Exam 3 - Diabetes day 3 jeopardy

Question 1

sitagliptin works via this MOA

Answer 1

DPP-4 inhibitor

Question 2

In addition to pharmacological therapy it is important to counsel the patients on the importance of these types of modifications

Answer 2

lifestyle modifications

Question 3

this medication class can take several weeks to see the maximum effect (3-4 months)

Answer 3

TZD’s

Question 4

Sulfonylurea and glinides need to be does this way

Answer 4

with food…if there is not food intake, skip the dose

Question 5

If this agent is used the dose of pre-prandial insulin should be decreased by 50%

Answer 5

symlin

Question 6

these 2 drug classes are associated with either weight loss or weight neutral effects

Answer 6

biguanides, DPP IV’s and GLP-1’s and Amylin analogs

Question 7

This is what we recommend with patients with a sulfa allergy and they are about to start a sulfonylurea

Answer 7

Normally this should be fine…be cautious with patients who have had a anaphylactic reaction with a sulfa drug in the past

Question 8

This medication was removed from the market due to toxicity

Answer 8

troglitazone

Question 9

female patients that are taking TZD’s or metformin need to be aware of this possible “side effect”

Answer 9

induce ovulation for patients with polycystic ovarian syndrome

Question 10

Acarbose work by this MOA

Answer 10

competitively inhibit enzymes (maltase, isomaltase etc) in the small intestine which delays the breakdown of sucrose and complex carbohydrates

Question 11

The following DDP Iv’s require dose adjustment in renal disease

Answer 11

sitagliptin, saxagliptin, and alogliptin

Question 12

TZD’s are associated with these common side effects

Answer 12

edema and weight gain

Question 13

We wouldn’t want to use Symlin in the patients with the following characteristics

Answer 13

• 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

Question 14

The glucose lowering effects tend to plateau at about 1/2 of the maximum dose of this class of medication

Answer 14

sulfonylureas

Question 15

This class of medications enhance insulin sensitivity (at muscle,liver and fat tissue) and they do it by binding to PPAR receptors

Answer 15

TZD’s

Question 16

Flatulence, bloating, abdominal discomfort and diarrhea occur in >70% of patients taking this medication

Answer 16

glucosidase inhibitors

Question 17

If a patients is on Acarbose and begins to have symptoms of hypoglycemia, you recommend they take this treatment

Answer 17

Glucose tablets (no OJ etc b/c the drug prevents complex sugars from being absorbed)

Question 18

this is one contraindication of acarbose

Answer 18

inflammatory bowel disease

Question 19

this is the MOA of Glipizide

Answer 19

increasing the secretion of insulin from the beta-cells in the pancreas

Question 20

AST/ALT need to be monitored at baseline and fluid status is another monitoring parameter for this drug class

Answer 20

TZD’s

Question 21

This is an important point to mention when discussing the timing of the doses of Nateglinide and Regaglinide

Answer 21

Take 15-30mins before meals and be sure to skip the dose if patient is not eating

Question 22

this medication decreases glucose production in the liver

Answer 22

metformin

Question 23

This sulfonylureas is the best agent choice for patients with renal impairment (who need a sulfonylurea)

Answer 23

Glipizide

Question 24

Hypoglycemia is mainly associated with these 2 classes of medications

Answer 24

Sulfonylureas and glinides

Question 25

his is one contradiction associated with TZD’s

Answer 25

Class III or IV HF

Question 26

The HbA1c will fall by this percentage when Metformin is utilized at its maximum dose

Answer 26

1.5-2%

Question 27

this is the goal dose of metformin

Answer 27

1000mg BID

Question 28

It is important to explain to the patient that the GI effects of this medication will subside and we will titrate the dose of this medication as tolerated

Answer 28

metformin

Question 29

This is a contradiction associated with Metformin

Answer 29

Cr>1.4mg/dL (female) or

Cr>1.5mg.dL (male)

Question 30

this is the most common side effect of metformin

Answer 30

diarrhea