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Endo/Eye/Derm - Women/Men > EXAM 4 Diabetes Drugs Dr. Hess > Flashcards

EXAM 4 Diabetes Drugs Dr. Hess Flashcards

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1
Q

What is the backbone of treating Prediabetes and T2DM?

A

-Medical nutrition therapy -> individualized meals (dietitian) -> weight loss
-Exercise

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2
Q

MOA of Metformin

A

Insulin Sensitizer (reducing Insulin resistance)

-reduces hepatic glucose production and glucose absorption in the gut

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3
Q

What is the most common side effect of Metformin?

A

Diarrhea
-it reduces glucose absorption in the gut -> glucose stays in the gut where bacteria comes in

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4
Q

What are ways to reduce the adverse effects of diarrhea when taking Metformin?

A

-take with food
-titrate weekly (increase by 500 mg)
-use the ER formulation

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5
Q

What is the maximum dose of Metformin?

A

2550 mg/day (850mg TID)

the maximum dose that is actually effective and seen in practice is 2000 mg

-titrate up until 2000 mg or control of blood glucose
-if blood glucose is controlled then don’t need to go to 2000 mg and potentially cause diarrhea (dose-depndent)

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6
Q

How much does Metformin lower A1c?

A

on average 1-2%

(reducing A1c by more than 1% is considered high efficacy)

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7
Q

What is the risk of Hypoglycemia of Metformin?

A

Low

-since it doesn’t stimulate insulin release but increases sensitivity

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8
Q

How does Metformin affect weight?

A

weight-neutral

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9
Q

Contraindications of Metformin

A

-Renal disease (eGFR < 30)
->excreted 100% in the kidney

-use of contrast dye - nephrotoxic (eGFR < 60)

-BBW: Lactic acidosis (don’t give if hx of Lactic acidosis)

-reduces Vitamin B12 absorption

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10
Q

A patient’s eGFR on Metformin has decreased to 35, what is the medical approach to it?

A

eGFR: 30-45
-if they were not on Metformin don’t start
-if they are on Metformin: consider a 50% dose reduction and close monitoring

if the eGFR is below 30: CONTRAINDICATED

if eGFR is over 45: it is OK to start or continue

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11
Q

MOA of SGLT2i

A

blocking glucose reabsorption in the kidney
-> excreted via urine

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12
Q

Efficacy of SGLT2i

A

0.5 - 1% (moderate)

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13
Q

What are the other protective effects of SGLT2i?

A

-Cardiovascular protective (heart failure)
-Renal protective (CKD)

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14
Q

Hypoglycemia risk for SGT2i

A

Low

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15
Q

Adverse effects of SGLT2i

A

Mycotic infections, UTI
-Polyuria
-dehydration (mild diuretic)
-Hypotension
-Weight loss !!!
-Euglycemic diabetic ketoacidosis (rare)

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16
Q

Why may patients on SGLT2i develop Euglycemic diabetic ketoacidosis?

A

the blood glucose is normal (normal-high) but they are acidic

they pee out the sugar which lowers the blood glucose

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17
Q

When are SGLT2i contraindicated?

A

severe renal dysfunction (eGFR < 20)

18
Q

Which SGLT2i is indicated for T2DM with ASCVD, HF, and CKD?

A

Jardiance (Empagliflozin)

19
Q

What is the indication of Farxiga (dapagliflozin)?

A

T2DM
HF
CKD

20
Q

What is the indication of Invokana (Canagliflozin)?

A

T2DM
T2DM with ASCVD
T2DM with CKD

had a BBW for imputations, but it was removed
-not often used in practice

21
Q

What is the risk of hypoglycemia for SGLT2i when combined with other antidiabetics?

A

-SGLT2i has a low risk of hypoglycemia
-SU has a higher risk of hypoglycemia -> combined higher risk for hypoglycemia

reduce the dose of SU to reduce the risk of hypoglycemia

22
Q

Which SGLT2is have shown renal benefits?

A

Farxiga (dapagliflozin)
Invokana (canagliflozin)

23
Q

Which of the SGLT2i have HF benefits?

A

Farxiga (dapagliflozin)
Jardiance (empagliflozin)

24
Q

Which of the SGLT2i have CVD benefits?

A

Jardiance (empagliflozin)
Invokana (canagliflozin)

25
Q

Which drugs may cause weight loss?

A

SGLT2i (pee out 80g sugar per day)
GLP-1
..

26
Q

MOA of GLP-1 and GIP

A

activate GLP-1 receptors -> increase in insulin secretion (endegeounous GLP-1 comes from the gut)

high efficacy: 0-75 - 1.5%

27
Q

How does GLP-1 cause weight loss?

A

it works in different parts of the body:

Brain: reduced food intake, increased satiety
Pancreas: GLP-1: increased insulin, decreased glucagon
Stomach: reduced gastric emptying

28
Q

Why does GLP-1 have a low hypoglycemia risk despite increasing insulin release?

A

Because the insulin release is glucose-dependent

29
Q

What are the side effects of GLP-1?

A

-N/VD
-Weight loss
-Pancreatitis (rare)
-Injection reactions

30
Q

What is the BBW for GLP-1?

A

-Hx of medullary thyroid carcinoma (MTC) seen in rats
-not thyroids, but medullary thyroid cancer -> produces calcitonin

-Hx of multiple endocrine neoplasm type 2 (MEN2)

31
Q

Patient population to be cautious when using GLP-1?

A

-poor renal function (should be over 30)
-when they use Sulfonylurea -> hypoglycemia risk

-Hx pancreatitits
-Hx of gastroparesis or delayed gastric emptying

32
Q

Which GLP-1s have an indication for T2DM with ASCVD?

A

Victoza
-Ozempic
-Trulicity (dulaglutide)

33
Q

How are GLP-1 dosed?

A

weekly
except for Vicotza

34
Q

How are SGLT2i dosed?

A

daily

start dosing -> uptitration

35
Q

Which drug is a GIP and GLP-1 agonist?

A

Tirzepatide (Mounjaro)

36
Q

How is Tirzepatide (Mounjaro) dosed?

A

increase in the dose every month by 2.5 mg (if they tolerate it)

it is taken once a week

37
Q

Which GLP-1 has the longest/shortest storage time at room temperature?

A

longest: Ozempic (56 days)

shortest: Trulicity (14 days)

38
Q

Which GLP-1s have a storage time at room temperature of 28-30 days?

A

Bydureon BCise (exenatide LA): 28 days
Byetta (exenatide): 30 days
Victoza (Liraglutide): 30 days

all of them including Ozempic, Trulicity and Mounjaro should be kept in the fridge prior using

39
Q

What is the orally formulated GLP-1 and how should it be taken?

A

Semaglutide (Rybelsus)

-at least 30 minutes before the first food, beverage, or other oral medications
-not more than 4 oz water
-Keep in the original blister pack (protection from moisture)

40
Q

Which of the GLP-1s have CVD benefits?

A

-Victoza (Trulicity)
-Ozempic (Semaglutide)
-Trulicity (Dulaglutide)

41
Q

What is the first-line antidiabetic drug based on the guidelines?

A

if they have ASCVD risk, HF, or CKD
-> go with SGLT2i or GLP-1 before metformin

in practice, Metformin is often used first

Endo/Eye/Derm - Women/Men (30 decks)

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