Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics P2 > Exam 3 lecture 5 > Flashcards

Exam 3 lecture 5 Flashcards

1
Q

Name DPP-IV inhibitors

A

Sitagliptin, Saxagliptin, Linagliptin, Alogliptin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does DPP IV do as an enzyme?

A

Breaks down GLP-1 and GIP. DPP inhibitors stop this breakdown.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe GLP and GIP

A

they are incretin hormones that are released from the gut and help enhance insulin secretion in response to food.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do GLPs and GIPs do?

A

stimulate insulin response in glucose dependent manner (prevent hypoglycemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DPP IV inhibitor efficacy

A

reduces A1c 0.5-1% (not as effective as GLPs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DPP IV inhibitor effect on weight?

A

weight neutral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

DPP IV dosing strategy

A

Excreted renally so dose should be adjusted in renal dysfunctions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

side effects on DPP IV inhibitors

A

Nasopharyngitis
pancreatitis
upper respiratory infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

FDA warning for DPP IV inhibitors

A

Joint pain
HF risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which DPP IV inhibitor has no increased risk for CV events

A

Sitagliptin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

sitagliptin dosing

A

100 mg qd
CRCL 30-50- 50 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Saxagliptin dosing

A

2.5-5 mg
crcl 30-50- 2.5 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the only DPP IV inhibitor not renally eliminated

A

Linagliptin (no renal adjustments needed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Linagliptin dose

A

5 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

alogliptin dosing

A

25 mg
CRCL 30-50- 12.5 mg
less than 30 CRCL- 6.25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

sulfonylurea MOA

A

Stimulates insulin release from B cells
increases binding between insulin and receptor and also increases the number of receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What type of pts in sulfonylureas used in?

A

type 2 pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

name suulfonylurea drugs

A

Glyburide, glipizide, glimepride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which sulfonylurea is preferred in renally impaired pts? why?

A

Glipizide

It is metabolized without active metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

side effects of sulfonylurea

A

Risk for hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

glipizide dosing?
glipizide XL dosing?

A

starting 2.5-5
increase dose every 1-2 weeks until 20 mg (until 10 mg in glipizide XL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

glyburide dosing?

A

starting 1.25-5, max is 10 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Who are the best candidates for sulfonylureas

A

No type 1 pts
FBS<250

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

TZDs MOA

A

bind to PPAR-gamma on fat cells to allow us to decrease insulin resistance and decrease hepatic glucose production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

TZD drug name

A

pioglitazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Benefits of TZDs

A

Pioglitazones can decrease TG by 10-20% (make LDL fluffy and they do not stick together)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are things we should monitor when taking pioglitazine

A

LFT (liver function test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Adverse effects of TZDs

A

Hepatotoxicity
increases fracture risk
weight gain and edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

when to dx pioglitazone

A

when LFT is 3x normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which drugs exacerbate HF

A

TZDs (pioglitazone, metformin, DPP IV inhibitors (except sitagliptin)

31
Q

Which drugs are good in HF pts

A

SGLT-2 inhibitors

32
Q

dosing of pioglitazone

A

initial- 15-30 mg
max- 30-45
titrate dose every 12 weeks

33
Q

Can pioglitazone be used for MI/stroke pts?

A

Yes, not in HF pts

34
Q

T/F In patients with T2DM, a GLP-1 is preferred to insulin when possible

A

True

35
Q

When should we consider adding insulin (basal bolus) to GLP-1 agonists

A

evidence of weight loss, polyuria, dipsia and phagia. BG readings are >300, a1c>10%

36
Q

When to add bolus insulin to basal insulin

A

If basal dose= 0.5 units/kg/day

37
Q

Can we use DPP IV inhibitors and GLP 1 together?

A

No

38
Q

goal A1c for women with diabetes that are planning to concieve

A

<6%

39
Q

Glycemic targets in pregnancy

A

fasting-70-95
1h ppg- 110-140
2 h ppg- 100-120
a1c<6%
use CGMs

40
Q

What are some changes to insulin physiology in pregnancy

A

In early pregnancy, insulin sensitivity is enhanced, leading to hypoglycemia.

By 16 weeks resistance increases exponentially

41
Q

When is there an increased risk of hypoglycemia in pregnancy

A

Early pregnancy.

42
Q

Pregnancy is a ______ state

A

Ketogenic

DKA can increase still births

43
Q

What happens to insulin sensitivity after baby is delivered

A

insulin sensitivity increases

44
Q

what meds need to be dx at pregnancy

A

statins, ACE-I, ARBs,

45
Q

type 2 pregnant patients BP goal

A

110-135/85

46
Q

what type of pregnancy loss is more common in T1DM? What about T2DM?

A

T1DM- first trimester
T2DM- Third trimester

47
Q

Insulin dose requirements during pregnancy

A

Increases. drops after delivery

48
Q

Dose of insulin for gestational diabetes

A

0.7-1 units/kg/day as basal-bolus

49
Q

What should be used in gestational diabetes if patient can not take insulin

A

metformin. If taking for PCOS, dx by the end of 1st trimester

50
Q

T/F GDM is associated with risk of diabetes at 50-75% after 15-25 yrs

A

true

51
Q

How is type 2 in children different from type 2 in adults

A

Children have a more rapid decline in B cell function

52
Q

type 1 treatment

A

Insulin

53
Q

what is the honeymoon phase in type 1 DM

A

The body responds really well to insulin 1st few months of therapy so only 1 dose a day can be sufficient. This will eventually stop

54
Q

for type 2 diabetic children with A1C<8.5%, what is the initial therapy

A

metformin

55
Q

for type 2 diabetic children with A1c >8.5%, what is initial therapy

A

basal insulin+metformin

56
Q

In children with type 2 diabetes already on basal insulin and metformin that are not controlled, what do we add to therapy

A

GLP-1 RAs on children 10 or above

57
Q

What are some GLP 1 RAs approved in children

A

Liraglutide
exenatide

58
Q

What do we add to type 2 children that are not at goal on metformin, basal and GLP1 RAs

A

Bolus insulin

59
Q

If a patient presents with DKA we treat with

A

SQ or IV insulin

60
Q

diabetes goals in older patients with very few coexisting conditions

A

A1c-7-7.5
Fasting- 80-130
bedtime- 80-180
BP<130/80

61
Q

diabetes goals in older patients with complex/intermediate chronic illnesses

A

A1c<8%
fasting- 90-150
bedtime-100-180
BP<130/80

62
Q

Diabetes goals in pts with older pts very poor health

A

control hyper/hypo glycemia
BP<140/90

63
Q

Medication causes for elevated BS

A

Glucocorticoids (prednisone) reahces peak plasma levels at around 4-6 hours.

64
Q

How do we adjust Insulin when taking prednisone

A

Since BG peaks in 4-6 hours on prednisone, it peaks at the same time as NPH, addition of NPH can help this.
Morning dose of prednisone= more insulin in morning

65
Q

How do we adjust insulin when taking dextromethorphan

A

Long acting insulin is increased because dextromethorphan is long acting

66
Q

peri operative management in diabetuiucs

A

BG target- 100-180
reduce basal insulin the evening before surgery by 25%
Hold all bolus insulin once patient becomes NPO
metformin should be held the day of surgery
SGLT-2 should be held 3 days before (4 days for empagliflozin)
hold allogliptin the morning of surgery
Give half NPH dose

67
Q

GB target before surgery

A

100-180

68
Q

basal insulin perioperative

A

reduce basal insulin by 25%

69
Q

bolus insulin perioperative

A

hold all bolus insulin once patient becomes NPO

70
Q

Metformin perioperative

A

metformin should be held the day of surgery

71
Q

SGLT2 perioperative

A

should be stopped 3 days before surgery (4 for empagliflozin)

72
Q

Allogliptin perioperative

A

should be stopped the morning of surgery

73
Q

NPH perioperative

A

give half dose the morning of surgery

Therapeutics P2 (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions