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Therapeutics P2 > Exam 3 lecture 3 > Flashcards

Exam 3 lecture 3 Flashcards

1
Q

What is the somogyi effect

A

Nocturnal hypoglycemia and their body rebounds as hyperglycemia in the morning.
We rule this out by checking hypoglycemia in the middle of the night.

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2
Q

How to treat somogyoi effect

A

Move NPH from dinner to bedtime or add a bedtime snack

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3
Q

What to do on sick days as a diabetic

A

Let someone know you are feeling sick
continue insulin even if food intake decreases
maintain fluid intake
Test BG every 1-4 hours
Test urine for ketone

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4
Q

When to switch to concentrated for?

A

When there is leakage or 200-300 TDD dose

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5
Q

What are some non-insulin agents

A

Metformin, SGLT-2 Inhibitors, GLP-1, DPP 4, TZD, sulfonylurea

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6
Q

Which non insulin drugs increase insilin secretion

A

Increased by sulfonylureas
meglitinides
Incretins

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7
Q

Which non insulin drugs decrease glucagon secretion

A

Incretins and amylin

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8
Q

Hepatics glucose output is decreased by

A

Metformin and TZDs

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9
Q

Glucose uptake and utilization is increased by

A

TZDs and metformin

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10
Q

Glucose reabsorption is decreased by

A

SGLT-2 inhibitors

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11
Q

mechanism of action of metformin

A

Decreases hepatic glucose production
increases glucose utilization
increases GLP-1 secretion
Increases uptake and utilization by muscles

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12
Q

When to use metformin? Uses of metformin?

A

On type 2 patients and obese type 1 pts. Decrease CV risk.

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13
Q

Metformin CV risk? hypoglycemia risk? effect on weight? Price? Lipid levels?

A

lowers risk for CV event
minimal risk for hypoglycemia
neutral effect on weight
not expensive
decrease LDL

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14
Q

A1c reduction by metformin

A

1.5-2% (not as efficacious as insulin, but better than other non-insulin meds)

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15
Q

metformin might cause_____ which can be a disadvantage

A

lactic acidosis

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16
Q

Who is at risk for developing lactic acidosis when taking metformin

A

Alcoholics, HF patients, Post MI and COPD, decreased renal function

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17
Q

What do we consider when dosing metformin

A

eGFR

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18
Q

MEtformin and surgery?

A

Dx metformin before and a little after surgery

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19
Q

Metformin can cause what deficiency

A

B12

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20
Q

What side effects does metformin have

A

GI side effects (food helps decrease side effects)
(nausea, diarrhea)
gets better with time
titrate from 500 per day to 2000 grams

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21
Q

dosing for metformin based of EGFR

A

> 60- Monitor Scr annually, no problems

between 45 and 60- safe to start therapy, monitor scr every 3-6 months

between 30 and 45- starting metformin not recommended, decrease dose by 50% if already taking. Monitor every 3 months

below 30- do not start
stop if already taking

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22
Q

How do SGLT2 inhibitors work?

A

They lead to renal glucose excretion via urine.

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23
Q

What is the initial therapy for type 2 diabetics

A

SGLT-2 inhibitors or GLP-1 inhibitors with or without metformin

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24
Q

What other conditions does SGLT-2 inhibitors affect

A

Used in type 2 at risk for CVD, HF and CKD.

25
Q

Can SGLT-2 inhibitors be used in HF patinets

A

Yes

26
Q

Efficacy of sglt-2 inhibitors

A

Weaker than GLP-1 and metformin in reduction of A1c
Lowers weight
Lowers BP
very effective at post prandial reduction

27
Q

What drugs are good for BP reduction

A

SGLT-2 inhibitors

28
Q

Side effects of SGLT2 inhibitors

A

UTIs (because of sugar in urine) and genital fungal infections (yeast infection)
hypotension
Can increase cholesterol

29
Q

FDA warnings for SGLT2 inhibitors

A

-DKA (seen in type 2 patients with elevated bs, caused by dehydration or lowering of insulin) (do not give pt SGLT-2 with hx of DKA)
bone fractures (especially in canagliflozin)
-acute kidney injury
-foot amputations (becareful in pts with acute foot infections)
-fourniers gangrene (seek immediate medical attention if soreness or pain in taint area)

30
Q

How long before a surgery should we hold SGLT2?

A

3 days
4 days for ertugliflozin
restart after baseline food/oral intake is back to normal

31
Q

Can you use SGLT2 inhibitors on dialysis?

A

No, you can not pee it out.

32
Q

when not to start SGLT2 inhibitors based on eGFR

A

<30
Of already on it, monitor

33
Q

name SGLT-2 drugs

A

Canagliflozin
dapagliflozin
empagliflozin

34
Q

HF an kidney disease patients with diabetes should use

A

SGLT2 inhibitors, these drugs are expensive

35
Q

Name GLP-1 antagonist drugs

A

Liraglutide, dulaglutide, semaglutide

36
Q

what do GLP-1 drugs do?

A

promote insulin secretion by stimulating basal cell growth
inhibits glucagon secretion, delays gastric emptying, decreases apetite

37
Q

Hypoglycemic risk with GLP-1 inhibitors

A

very low because insulin is only released when glucose is elevated

38
Q

Initial treamment with type 2 diabetes?

A

SGLT 2 or GLP 1 inhibitors with or without metformin

39
Q

GLP can reduce risk for

A

CV risk, CKD, HF

40
Q

WHy is insulin +GLP 1 recommended?

A

Efficacy is incredible with both of these.

41
Q

efficacy of GLP-1

A

Lowers A1c better than SGLT-2 but not as good as metformin
Massive weight loss

42
Q

Which GLP-1 inhibitors have a bigger effect on PPG? which ones of fasting BG?

A

Short acting affect PPG
long affect fasting

43
Q

What are some adverse effects of GLP-1 agonists

A

nausea in half of the users

44
Q

Which type of patients is GLP-1 never used in

A

pancreatitis and thyroid cancer

45
Q

What new warning id there for GLP-1 pts

A

Gall bladder disease (ask pt for FH), dx if there is FH

46
Q

Avoid GLP-1 is pts with _________ and _________

A

gastroparesis and retinopathy

47
Q

What are the 4 contraindications that we should look out for when giving out GLP-1s

A

Retinopathy, gall bladder issues, pancreatitis, thyroid cancer

48
Q

What are the dosings of some popular GLP-1s

A

Trulicity- once weekly
Victoza- daily
Ozempic- Weekly

49
Q

oral semaglutide name

A

Rybelus

50
Q

Dosing for rybelus

A

Start at 3 mg po x 30 days
increase dose to 7 mg, can increase to 14 mg if neededs

51
Q

side effects of rybelus

A

lots of nausea

52
Q

How to prevent nausea from rybelus

A

Take 30 mins before food

53
Q

Other than improving diabetes, what other uses do GLP-1 agonists have

A

CV benefits and renal benefits

54
Q

Which drug has dual action as GLP-1 and GIP RA

A

Mounjaro (tirzepatide)

55
Q

Does mounjaro act in a glucose dependent manner?

A

Yes, it reduces glucagon in a glucose dependent manner. It also delays gastric emptying and increases satiety, causing weight loss.

56
Q

efficacy of mounjaro

A

reduces A1c comparable to metformin.
leads to massive weight loss and lowering of FBG

57
Q

Mounjaro adverse effects

A

Ask about retinopathy, gall bladder, thyroid cancer and pancreatitis.
tachycardia

58
Q

Dosing mounjaro

A

Start at 2.5 mg per week
adjust by 2.5 every week until 15 mg/week

59
Q
A

Therapeutics P2 (41 decks)

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