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PHRM 844 Therapeutics > Exam 3 - Diabetes Part 3 Non-Insulin Treatments > Flashcards

Exam 3 - Diabetes Part 3 Non-Insulin Treatments Flashcards

1
Q

metformin off-label uses (2 of them)

A

-T1DM pts who are overweight and have low risk of ketoacidosis
-PCOS (lowers androgen, inc ovulation)

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2
Q

metformin drops A1C by ___-___% and FBG by ___-___ mg/dL

A

1.5-2%
60-80 mg/dL

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3
Q

metformin decreases TG and LDL by ___-___%

A

8-15%

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4
Q

metformin disadvantage: it can cause _____ _____

A

lactic acidosis

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5
Q

avoid metformin in pt at risk for lactic acidosis. What are the risk factors? (5 of them)

A

-post MI
-COPD
-hepatic failure
-shock
-surgery/radiologic procedure with contrast dye

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6
Q

how long should metformin be held in pts with surgery/radiologic procedure with contrast dye?

A

1-2 days before and then ~2 days after depending upon pt status

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7
Q

how often should metformin be titrated?

A

weekly or bi-monthly and inc by 250-500 mg/day

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8
Q

why was SA metformin recalled in May/June 2020?

A

due to levels of N-ntrosodimethhylamine (NDMA) above acceptable levels; NDMA can inc risk of cancer and liver damage

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9
Q

metformin dosing if eGFR is 60 or more

A

no renal CI to metformin, monitor SCr annually

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10
Q

metformin dosing if eGFR is > 45 and < 60

A

safe to use, continue use if already taking; monitor SCr every 3-6 months

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11
Q

metformin dosing if eGFR is 30-45

A

starting metformin not recommended; reduce metformin dose by 50% if already taking; monitor SCr every 3 months

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12
Q

metformin dosing if eGFR < 30

A

don’t start; stop metformin if currently taking

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13
Q

SGLT2’s efficacy:

dec A1C ___-___%
dec FBG ___-___ mg/dL
dec PPG ___-___ mg/dL
dec weight ___-___ kg
dec SBP ___-___ mmHg and dec DBP ___-___ mmHg

A

A1C: 0.5-1.0%
FBG: 25-35 mg/dL
PPG: 40-60 mg/dL
weight: 1-5 kg
SBP: 3-6 mmHg, DBP: 2-3 mmHg

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14
Q

PK of SGLT2’s: undergoes __________ to inactive metabolites

A

glucuronidation

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15
Q

hold SGLT2 ___ days before surgery (___ if on ertugliflozin)

A

3; 4

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16
Q

there is an FDA warning for bone fractures and dec BMD in pts taking which SGLT2?

a. dapagliflozin
b. ertugliflozin
c. canagliflozin
d. empagliflozin

A

c. canagliflozin

(Invokana)

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17
Q

there is an FDA warning for AKI for which TWO SGLT2s?

a. dapagliflozin
b. ertugliflozin
c. canagliflozin
d. empagliflozin

A

a. dapagliflozin
c. canagliflozin

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18
Q

which SGLT2 had an FDA warning for inc risk of leg and foot amputations, which was removed in 2020?

a. dapagliflozin
b. ertugliflozin
c. canagliflozin
d. empagliflozin

A

c. canagliflozin

(Invokana)

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19
Q

all SGLT2s have an FDA warning for serious genital infections, such as necrotizing fasciitis of the perineum, also known as what?

A

Fournier’s gangrene

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20
Q

canagliflozin dosing if eGFR > 60

A

100 mg daily

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21
Q

max dosing for canagliflozin if eGFR > 60

A

300 mg/day

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22
Q

canagliflozin max daily dose if eGFR 30-60

A

max 100 mg daily if no albuminuria

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23
Q

dapagliflozin dosing if eGFR > 45

A

5 mg daily

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24
Q

dapagliflozin max daily dose if eGFR > 45

A

max 10 mg daily

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25
Q

empagliflozin dosing if eGFR > 30

A

10 mg daily

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26
Q

empagliflozin max daily dose if eGFR > 45

A

max 25 mg daily

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27
Q

ertugliflozin dosing if eGFR > 60

A

5 mg daily

28
Q

ertugliflozin max daily dosing if eGFR > 60

A

max 15 mg daily

29
Q

canagliflozin dosing if eGFR < 30

a. don’t start, but if already taking, may use 100 mg daily if albuminuria > 300 mg/day
b. don’t start, but if on therapy, may continue and monitor

A

a. don’t start, but if already taking, may use 100 mg daily if albuminuria > 300 mg/day

30
Q

dapagliflozin: less than what eGFR value should we not start a pt on this?

a. < 45
b. < 30
c. < 25

A

c. < 25

31
Q

true or false: pts on dialysis can take SGLT2s

A

false (no kidney function, pts should not take)

32
Q

at what eGFR should ertugliflozin not be started?

a. < 45
b. < 30
c. < 25

A

a. < 45

33
Q

in T2DM, a GLP-1RA is preferred to _____ when possible

A

insulin

34
Q

GLP-1 efficacy:

A1C dec ___-___%
weight dec ___-___ kg

A

A1C: 0.7-1.6%
weight: 1.5-3 kg

35
Q

black box warning for GLP-1s?

A

thyroid C-cell tumors

36
Q

N/V/D and __________ are some adverse effects of GLP-1s

A

pancreatitis (avoid in pts with chronic pancreatitis)

37
Q

new warning for GLP-1s

A

gall bladder disease (cholelithiasis and cholecystitis)

38
Q

trulicity (dulaglutide) dosing

A

0.75 mg up to 4.5 mg; use caution in ESRD; once weekly

39
Q

ozempic (semaglutide) dosing

A

0.25 mg x 4 weeks, then 0.5 mg up to 2 mg; once weekly

40
Q

victoza (liraglutide) dosing

A

0.6 mg x 7 days, then 1.2 mg up to 1.8 mg; daily

41
Q

byetta (exenatide) dosing

A

5 mcg x one month, then 10 mcg; avoid CrCl < 30; twice daily

42
Q

bydureon bcise dosing

A

2 mg; avoid CrCl < 30; once weekly

43
Q

adylyxin (lixisenatide) dosing

A

10 mcg x 14 days, then 20 mcg; avoid eGFR < 15; daily

44
Q

which of these GLP-1s are once weekly dosing?

a. trulicity
b. ozempic
c. victoza
d. byetta
e. bydureon bcise
f. adylyxin

A

a, b, e

a. trulicity
b. ozempic
e. bydureon bcise

45
Q

true or false: trulicity must be taken with meals

A

false (can be given independently of meals)

46
Q

Rybelsus dosing

A

3 mg po daily x 30 days, then inc to 7 mg daily

47
Q

if on semaglutide 0.5 mg subQ weekly, can change to what strength of Rybelsus daily?

A

7 mg po daily

48
Q

mounjaro efficacy:

A1C dec ___-___%
FBS dec ___-___ mg/dL
PPG dec ___-___ mg/dL
weight dec ___-___ kg

A

A1C: 1.5-2.3%
FBS: 40-60 mg/dL
PPG: 20-40 mg/dL
weight: 6-11 kg

49
Q

DPP-IV inhibitors have an FDA warning for what 2 things?

A

joint pain, heart failure risk

50
Q

sitagliptin (Januvia) dose for CrCl > 50 mL/min

A

100 mg daily

51
Q

sitagliptin (Januvia) dose for CrCl 30-50 mL/min

A

50 mg daily

52
Q

sitagliptin (Januvia) dose for CrCl < 30 mL/min or with ESRD on dialysis

A

25 mg daily

53
Q

saxagliptin (Onglyza) normal dose

A

2.5-5.0 mg once daily

54
Q

saxagliptin (Onglyza) dose for CrCl < 50 mL/min

A

2.5 mg daily

55
Q

linagliptin (Tradjenta) dose

A

5 mg once daily

56
Q

alogliptin (nesina) normal dose

A

25 mg daily

57
Q

alogliptin (nesina) dose if CrCl is 30-60

A

12.5 mg daily

58
Q

alogliptin (nesina) dose with CrCl < 30 or with ESRD on dialysis

A

6.25 mg daily

59
Q

max daily dose glipizide (glucotrol)

a. 12 mg
b. 20 mg
c. 40 mg

A

c. 40 mg

60
Q

max daily dose glipizide (glucotrol XL)

A

20 mg

61
Q

glyburide (Micronase/Diabeta) max daily dose

a. 12 mg
b. 20 mg
c. 40 mg

A

b. 20 mg

62
Q

glyburide micronized (Glynase) max daily dose

a. 12 mg
b. 20 mg
c. 40 mg

A

a. 12 mg

63
Q

discontinue Tzd’s if LFT’s are greater than how many times compared to normal?

A

3 times

64
Q

initial dose pioglitazone (range)

A

15-30 mg daily

65
Q

max daily dose pioglitazone (range)

A

30-45 mg daily

66
Q

how often do we titrate the dose for pioglitazone?

A

every 12 weeks

67
Q

per ADA guidelines, start dual therapy if A1C > ___%

A

9%

PHRM 844 Therapeutics (28 decks)

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