Exam 3 - Diabetes day 3 jeopardy Flashcards
sitagliptin works via this MOA
DPP-4 inhibitor
In addition to pharmacological therapy it is important to counsel the patients on the importance of these types of modifications
lifestyle modifications
this medication class can take several weeks to see the maximum effect (3-4 months)
TZD’s
Sulfonylurea and glinides need to be does this way
with food…if there is not food intake, skip the dose
If this agent is used the dose of pre-prandial insulin should be decreased by 50%
symlin
these 2 drug classes are associated with either weight loss or weight neutral effects
biguanides, DPP IV’s and GLP-1’s and Amylin analogs
This is what we recommend with patients with a sulfa allergy and they are about to start a sulfonylurea
Normally this should be fine…be cautious with patients who have had a anaphylactic reaction with a sulfa drug in the past
This medication was removed from the market due to toxicity
troglitazone
female patients that are taking TZD’s or metformin need to be aware of this possible “side effect”
induce ovulation for patients with polycystic ovarian syndrome
Acarbose work by this MOA
competitively inhibit enzymes (maltase, isomaltase etc) in the small intestine which delays the breakdown of sucrose and complex carbohydrates
The following DDP Iv’s require dose adjustment in renal disease
sitagliptin, saxagliptin, and alogliptin
TZD’s are associated with these common side effects
edema and weight gain
We wouldn’t want to use Symlin in the patients with the following characteristics
- Poor compliance with current insulin regimen
- Poor compliance with monitoring blood glucose
- A1c >9%
- Recurrent severe hypoglycemia in the past 6 months -Hypoglycemia unawareness
- Confirmed gastroperesis diagnosis
- Use of drugs that stimulate gastric motility
The glucose lowering effects tend to plateau at about 1/2 of the maximum dose of this class of medication
sulfonylureas
This class of medications enhance insulin sensitivity (at muscle,liver and fat tissue) and they do it by binding to PPAR receptors
TZD’s
Flatulence, bloating, abdominal discomfort and diarrhea occur in >70% of patients taking this medication
glucosidase inhibitors
If a patients is on Acarbose and begins to have symptoms of hypoglycemia, you recommend they take this treatment
Glucose tablets (no OJ etc b/c the drug prevents complex sugars from being absorbed)
this is one contraindication of acarbose
inflammatory bowel disease
this is the MOA of Glipizide
increasing the secretion of insulin from the beta-cells in the pancreas
AST/ALT need to be monitored at baseline and fluid status is another monitoring parameter for this drug class
TZD’s
This is an important point to mention when discussing the timing of the doses of Nateglinide and Regaglinide
Take 15-30mins before meals and be sure to skip the dose if patient is not eating
this medication decreases glucose production in the liver
metformin
This sulfonylureas is the best agent choice for patients with renal impairment (who need a sulfonylurea)
Glipizide
Hypoglycemia is mainly associated with these 2 classes of medications
Sulfonylureas and glinides
