L30- Antidiabetic Drugs II (drug guidelines) Flashcards

1
Q

_____ is the initial drug 1st line therapy for type II DM

A

Metformin (inhibits gluconeogenesis, inc liver/muscle glucose utilization)

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

Monotherapy with non-insulin antidiabetic can by itself reduce HbA1c by (1)

Dual therapy in newly diagnosed type II DM patients is considered if (2)

A

1- ~1%

2- HbA1c is >1.5% above glycemic target

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

Monotherapy, = (1), is advanced to dual combination therapy if (2) is not achieved. (3) or (4) are the additional 2nd drug.

A

1- metformin

2- HbA1c goal is reached in ~3 mos

3- GLP-1 agonist (incretiin analog: exentide)
4- basal insulin

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

Dual therapy, = (1), is advanced to triple therapy if (2) persists, then (3) will be added.

A

1- metformin, GLP-1 agonist (exentide)

2- HbA1c >8.5%

3- insulin (basal, then mealtime)

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

describe why GLP-1 receptor agonist or insulin therapy is preferred

A

*GLP-1 receptor agonist (incretin analog: exentide)

Pros: (to minimize hypoglycemia or weight gain)

  • similar efficacy
  • lower hypoglycemic risk
  • dec weight

Cons:

  • greater GI side-effects, lower tolerability
  • high cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Insulin is indicated as initial diabetic therapy if……

A

(for DM II)

  • ongoing catabolism (weight loss)
  • significant hyperglycemic Sxs
  • ketonuria
  • HbA1c >10%
  • random glucose >300
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe the management of diabetes in pregnancy

A

(pre-existing DM I or II, and gestational DM)

insulin (doesn’t cross placenta)

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

DM managment in pregnancy:

  • (1) is typical insulin regimen choice
  • (2) is then usually added if needed
A

1- NPH (intemediate acting), single dose at bedtime

2- postprandial control: lispro, aspart (rapid-acting)

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

list the main diabetic complications

A

CVS: HTN, dyslipidemia, anti-platelet therapy

Nephropathy

Neuropathy: neuropathic pain, gastroparesis, ED

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

________ is the major cause of death in diabetics

A

cardiovascular disease

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

list the drugs of choice for HTN in DM

A

1) ACEI / ARB (especially to reduce albuminuria if present –> dec risk of CRF)
2) thiazide
3) dihydropyridine CCB

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

describe management of dyslipidemia in DM

A

Statins regardless of lipid levels for patients with:

  • overt CVD
  • <40 y/o w/ CVD risk factors
  • > 40 y/o w/ or w/o CVD risk factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

_____ therapy (OTC) is considered as a primary prevention strategy in patients with DM I or II

A

ASA- anti-platelet agent

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

(T/F) neuropathic pain is simply treated with traditional pain therapies (NSAIDs, opiods, etc)

A

F- does not respond well to traditional pain therapies

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

(1) and (2) are common ANS neuropathic symptoms, include Tx

A

1- Gastroparesis (delayed gastric emptying Sxs) –> Prokinetic Agents: metoclopramide, erythromycin

2- ED –> phosphodiesterase type 5 inibitors (sidenafil)

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

list the clinical uses of Glucagon

A

Severe Hypoglycemia, especially in diabetic Pts
β-blocker poisoning / overdose

Bowel Radiology –> relaxes bowel
Glucagon C-peptide Test (tests residual β-cell function in diabetics)