Exam 3 - Diabetes Day 3 Jeopardy Questions

Question 1

Sitagliptin works via this MOA

Answer 1

DPP-4 inhibitor

Question 2

In addition to effective pharm therapy, it is important to counsel pt’s on the importance of these types of modifications

Answer 2

Lifestyle!! (diet and exercise)

Question 3

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

Answer 3

TZD’s

• -> rosiglitizone
• -> pioglitizone

Question 4

Sulfonylurea and glinides need to be dosed this way

Answer 4

w/ food

If they skip a meal, they don’t take that dose

Question 5

If this agent is used, the dose of preprandial insulin should be decreased by 50%

Answer 5

Pramlintide

Question 6

These 2 drug classes are associated w/ either weight loss or weight neutral effects

Answer 6

1. Pramlintide (amylin)
2. Biguanides
3. DPP-4 inhibitors
4. GLP1’s

Question 7

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

Answer 7

Normally this should be fine

Be cautious w/ patien’ts who have had anaphylactic rxn w/ sulfa drug in the past

Question 8

This medication was removed from the market d/t hepatotoxicity

Answer 8

Troglitazone

Question 9

Female pts that have taken TZDs or metformin need to be aware of this possible side effect

Answer 9

Induced ovulation for pt’s w/ POS

Question 10

Acarbose works by this MOA

Answer 10

Competitively inhibits enzymes in small intestine which delays breakdown of sucrose and complex carbs

Question 11

The following DDP-4’s require dose adjustment in renal dz

Answer 11

1. Sitagliptin
2. Saxagliptin
3. Alogliptin

Question 12

TZD’s are associated w/ these common side effects

Answer 12

Edema

Weight gain

Question 13

We wouldn’t want to use Symlin in these patients

Answer 13

• Pediatrics
• A1C > 9
• Pt’s w/ poor compliance with insulin regimen and monitoring their blood glucose
• Recurrent/severe hypoglycemia in past 6 months
• Confirmed gastroparesis dx
• Use of drugs that stimulate gastric motility
• Hypoglycemic unawareness

Question 14

The glucose lowering effects tend to plateau at about 1/2 max dose of this class of meds

Answer 14

Sulfonylureas

Question 15

This class of meds enhances insulin sensitivity (muscle, liver, fat) and they do it by binding to the PPAR receptor

Answer 15

TZDs

Question 16

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

Answer 16

Alpha Glucosidase inhibitors

Question 17

If a patient is on Acarbose and begins to have symptoms of hypoglycemia, you recommed they take this tx

Answer 17

Glucose tablets bc drug prevents complex sugars from being absorbed

Question 18

This is the MOA of glipizide

Answer 18

Increase secretion of insulin from the beta cells in the pancreas

(Glipizide is a sulfonylurea)

Question 19

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

Answer 19

TZD’s

rosiglitizone and pioglitizone

Question 20

This is an important point to mention when discussing the timing of doses of Nategline and regaglinide

Answer 20

Take 15-30 min before meals and be sure to skip the dose if you are skipping a meal

Question 21

This med decreases glucose production in the liver

Answer 21

Metformin

Question 22

This sulfonylurea is the best agent choice for patients w/ renal impairment

Answer 22

Glipizide

Question 23

Hypoglycemia is mainly associated w/ these 2 classes of meds

Answer 23

Sulfas and glinides

Question 24

This is one contraindication associated w/ TZDs

Answer 24

Class 3 or 4 heart failure

Question 25

The hgA1C will fall by this % when metformin is utilized at max dose

Answer 25

1.5-2%

Question 26

This is the goal dose of metformin

Answer 26

1000mg BID

Question 27

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

Answer 27

Metformin

Question 28

This is a contraindication associated w/ metformin

Answer 28

Cr > 1.4 in women

Cr > 1.5 in men