Exam 3 - Diabetes Day 3 Jeopardy Questions Flashcards
Sitagliptin works via this MOA
DPP-4 inhibitor
In addition to effective pharm therapy, it is important to counsel pt’s on the importance of these types of modifications
Lifestyle!! (diet and exercise)
This medication class can take several weeks to see maximum effect (3-4 months)
TZD’s
- -> rosiglitizone
- -> pioglitizone
Sulfonylurea and glinides need to be dosed this way
w/ food
If they skip a meal, they don’t take that dose
If this agent is used, the dose of preprandial insulin should be decreased by 50%
Pramlintide
These 2 drug classes are associated w/ either weight loss or weight neutral effects
- Pramlintide (amylin)
- Biguanides
- DPP-4 inhibitors
- GLP1’s
This is what we recommend w/ patients with a sulfa allergy and they are about to start a sulgonylurea
Normally this should be fine
Be cautious w/ patien’ts who have had anaphylactic rxn w/ sulfa drug in the past
This medication was removed from the market d/t hepatotoxicity
Troglitazone
Female pts that have taken TZDs or metformin need to be aware of this possible side effect
Induced ovulation for pt’s w/ POS
Acarbose works by this MOA
Competitively inhibits enzymes in small intestine which delays breakdown of sucrose and complex carbs
The following DDP-4’s require dose adjustment in renal dz
- Sitagliptin
- Saxagliptin
- Alogliptin
TZD’s are associated w/ these common side effects
Edema
Weight gain
We wouldn’t want to use Symlin in these patients
- 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
The glucose lowering effects tend to plateau at about 1/2 max dose of this class of meds
Sulfonylureas
This class of meds enhances insulin sensitivity (muscle, liver, fat) and they do it by binding to the PPAR receptor
TZDs
Flatulence, bloating, abdominal discomfort, and diarrhea occur in > 70% of patients taking this medication
Alpha Glucosidase inhibitors
If a patient is on Acarbose and begins to have symptoms of hypoglycemia, you recommed they take this tx
Glucose tablets bc drug prevents complex sugars from being absorbed
This is the MOA of glipizide
Increase secretion of insulin from the beta cells in the pancreas
(Glipizide is a sulfonylurea)
AST/ALT need to be monitored at baseline and fluid status is another monitoring parameter for this drug class
TZD’s
rosiglitizone and pioglitizone
This is an important point to mention when discussing the timing of doses of Nategline and regaglinide
Take 15-30 min before meals and be sure to skip the dose if you are skipping a meal
This med decreases glucose production in the liver
Metformin
This sulfonylurea is the best agent choice for patients w/ renal impairment
Glipizide
Hypoglycemia is mainly associated w/ these 2 classes of meds
Sulfas and glinides
This is one contraindication associated w/ TZDs
Class 3 or 4 heart failure
The hgA1C will fall by this % when metformin is utilized at max dose
1.5-2%
This is the goal dose of metformin
1000mg BID
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:
Metformin
This is a contraindication associated w/ metformin
Cr > 1.4 in women
Cr > 1.5 in men
