Endocrine: DM Drugs Indications & Contraindications

Question 1

This type of insulin is used 1st in T2DM as basal insulin when A1C is > 10%

Answer 1

Long-Acting Insuling

Glargine
Detemir
Degludec

Question 2

What two regimens are available for T1DM to create an insulin profile?

Answer 2

regular insulin + intermediate insulin:
(Regular and intermediate injected at breakfast and dinner)

rapid acting insulin + long acting insulin
(rapid before every meal, long acting at bedtime)

Question 3

What type of insulin is used in insulin pump?

Answer 3

rapid acting

Question 4

What drug can be used parenterally to counteract insulin-induced hypoglycemia?

Answer 4

glucagon

Question 5

This insulin inhibitor is used in patients with insulinoma…

Answer 5

diazoxide

Question 6

This drug can decrease serum glucose without insulin secretion.

It decreases macrovascular events and all cause mortality.

Answer 6

Metformin

Question 7

What effect does metformin have on weight?

Answer 7

weight neutral

Question 8

What are 4 adverse effects of metformin?

Answer 8

Diarrhea (MC), Lactic Acidosis (dangerous), B12 Deficiency (reversible), Hypoglycemia (Rare)

Question 9

What are the 2 contraindications for metformin?

Answer 9

lactic acidosis, kidney disease (GFR < 30)

Question 10

Tissue hypoxia (HF, COPD), alcoholism and hepatic disease are precautions for which drug?

Answer 10

metformin

Question 11

Which GLP-1 Receptor Agonist is FDA approved to decrease major CV events and weight loss?

Answer 11

liraglutide

Question 12

GLP-1 Receptor Agonists have what effect on beta cells?

Answer 12

increase number and function

Question 13

What are the two adverse effects of GLP-1 Receptor Agonists? (exenatide, liraglutide, semaglutide)

Answer 13

hypoglycemia (low), acute pancreatitis

Question 14

Which drug class has the following contraindications?

Slow GI

renal impairment

other meds that cannot have prolonged GI exposure

Answer 14

GLP-1 Receptor Agonists (exenatide, liraglutide, semaglutide)

Question 15

What are two precautions for GLP-1 Receptor Agonists?

Answer 15

Thyroid CA, pancreatitis

Question 16

What are two therapeutic effects of DPP-4 Inhibitors? (sitagliptin, linagliptin)

Answer 16

neutral on CVD, weight neutral

Question 17

What are three adverse effects of DPP-4 Inhibitors?

Answer 17

hypoglycemia (low risk)
acute pancreatitis
severe joint pain

Question 18

What are three contraindications/precautions for DPP-4 Inhibitors? (-gliptin)

Answer 18

renal impairment, pancreatitis, slow GI

Question 19

Does linagliptin cause renal impairment?

Answer 19

no

Question 20

Which two SGLT-2 Inhibitors are FDA approved to decrease CV events?

Answer 20

empagliflozin and canagliflozin

Question 21

Which SGLT-2 inhibitor reduces CKD progression?

Answer 21

canagliflozin

Question 22

which two SGLT-2 inhibitors can decrease heart failure hospitalization?

Answer 22

canagliflozin and dapagliflozin

Question 23

All SGLT-2 inhibitors have what two therapeutic effects?

Answer 23

decrease BP, weight loss

Question 24

What are three contraindications for SGLT-2 Inhibitors?

Answer 24

severe renal impairment, dialysis, prone to UTI or GU infx

Question 25

Which drug class has the following adverse effects? Hypoglycemia (rare) Frequency Renal Impairment AKI

Answer 25

SGLT-2 Inhibitors (gliflozin)

Question 26

What are the three major therapeutic effects of TZDs?

Answer 26

major: decrease insulin resistance decrease TGs w/ long term use increase HDL

Question 27

This drug class has the following contraindications? hepatic disease heart failure

Answer 27

TZDs (-glitazone)

Question 28

What are 4 adverse effects of TZDs? (-glitazone)

Answer 28

weight gain, edema, bone fx, hypoglycemia (low risk)

Question 29

Alpha-glucoside inhibitors (acarbose, miglitol) have what three therapeutic effects?

Answer 29

↓ post-prandial glucose, weight neutral, no hypoglycemia

Question 30

What drug class has the following adverse effects? flatulence, GI issues

Answer 30

alpha-glucoside inhibitors (acarbose, miglitol)

Question 31

Which drug class has the following contraindications? GI Disease, GI Obstruction, Ileus, IBD, Hiatal Hernia, Hepatic Disease, Renal Impairment

Answer 31

Alpha Glucoside Inhibitors: | acarbose, miglitol

Question 32

Which drug class has the following therapeutic effects? ↓ All-Cause Mortality, ↓ Serum Glucagon (Long Term) CV: Short Term Neutral on CVD, Long Term ↓ MI risk and microvascular risk

Answer 32

Sulfonylureas: | glyburide, glipizide, glimepiride

Question 33

Which drug class is the highest risk for hypoglycemia?

Answer 33

sulfonylureas: glyburide, glipizide, glimepiride

Question 34

What is the contraindication for sulfonylureas?

Answer 34

sulfa allergy

Question 35

What are two precautions for sulfonylureas? (glyburide, glipizide, glimepiride)

Answer 35

severe renal disease, hepatic dysfunction

Question 36

What drug class has the following adverse effects? High Risk Hypoglycemia, Insulin Resistance, Weight Gain, GI SFX

Answer 36

Sulfonylureas: glyburide, glipizide, glimepiride

Question 37

This drug has the following characteristics: Therapeutic effects: ↓ Postprandial Glucose, Weight Neutral Adverse Effects: Mod. Hypoglycemia C/I: liver impairment, use w/ sulfonylureas

Answer 37

meglitinides/GLN: Repaglinide (Prandin)

Question 38

This drug can be used in combination w. other DM medicines. It is used to lower LDL if a statin isn't tolerable.

Answer 38

Colesevelam (WelChol)

Question 39

What are two adverse effects of colesevelam?

Answer 39

constipation, bloating

Question 40

This drug decreases postprandial glucose, FFAs and TGs. It shouldn't be used w. CYP3A4 drugs

Answer 40

bromocriptine (cycloset)

Question 41

This drug is used in combination with insulin to decrease postprandial glucose, and to spur weight loss.

Answer 41

amylin-like peptide: | Pramlintide (symlin)

Question 42

What is a contraindication for pramlintide (symlin)?

Answer 42

slow GI/gastroparesis

Question 43

Pramlintide (symlin) can cause hypoglycemia in what conditions?

Answer 43

when used with insulin