimepiride on BEERs list?

A

yes

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67
Q

Repaglinide

A

Meglitinide: Prandin

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68
Q

Nateglinide

A

Meglitinide: Starlix

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69
Q

metformin

A

biguanide

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70
Q

rosiglitazone

A

TZD: avandia

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71
Q

pioglitazone

A

TZD: actos

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72
Q

acarbose

A

alpha-glucosidase inhibitor: precose

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73
Q

miglitol

A

alpha-glucosidase inhibitor: glyset

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74
Q

sitagliptin

A

DPP4i: Januvia

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75
Q

linagliptin

A

DPP4i: tradjenta

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76
Q

Saxagliptin

A

DPP4i: Onglyza

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77
Q

Alogliptin

A

DPP4i: nesina

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78
Q

canagliflozin

A

SGLT2i: invokana

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79
Q

dapagliflozin

A

SGLT2i: farixiga

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80
Q

empagliflozin

A

SGLT2i: jardiance

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81
Q

ertugliflozin

A

SGLT2i: steglatro

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82
Q

exenatide

A

GLP-1: bydureon

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83
Q

liraglutide

A

GLP-1: victoza

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84
Q

dulaglutide

A

GLP-1: trulicity

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85
Q

lixisenatide

A

GLP-1: adlyxin

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86
Q

semaglutide

A

GLP-1: ozempic

Rybelsus = semaglutide oral

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87
Q

What is basal secretion rate?

A

0.5-1 unit/hr

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88
Q

Is insulin a hormone?

A

yes

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89
Q

Where is insulin produced?

A

in the beta cells of the islets of langerhans in the pancreas

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90
Q

What is insulin formed from?

A

proinsulin (cleaved by beta cella peptidases to insulin)

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91
Q

insulin aspart

A

Novolog, Fiasp

Rapid-Acting Insulin

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92
Q

insulin lispro

A

Humalog, admelog

Rapid-Acting Insulin

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93
Q

Insulin Glusine

A

Apidra

rapid acting insulin

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94
Q

insulin degludec

A

Tresiba

long acting insulin

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95
Q

insulin determir

A

Levemir

Long-Acting Insulin

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96
Q

insulin glargine

A

Lantus, Toujeo, basaglar, semglee

long acting insulin

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97
Q

Insulin Aspart can be administered IV?

A

no

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98
Q

Can insulin aspart be mixed with NPH?

A

yes

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99
Q

Can insulin lispro be administered IV?

A

no

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100
Q

Can insulin lispro be mixed with NPH?

A

yes

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101
Q

What are the ultra-rapid acting insulins?

A

insulin aspart and insulin lispro

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102
Q

What are the rapid acting insulins?

A

insulin lispro, aspart, glulisine

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103
Q

When should you eat after administering a rapid acting insulin?

A

eat within 15mins of injection

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104
Q

Can a rapid acting insulin be mixed with NPH?

A

yes

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105
Q

Can a rapid acting insulin be administered IV?

A

no

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106
Q

What is a short acting insulin?

A

Regular insulin (Humulin R, Novolin R)

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107
Q

What color is regular insulin?

A

clear, colorless

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108
Q

Can regular insulin be given IV?

A

yes (it is the only insulin that can be administered IV)

  • DKA Tx, TPN
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109
Q

What is an intermediate acting insulin?

A

NPH (humulin NPH , Novolin NPH)

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110
Q

What can NPH insulin be mixed with?

A

regular insulin, aspart, lispro, glulisine

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111
Q

What color should NPH insulin be?

A

should be cloudy bc its a suspension but not frosty –> DONT SHAKE WILL DENATURE INSULIN INSIDE

frosting = loss of potency

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112
Q

What are long-acting insulins?

A

glargine, detemir, degludec

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113
Q

Can you dilute long acting insulins?

A

no

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114
Q

Can you mix long acting insulin?

A

no

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115
Q

insulin glargine MOA

A

forms a precipitate right under the skin

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116
Q

insulin detemir MOA

A

has neutral pH of 7.4

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117
Q

Insulin degludec MOA

A

injected as a multi-hexamer –> long time to get broken down to monomer then attaches to albumin

3-5 day SS, no other insulin has this!!!

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118
Q

Inhaled regular insulin

A

Afrezza –> bolus insulin

BBW: acute bronchospasm

approved for 18y/o+

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119
Q

What dosage is blue afrezza?

A

4 units

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120
Q

what dosage is green afrezza?

A

8 units

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121
Q

what dosage is gold afrezza?

A

12 units

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122
Q

Insulin ADES

A

HYPOGLYCEMIA

  • allergy extremely rare
  • injection site
  • lipohypertrophy
  • cough (Afrezza only)
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123
Q

Using AACE guidelines, what insulin dosage should someone with an A1C < 8% get?

A

TDD: 0.1-0.2U/kg

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124
Q

Using AACE guidelines, what insulin dosage should someone with an A1C > 8% get?

A

TDD: 0.2-0.3U/kg

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125
Q

Using AACE guidelines, pt is on basal insulin and you want to add bolus insulin, how do you do this?

A

start 1 bolus shot/day

start: 10% of basal dose

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126
Q

Using AACE guidelines, you want to start basal and bolus insulin , how do you do this?

A
  • start bolus before each meal
  • if not on basal: 0.3-0.5U/kg/day
  • if on basal: 50% of basal dose divided by 3 for each meal
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127
Q

Using ADA guidelines, you want to start bolus insulin in a patient already on basal insulin, how do you do this?

A

10% of basal dose injected once a day at largest meal of day

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128
Q

Using ADA guidelines, you want to start basal insulin in a patient, how much do they get?

A

0.1-0.2U/kg/day

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129
Q

insulin drug interactions

A
  • TZDs
  • ACEi, MAOi
  • thiazide diuretics
  • hormones (estrogens/androgens/thyroid)
  • beta blockers
  • alpha-glucosidase inhibitors
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130
Q

insulin monitoring

A
  • FBG/PPG
  • hypoglycemia
  • weight gain
  • injection site rxns
  • cough (afrezza only)
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131
Q

Whats the MDD for insulin?

A

there is none

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132
Q

does insulin cause weight gain or loss?

A

weight gain

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133
Q

Whats absorbed faster, injectable or nasal insulin?

A

injectable

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134
Q

What SQ injection site has fastest absorption?

A

abdomen > arms > thighs > buttocks

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135
Q

What SQ injection depth has fastest absorption?

A

IV > IM > SQ

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136
Q

Regional blood flow is affected by?

A
  • exercise
  • skin temp.
  • hydration status
  • local heat
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137
Q

Insulin glargine + Lixisenatide

A

(Soliqua)

  • MDD: 60units/20mcg
  • admin. 1hr before breakfast
  • no thyroid C-cell tumor BBW
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138
Q

insulin degludec + liraglutide

A

xultophy

  • MDD: 50U/1.8mg
  • pen delivers doses between 10-50U
  • admin. anytime once daily without regard to food
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139
Q

Are sulfonylureas PO or SQ?

A

PO

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140
Q

What drugs are SUs?

A

(-ide)

Glyburide, Glipizide, Glimepiride

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141
Q

How often are SUs dosed?

A

QD-BID

142
Q

What is the MDD for glyburide?

A

20mg

143
Q

what is the MDD for glipizide?

A

IR: 40mg

ER: 20mg

144
Q

What is the MDD for glimepiride?

A

8mg

145
Q

what is the MOA for SUs?

A

stimulate insulin release from beta cells

  • “insulin secretagogues”
146
Q

What is the SOA for SUs?

A

beta cells in the pancreas

147
Q

What are CIs of SUs?

A

hypersensitivity

T1DM

DKA

148
Q

When is glyburide CI?

A

CrCl < 50

149
Q

When is glipizide CI?

A

CrCl < 10

150
Q

when is glimepiride CI?

A

CrCl < 15

151
Q

What SUs are CI if pregnancy-near term?

A

Glyburide and Glipizide

152
Q

What are ADEs of SUs?

A

hypoglycemia

N/V

weight gain

153
Q

What SUs are on the BEERs list?

A

glyburide and glimepiride

154
Q

When should you take SUs?

A

Take with breakfast or first meal of the day

Exception: Glipizide should be taken 30 min before a meal

155
Q

What should you ask about at every refill for SUs?

A

hypoglycemia and weight gain

156
Q

What efficacy is SUs?

A

high efficacy

157
Q

What cost is SUs?

A

low cost

158
Q

What durability are SUs?

A

low durability –> become less efficacious over time

159
Q

SUs may blunt ___?

A

may blunt myocardial ischemia preconditioning

160
Q

What is the ASCVD risk of SUs?

A

neutral

161
Q

What is the HF risk of SUs?

A

neutral

162
Q

What is the CKD risk of SUs?

A

neutral

163
Q

Do SUs cause weight gain or loss?

A

weight gain

164
Q

What do you monitor in SUs?

A

Hypoglycemia

FBG

A1C

allergic rxns, sun sensitivity

165
Q

How long until SUs reach peak effect?

A

4-6 weeks

166
Q

What drugs are meglitinides?

A

(-glinide)

Repaglinide

Nateglinide

167
Q

Are meglitinides PO or SQ?

A

PO

168
Q

What is the MDD for Nateglinide when A1C < 8%?

A

4mg

169
Q

What is the MDD for Nateglinide when A1C > 8%?

A

16mg

170
Q

What is the MOA for meglitinides?

A
  • stimulate insulin release from beta cells

- insulin secretagogues

171
Q

What is the SOA for meglitinides?

A

beta cells in pancreas

172
Q

What are DDI with Repaglinide?

A

NPH insulin –> inc. risk of MI

Gemfibrozil –> inc. Repaglinide levels

173
Q

What are DDI with Nateglinide?

A

Mifepristone (abortificant): do not use within 14 days

Pazopanib (cancer agent) –> inc. nateglinide levels

174
Q

What are meglitnides CI in?

A

hypersensitivity

T1DM

DKA

175
Q

What are precautions with meglitnides?

A

severe renal disease

impaired liver fx

use with insulin

176
Q

What are ADEs of meglitinides?

A

hypoglycemia (less common than SUs)

GI disturbances

weight gain

headache

177
Q

When do you administer meglitinides?

A

before meals

  • skip meal, skip dose
178
Q

When do you take repaglinide?

A

15-30mins before meals

179
Q

When do you take nateglinide?

A

1-30min before meals

180
Q

Meglitinides are the short acting form of?

A

SUs

181
Q

What should you ask about at every Meglitinide refill?

A

hypoglycemia and weight gain

182
Q

What efficacy are meglitnides?

A

low efficacy

183
Q

What cost are meglitnides?

A

intermediate cost

184
Q

What is the ASCVD risk of meglitnides?

A

neutral

185
Q

What is the HF risk of meglitnides?

A

neutral

186
Q

What is the CKD risk of meglitnides?

A

neutral

187
Q

Do meglitnides require renal dosing?

A

no

188
Q

Meglitnides work specifically on?

A

PPG, so if pt with high PPG these might be good meds

189
Q

What do you monitor for Meglitnides?

A

PPG

hypoglycemia

A1C

weight gain

190
Q

How long until meglitnides reach peak effect?

A

4-6 weeks

191
Q

Do meglitnides cause weight gain or loss?

A

weight gain

192
Q

What drugs are biguanides?

A

metformin

193
Q

Are biguanides PO or SQ?

A

PO

194
Q

How is IR Metformin dosed?

A

850-1000mg BID

195
Q

How is ER metformin dosed?

A

1000-2000mg QD

196
Q

What is minimal effective dose for metformin?

A

500mg

197
Q

What is the primary MOA of biguanides?

A

dec. glucose output from liver

198
Q

what is the secondary MOA of biguanides?

A

inc. peripheral muscle glucose sensitivity

199
Q

What is the SOA of biguanides?

A

liver and peripheral muscle

200
Q

When are biguanides CI?

A

eGFR < 30

Acute Renal Failure

201
Q

When should you dec. biguanides dose?

A

eGFR 30-45 = 1/2 dose

202
Q

What are DDIs with biguanides?

A

radiopaque contrast dyes!!!

d/t 24hrs prior and 48hrs after admin.

203
Q

What are ADEs of biguanides?

A

GI

weight loss

lactic acidosis

cardio protection

vit. B12 deficiency

204
Q

What is a rule of biguanides?

A

titrate SLOWLY to avoid GI ADEs

205
Q

How should you take biguanides?

A

take with food to dec. GI effects

start low, go slow

206
Q

What should you ask about for every biguanide refill?

A

GI upset, weight loss, S/Sx of lactic acidosis (SOB, muscle cramping, tachycardia)

207
Q

What efficacy are biguanides?

A

high

208
Q

Do biguanides cause hypoglycemia?

A

no

209
Q

What cost are biguanides?

A

low cost

210
Q

What ASCVD risk do biguanides have?

A

potential benefit

211
Q

What HF risk do biguanides have?

A

neutral

212
Q

What CKD risk do biguanides have?

A

neutral

213
Q

What do you monitor for biguanides?

A
  • renal fx (eGFR) –> check 6 weeks after initiation, then annually, most providers do Q3-6months
  • GI intolerance

FBG/PPG

  • A1C –> Q3months
  • B12 levels
  • weight loss
  • s/sx of lactic acidosis
214
Q

When do biguanides reach peak effect?

A

6-8 weeks

215
Q

Do biguanides cause weight gain or loss?

A

weight loss

216
Q

What drugs are Thiazolidinediones?

A

(-glitazone)

Rosiglitazone

Pioglitazone

217
Q

Are TZDs PO or SQ?

A

PO

218
Q

How often are TZDs dosed?

A

QD

219
Q

What is the MDD of Rosiglitazone?

A

8mg

220
Q

What is the MDD of pioglitazone?

A

45mg

221
Q

What is the primary MOA of TZDs?

A

inc. peripheral muscle glucose sensitivity

222
Q

What is the secondary MOA of TZDs?

A

dec. glucose output from the liver

223
Q

What is the SOA of TZDs?

A

liver and peripheral muscle

224
Q

What DDI does Rosiglitazone have?

A

insulin, nitrates

225
Q

What DDI does Pioglitazone have?

A

oral contraceptives, progestins, pazopanib

226
Q

What are CI of TZDs?

A

hypersensitivity

T1DM

DKA

ALT > 2.5xULN

NYHA Class 3-4

Symptomatic CHF

ACS

227
Q

What is a CI of pioglitazone?

A

active bladder cancer

228
Q

What are precautions for TZDs?

A

NYHA class 1-2

edema

impaired liver fx

insulin/SU use

bladder cancer hx

fracture risk

MI –> rosiglitazone has higher risk

females –> can induce ovulation

229
Q

What is the BBW for TZDs?

A

CHF

230
Q

What is the BBW specific to Rosiglitazone?

A

MI

231
Q

What are ADEs of TZDs?

A

edema –> may worsen CHF

weight gain

hepatotoxicity

fractures

232
Q

What is an ADE specific to Pioglitazone?

A

Bladder cancer

233
Q

How are TZDs dosed?

A

QD; same time each day

report weight gain &/or swelling of legs immediately

234
Q

What should you ask about for every refill of TZDs?

A

edema and weight gain

235
Q

What efficacy are TZDs?

A

high

236
Q

Do TZDs cause hypoglycemia?

A

no

237
Q

what cost are TZDs?

A

low cost

238
Q

What ASCVD risk do TZDs have?

A

potential benefit with pioglitazone

239
Q

What HF risk do TZDs have?

A

inc. risk

240
Q

What CKD risk do TZDs have?

A

neutral

241
Q

Do TZDs require renal dose adjustment?

A

no

242
Q

What do you monitor in TZDs?

A

LFTs

edema

weight gain

cholesterol panel

FBG/PPG

A1C

243
Q

How long until TZDs reach peak effect?

A

6-8 weeks

244
Q

What drugs are alpha-glucosidase inhibitors (AGIs)?

A

acarbose

miglitol

245
Q

Are AGIs PO or SQ?

A

PO

246
Q

How are AGIs dosed?

A

TID; dosed with every meal –> take with first bite of each meal

skip meal, skip dose

start low, go slow

they have a v short half life

247
Q

What is the MDD of Acarbose?

A

50mg

248
Q

What is the MDD of Miglitol?

A

100mg

249
Q

What is the MOA of AGIs?

A

dec. breakdown of sucrose and complex carbs in the brush border of the SI

250
Q

What is the SOA of AGIs?

A

gut

251
Q

What are the CIs of AGIs?

A

hypersensitivity

T1DM

DKA

IBS

Crohn’s disease

colonic ulceration

intestinal obstruction

SCr > 2.0

252
Q

What are precautions of AGIs?

A

impaired renal fx

253
Q

What are ADEs of AGIs?

A

GI: abdominal pain, diarrhea, flatulence, bloating –> ADEs more intense than metformin

254
Q

When on AGI, when should you contact a MD?

A

if severe diarrhea or vomiting occur

255
Q

What should you ask about for every refill of a AGI?

A

GI upset and meal timing

256
Q

What efficacy are AGIs?

A

high

257
Q

Do AGIs cause hypoglycemia?

A

no

258
Q

What are the cost of AGIs?

A

intermediate cost

259
Q

What ASCVD risk are AGIs?

A

neutral

260
Q

What HF risk are AGIs?

A

neutral

261
Q

What CKD risk are AGIs?

A

neutral

262
Q

What ASCVD risk are AGIs?

A

no

263
Q

Do AGIs cause weight gain or weight loss?

A

no weight change

264
Q

What do you monitor in AGIs?

A

PPG, A1C

GI intolerance

265
Q

How long until AGIs reach peak effect?

A

4-6 weeks

266
Q

What drugs are Gliptins/DPP4is?

A

(-gliptin)

Sitagliptin

Linagliptin

Saxagliptin

Alogliptin

267
Q

Are DPP4s PO or SQ?

A

PO

268
Q

What is the dose of Sitagliptin?

A

100mg daily

269
Q

What is the dose of Linagliptin?

A

5mg daily

270
Q

What is the dose of saxagliptin?

A

5mg daily

271
Q

What is the dose of Alogliptin?

A

25mg daily

272
Q

What is the MOA of DPP4s?

A

potentiate the effects of incretin hormones (which are involved in the physiologic regulation of glucose homeostasis)

273
Q

What is the SOA of DPP4s?

A

suppresses glucagon secretion

slows gastric emptying

dec. food intake

promotes beta cell proliferation

274
Q

What DPP4 inhibitor is does not have a renal dose adjustment?

A

linagliptin

275
Q

What is a DDI with Saxagliptin?

A

conivaptan

276
Q

What is a DDI with Linagliptin?

A

carbamazepine

Efavirenz

phenytoin

rifampin

St. John’s Wort

277
Q

What is a DDI with Sitagliptin?

A

none

278
Q

What is a DDI with Alogliptin?

A

none

279
Q

What are CIs are DPP4s?

A

hypersensitivity

T1DM

DKA

280
Q

What is a precaution of DPP4s?

A

impaired renal & hepatic fx

281
Q

What is a precaution specific to Saxagliptin and Alogliptin?

A

HF –> FDA warning

282
Q

What drug class should you never use with DPP4 inhibitors?

A

GLP-1 RA

283
Q

What are ADEs of DPP4s?

A

nasopharyngitis

URI

abdominal pain

N/V/D

headache

edema

hepatotoxicity

284
Q

How should you take DPP4s?

A

take QD; same time each day

can be taken with or without food

285
Q

What should you ask about at every refill for a DPP4?

A

nasopharyngitis and URI

286
Q

What efficacy are DPP4s?

A

intermediate

287
Q

Do DPP4s cause hypoglycemia?

A

no

288
Q

What cost are DPP4s?

A

high cost

289
Q

What ASCVD risk do DPP4s have?

A

neutral

290
Q

What HF risk do DPP4s have?

A

potential risk with saxagliptin and alogliptin

291
Q

What CKD risk do DPP4s have?

A

neutral

292
Q

Do DPP4s require renal dosing?

A

Yes except Linagliptin!!!

293
Q

What should you monitor for DPP4s?

A

FBG, PPG

A1C

URI Sx

GI intolerance

294
Q

What drugs are SGLT2 inhibitors?

A

(-flozin)

Canagliflozin

Dapagliflozin

Empagliflozin

Ertugliflozin

295
Q

Are SGLT2s PO or SQ?

A

PO

296
Q

How are SGLT2 inhibitors dosed?

A

QD; same time each day

297
Q

What is the MOA of SGLT2s?

A

by inhibiting SGLT2, reabsorption of filtered glucose is dec. and the renal threshold for glucose (glucose reabsorption) is lowered, thereby inc. urinary glucose excretion

298
Q

How long until DPP4s reach peak effect?

A

6-8 weeks

299
Q

Do DPP4s cause weight gain or loss?

A

no weight change

300
Q

What is the SOA of SGLT2i?

A

proximal renal tubules

301
Q

What are CIs of SGLT2s?

A

eGFR < 30 (renal failure)

dialysis

ESRD

302
Q

What are DDIs with SGLT2s?

A

UGT enzyme inducers

Rifampin

Ritonavir

Phenytoin

Phenobarbital

watch for hypotension if pt on: ACE/ARB/diuretic

may alter digoxin levels

303
Q

What are precautions of SGLT2s?

A

hypotension

genital mycotic infections

UTIs

AKD

ketoacidosis

hyperkalemia

bladder cancer

amputations

304
Q

What are ADEs of SGLT2s?

A

genital mycotic infections

UTIS

inc. urination

hypotension

weight loss

ketoacidosis: stay hydrated

Fournier’s Gangrene

305
Q

What ADEs are specific to Canagliflozin?

A

lower limb amputations

bone fractures

hyperkalemia

306
Q

What ADEs are specific to Dapagliflozin?

A

bladder cancer

307
Q

What should you discuss in women who are taking an SGLT2i?

A

yeast infections/UTIs

308
Q

What should you discuss in men who are taking na SGLT2i?

A

circumcision status

UTIs

penile discharge

309
Q

What efficacy are SGLT2s?

A

high

310
Q

Do SGLT2s cause hypoglycemia?

A

no

311
Q

What cost are SGLT2s?

A

high cost

312
Q

What ASCVD risk do SGLT2s have?

A

benefit with Canagliflozin, dapagliflozin, empagliflozin

313
Q

What HF risk do SGLT2s have?

A

benefit with Canagliflozin, dapagliflozin, empagliflozin

314
Q

What CKDrisk do SGLT2s have?

A

benefit with Canagliflozin, dapagliflozin, empagliflozin

315
Q

Do SGLTs require renal dosing?

A

yes

316
Q

Do SGLT2s have weight gain or loss?

A

weight loss

317
Q

Do SGLT2s have studies in. black pts for ASCVD, HF and CKD benefits?

A

no

318
Q

What do you monitor in SGLT2s?

A

FBG/PPG

A1C

eGFR

hydration status

UTI & yeast infection sx

BP, weight

LDL cholesterol

319
Q

How long until SGLT2s reach peak effect?

A

4-6 weeks

320
Q

What drugs are GLP-1 RAs?

A

(-tide)

Liraglutide

Dulaglutide

Lixisenatide

Semaglutide

Exenatide

321
Q

Are GLP-1s PO or SQ?

A

SQ

322
Q

How do you dose Liraglutide?

A

SQ QD

323
Q

How do you dose Dulaglutide?

A

SQ weekly

324
Q

How do you dose Lixisenatide?

A

SQ QD, take within 60min of first meal of day

325
Q

What GLP-1 is PO and SQ?

A

Semaglutide

326
Q

How do you dose PO Semaglutide?

A

PO QD, take 30min prior. to first meal of day

327
Q

How do you dose SQ Semaglutide?

A

SQ weekly

328
Q

How do you dose ER Exenatide?

A

SQ weekly, must be reconstituted

329
Q

How do you dose IR Exenatide?

A

SQ BID, taken 60min before meals

330
Q

What is the MOA of GLP-1s?

A

slows gastric emptying

promotes beta cell proliferation

331
Q

What CI is specific to Exenatide?

A

CI if CrCl < 30

332
Q

What GLP-1 has a BBW?

A

Lixasenatide!!! Thyroid C-cell tumo

333
Q

What DDIs with GLP-1s cause hypoglycemia?

A

androgens

insulins/SUs

pegvisomant

334
Q

What DDIs with GLP-1s cause hyperglycemia?

A

corticosteroids

danazol

LHRH

somatropin

thiazide diuretics

335
Q

What are CIs for GLP-1s?

A

severe GI diseases (IBS, Crohn’s, gastroparesis, etc.)

hypoglycemia

pancreatitis

renal impairment

336
Q

What are ADEs of GLP-1s?

A

hypoglycemia

N/V/D

GERD/dyspepsia

injection site rxns

jitteriness

headache

URI/cough

pancreatitis

cholethiasis

337
Q

How should you store GLP-1s prior to initial use?

A

store in refrigerator

338
Q

How should you store GLP-1s after initial use?

A

may be stored at room temp.

339
Q

What should you ask about for every refill of a GLP-1?

A

GI upset and timing of doses

340
Q

What efficacy are GLP-1s?

A

high

341
Q

What cost are GLP-1s?

A

high cost

342
Q

Do GLP-1s cause hypoglycemia?

A

no

343
Q

Do GLP-1s cause weight gain or loss?

A

weight loss

344
Q

What ASCVD risk do GLP-1s have?

A

benefit with liraglutide, SQ semaglutide, dulaglutide

345
Q

What HF risk do GLP-1s have?

A

neutral

346
Q

What CKD risk do GLP-1s have?

A

improved renal outcomes with liraglutide and dulaglutide

347
Q

Do GLP-1s require renal dosing?

A

only exenatide

348
Q

What GLP-1s have significant data to support use in blacks?

A

liraglutide and semaglutide

349
Q

What do you monitor in GLP-1s?

A

renal fx

FBG, PPG ,A1C

GI Sx

patient use of device

350
Q

How long until GLP-1s reach peak effect?

A

6-8 weeks depending on titration schedule

351
Q

What is more dangerous, hyperglycemia or hypoglycemia?

A

Hypoglycemia

602 E1 (1 decks)

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