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PHRM 844 > Lecture 14 > Flashcards

Lecture 14 Flashcards

1
Q

DPP-4 inhibitors

MOA:
- increases activity of endogenous incretin hormones, ___ and ___

A

GLP-1, GIP

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2
Q

DPP-4 inhibitors

Efficacy:
A1C: decrease ___ - ___ %
FBG: decrease ___ mg/dL
PPG: decrease ___ - ___ mg/dL
Weight: decrease ___ - ___ kg (weight ___ )

A
  • 0.5-1%
  • 20 mg/dL
  • 20-40 mg/dL
  • 0-0.5 kg, neutral
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3
Q

DPP-4 inhibitors

PK
- excreted unchanged in the ___
- adjust dose for ___ function (exception: ___ )

A
  • urine
  • renal, linagliptin
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4
Q

DPP-4 inhibitors

adverse effects
- ___ pharyngitis
- ___ infections
- headache
- some reports of acute ___

A
  • nasopharyngitis
  • upper respiratory tract
  • pancreatitis
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5
Q

DPP-4 inhibitors

FDA warning for ___ pain
- symptoms usually resolved in 1 month after drug ___

A
  • joint
  • discontinuation
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6
Q

DPP-4 inhibitors

FDA warning for ___ risk
with ___ and ___
- if you have to use a DPP-4, use ___

A

HF, saxagliptin, alogliptin
- sitagliptin

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7
Q

DPP-V inhibitors - sitagliptin dosing

  • CrCl > 50 mg/min: ___ mg daily
  • CrCl 30-50 mg/min: ___ mg daily
  • CrCl < 30 mL/min or ESRD on dialysis: ___ mg daily
A
  • 100 mg
  • 50 mg
  • 25 mg
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8
Q

DPP-4 inhibitors - saxagliptin dosing

  • ___ mg daily
  • CrCl < 50 mg/min: ___ mg daily
A
  • 2.5-5 mg
  • 2.5 mg
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9
Q

DPP-4 inhibitors - linagliptin dosing

___ mg once daily

A

5 mg

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10
Q

DPP-V inhibitors - alogliptin dosing

  • __ mg daily
  • CrCl 30-60: ___ mg
  • CrCl < 30 or ESRD and dialysis: ___ mg
A
  • 25 mg
  • 12.5 mg
  • 6.25 mg
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11
Q

SUs

MOA:
- stimulate ___ release from ___ cells
- may increase binding between insulin and receptors or increase the number of ___

A
  • insulin, beta
  • receptors
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12
Q

SUs

Clinical Application
- adjunct to diet and exercise in type ___ pts
- used in combination therapy with insulin and other non-insulin agents

A

2

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13
Q

SUs

Efficacy
- A1C: decrease ___ - ___%
- FBG: decrease ___ - ___ mg/dL

A
  • 1-2%
  • 60-70 mg/dL
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14
Q

SUs

PK of 2nd gens:
- glyburide and glipizide, more effective when taken ___ min AC (before ___ would be ideal)
- metabolized by ___
- some excreted in the ___
- glipizide metabolized without the formation of ___ metabolites, therefore it is preferred in ___ disease

A
  • 30 min, breakfast
  • liver
  • urine
  • active, renal
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15
Q

SUs

What is the preferred SUs in general?
Especially in:
- elderly/malnourished pts
- renal/heptain insfficiency
- concurrent use of hypoglycemic drugs like insulin

A

glipizide

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16
Q

SUs

adverse effects
- ____glycemia
- weight ___ (up to ___ kg)
- ____ upset
- ___ logic: leukopeniam thrombocytopenia, aplastic anemia
- allergic skin reactions/ ____ sensitivity

A
  • Hypoglycemia
  • gain, 3 kg
  • GI
  • hematologic
  • photosensitivity
17
Q

SUs

Dosing
- start at ___ end of the dosing range, especially in the ____
- increase dose every ___ weeks until maximum dosage
- exceeding the max dosage increases ___, but does not decrease ___
- current max doses now being questioned; estimated to be 60-75% of package insert max dose

A
  • low, elderly
  • 1-2 weeks
  • side effect, BG
18
Q

SUs - glipizide (Glucotrol) dosing

starting dose: ___ - ___ mg daily
Max daily dose: ___ mg
Max daily dose (XL): ___ mg

A
  • 2.5-5 mg
  • 40 mg
  • 20 mg
19
Q

SUs - glyburide (Micronase/Diabeta)

starting dose: ___ - ___ mg daily
Max daily dose: ___ mg

A
  • 1.25-5 mg
  • 20 mg
20
Q

SUs - glyburide micronized (Glynase)

starting dose: ___ - ___ mg daily
Max daily dose: ___ mg

A
  • 1.5-3 mg
  • 12 mg
21
Q

SUs

use cautiously in the following pts due to increased risk of hypoglycemia
- ___ pts
- pts with ___ / ___ disease
- ___ dietary intake
- alcoholics
- pts taking concomitant ___ agents

A
  • elderly
  • renal/hepatic
  • irregular
  • hypoglycemic
22
Q

SUs

best candidates:
- no type ___ pts
- short duration of ___
- FBG < ___ mg/dL
- high fasting ___ peptide levels (means that the pt can still make ___. )

A
  • 1
  • diabetes
  • 250 mg/dL
  • C, insulin
23
Q

SUs

Treatment Failure
- ___ % will have primary failure
- after 5 years ___ - ___ % may experience secondary failure
- commons for these meds to fail after ___ months

A
  • 25%
  • 50-75%
  • 6-12 months
24
Q

TzDs

MOA:
- bind to PPAR-gamma on ___ and ___ cells
- improved cellular response to insulin without increasing ___
- decreases insulin ___
- decreases ___ glucose production

A
  • fat, vascular
  • secretion
  • resistance
  • hepatic
25
Q

TzDs

Other benefits
- pioglitazone can decrease ___ by 10-20%
- ___ remains unchanged; rosiglitazone may increase
- both meds increased ___ by 3-9 mg/dL
- endothelial function has improved and ___ may decrease slightly

A
  • TG
  • LDL
  • HDL
  • blood pressure
26
Q

TzDs

Efficay
- A1C: decrease ___ - ___ %
- FBG: decrease ___ - ___ mg/dL

A
  • 0.5-1.5%
  • 60-70 mg/dL
27
Q

TzDs

Adverse Effects: ___ toxicity
- do not start therapy in pts with baseline LFTs > ___ x normal
- check LFTs ___ months after starting, if stable, check in ___ months
- D/C med if LFTs are > ___ x normal

A

Hepatotoxicity
- 2.5x
- 3 months, 6 months
- 3x

28
Q

TzDs

Other Adverse Effects
- N/V
- abdominal pain
- fatigue
- anorexia
- dark urine
- resumption of ___
- exacerbations of ___ : use in caution with NYHA class III and IV
- increased ___ , greater than 10 lb weight gain in some pts
- ___ edema
- increased ___ risk

A
  • ovulation
  • HF
  • edema
  • macular
  • fracture
29
Q

T or F: TzD studies on CV benefit are controversial

A

True; not a lot of great evidence to use for CV. pioglitazone might have some anti-atherogenic potential

30
Q

TzDs - pioglitazone dosing

initial dose: ___ - ___ mg daily
Max dose: ___ - ___ mg daily
titrate dose every ___ weeks

A
  • 15-30
  • 30-45
  • 12
31
Q

in pts with high risk ASCVD, HF, and/or CKD;
___ and ___ are recommended independent of A1C

A

SGLT2s and GLP-1s

32
Q

start dual therapy if
ADA: A1C > ___ %
AACE: A1C > ___ - ___ %

A
  • 9%
  • 7.5-9%
33
Q

in pts with T2DM, a ___ is preferred to insulin when possible

A

GLP-1

34
Q

___ should be used if there is evidence of ongoing catabolism ( weight ___ ), if symptoms of ___ are present, or if A1C > ___ %, or blood glucose readings are > ___ mg/dL

A

insulin
loss
hyperglycemia
10%
300 mg/dL

35
Q

if insulin is used, combination therapy with a ___ is recommended for efficacy and durability of treatment

A

GLP-1

if pt isnt controlled on basal + GLP-1, switch to basal + bolus

36
Q

Be aware of overbasalization with insulin. If the basal dose is about ___ units/kg/day or there is high variability in BG readings, evaluate basal level and consider basal-bolus initiation

A

0.5 units/kg/day

PHRM 844 (52 decks)

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