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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
empagliflozin dosing if eGFR > 30
10 mg daily
26
empagliflozin max daily dose if eGFR > 45
max 25 mg daily
27
ertugliflozin dosing if eGFR > 60
5 mg daily
28
ertugliflozin max daily dosing if eGFR > 60
max 15 mg daily
29
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. don't start, but if already taking, may use 100 mg daily if albuminuria > 300 mg/day
30
dapagliflozin: less than what eGFR value should we not start a pt on this? a. < 45 b. < 30 c. < 25
c. < 25
31
true or false: pts on dialysis can take SGLT2s
false (no kidney function, pts should not take)
32
at what eGFR should ertugliflozin not be started? a. < 45 b. < 30 c. < 25
a. < 45
33
in T2DM, a GLP-1RA is preferred to _____ when possible
insulin
34
GLP-1 efficacy: A1C dec ___-___% weight dec ___-___ kg
A1C: 0.7-1.6% weight: 1.5-3 kg
35
black box warning for GLP-1s?
thyroid C-cell tumors
36
N/V/D and __________ are some adverse effects of GLP-1s
pancreatitis (avoid in pts with chronic pancreatitis)
37
new warning for GLP-1s
gall bladder disease (cholelithiasis and cholecystitis)
38
trulicity (dulaglutide) dosing
0.75 mg up to 4.5 mg; use caution in ESRD; once weekly
39
ozempic (semaglutide) dosing
0.25 mg x 4 weeks, then 0.5 mg up to 2 mg; once weekly
40
victoza (liraglutide) dosing
0.6 mg x 7 days, then 1.2 mg up to 1.8 mg; daily
41
byetta (exenatide) dosing
5 mcg x one month, then 10 mcg; avoid CrCl < 30; twice daily
42
bydureon bcise dosing
2 mg; avoid CrCl < 30; once weekly
43
adylyxin (lixisenatide) dosing
10 mcg x 14 days, then 20 mcg; avoid eGFR < 15; daily
44
which of these GLP-1s are once weekly dosing? a. trulicity b. ozempic c. victoza d. byetta e. bydureon bcise f. adylyxin
a, b, e a. trulicity b. ozempic e. bydureon bcise
45
true or false: trulicity must be taken with meals
false (can be given independently of meals)
46
Rybelsus dosing
3 mg po daily x 30 days, then inc to 7 mg daily
47
if on semaglutide 0.5 mg subQ weekly, can change to what strength of Rybelsus daily?
7 mg po daily
48
mounjaro efficacy: A1C dec ___-___% FBS dec ___-___ mg/dL PPG dec ___-___ mg/dL weight dec ___-___ kg
A1C: 1.5-2.3% FBS: 40-60 mg/dL PPG: 20-40 mg/dL weight: 6-11 kg
49
DPP-IV inhibitors have an FDA warning for what 2 things?
joint pain, heart failure risk
50
sitagliptin (Januvia) dose for CrCl > 50 mL/min
100 mg daily
51
sitagliptin (Januvia) dose for CrCl 30-50 mL/min
50 mg daily
52
sitagliptin (Januvia) dose for CrCl < 30 mL/min or with ESRD on dialysis
25 mg daily
53
saxagliptin (Onglyza) normal dose
2.5-5.0 mg once daily
54
saxagliptin (Onglyza) dose for CrCl < 50 mL/min
2.5 mg daily
55
linagliptin (Tradjenta) dose
5 mg once daily
56
alogliptin (nesina) normal dose
25 mg daily
57
alogliptin (nesina) dose if CrCl is 30-60
12.5 mg daily
58
alogliptin (nesina) dose with CrCl < 30 or with ESRD on dialysis
6.25 mg daily
59
max daily dose glipizide (glucotrol) a. 12 mg b. 20 mg c. 40 mg
c. 40 mg
60
max daily dose glipizide (glucotrol XL)
20 mg
61
glyburide (Micronase/Diabeta) max daily dose a. 12 mg b. 20 mg c. 40 mg
b. 20 mg
62
glyburide micronized (Glynase) max daily dose a. 12 mg b. 20 mg c. 40 mg
a. 12 mg
63
discontinue Tzd's if LFT's are greater than how many times compared to normal?
3 times
64
initial dose pioglitazone (range)
15-30 mg daily
65
max daily dose pioglitazone (range)
30-45 mg daily
66
how often do we titrate the dose for pioglitazone?
every 12 weeks
67
per ADA guidelines, start dual therapy if A1C > ___%
9%

PHRM 844 Therapeutics (28 decks)

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