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medications Flashcards

1
Q

what medication is a Biguanides?

A

Metformin

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2
Q

what is metformin’s main mechanism of action? What else does it do?

A

MOA: decreases hepatic glucose production and increases peripheral glucose utilization

also: decreases GI intestinal glucose absorption, increases insulin sensitivity (no effect on pancreatic beta cells)

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3
Q

because metformin has no affect on pancreatic beta cells what does that mean?

A

no hypoglycemia, no weight gain

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4
Q

why do you not give metformin to patients with renal impairment?

A

Lactic acidosis

Creatine has to be greater than 1.5

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5
Q

MOA: stimulates pancreatic beta cell insulin release by closing kATP channel

Primarily reduce fasting glucose without large effects on postprandial

A

Sulfonylureas (Glipizide, Glimperide)

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6
Q

what medications are sulfonylureas?

A

Glipizide, Glimperide

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7
Q

what are side effects of medications like Glipizide and Glimperide?

A

Hypoglycemia
GI upset (reduced if taken with food)
Dilsufiram reaction
Cardiac arrythmias
Weight gain

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8
Q

MOA: Stimulates pancreatic beta cell insulin release?

A

Meglitinides (Repaglinide, Nateglinide)

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9
Q

What are side effects to medications like repalinide, nateglinide?

A

Hypoglycemia
Weight Gain

Hypoglycemia is still less than sulfonylureas

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10
Q

What medications are metaglitinides?

A

Repaglinide, Nateglinide

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11
Q

MOA: delays intestinal glucose absorption (inhibits pancreatic alpha amylase and intestinal alpha glucosidase hydrolase)
does not affect insulin secretion

A

Glucosidase inhibitors (Acarbose)

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12
Q

which medication’s are glucosidase inhibitors?

A

Acarbose

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13
Q

side effects of Acarbose?

A

Hepatitis
Increased LFT’s
flatulence
diarrhea
abdominal pain

Cautious use in pts with gastroparesis, IBD, or on bile acid resins

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14
Q

MOA: increases insulin sensitivity at the peripheral receptor site adipose & muscle
no effect on pancreatic beta cells

A

Thiazolidinediones (pioglitazone, rosiglitazone)

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15
Q

which medications are Thiozoldinediones?

A

pioglitazone, rosiglizaone

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16
Q

what are side effects to medications such as pioglitazone, rosiglitazone?

A

Fluid retention and edema
Hepatotoxicity
bladder cancer
fractures
Cardiaovascular toxicity with rosiglitazone
weight gain
anemia

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17
Q

MOA: mimics incretin–> increases insulin secretion, delays gastric emptying, Decreases glucagon secretion
no weight gain

A

Glucagon-Like Peptide 1 (GLP-1)
(Exenatide, liraglutide)

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18
Q

what medications are GLP-1s?

A

Liraglutide, exenatide, bydureon

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19
Q

what are side effects to medications such as exenatide, liraglutide?

A

Hypoglycemia (less than sulfonylureas b/c glucose dependent)
pancreatitis
Caution with history of gastroparesis

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20
Q

which medications are dopamine agonists? what are they used to treat?

A

Bromocriptine, Cabergoline
prolactinomas

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21
Q

what are the only hormones secreted by the posterior pituitary

A

ADH and Oxytocin

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22
Q

what are medical therapy options for ED?

A

PDE-5i’s
(sildenafil, vardenafil, tadalafil, avanafil)

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23
Q

MOA: potentiate the effect of cGMP to prolong erections and increase sexual satisfaction

A

PDE5 Inhibitors

24
Q

what is an absolute contraindication to PDE5i’s? what should be used with caution

A

Contraindication- nitrates
Caution- alpha blockers

25
Q

which medication is especially effective at lowering fasting glucose (by 50-70mg/dL)?

A

metformin

26
Q

what are contraindications for metformin?

A
  • renal insufficency (NO in eGFR <30)
  • severe CHF
  • Acute or chronic acidosis
  • pts receiving IV contrast
27
Q

contraindications for sulfonylureas?

A

not indicated in type 1 patients
known hypersensitivity

28
Q

when is glipizide and glimeperide more effective?

A

15-30 minutes before meal than with meal

29
Q

due to mechanism, will take several weeks to month to produce clinical response

A

pioglitazone

30
Q

contraindication for TZD’s

A

Baseline liver transaminases >2.5x
pre-existing liver disease
class III or IV heart failure
significant caution in any CHF

31
Q

contraindications of Acarbose?

A

cirrhosis
inflammatory bowel disease
other significant bowel disease/malabsorption

32
Q

which medications are DPP-4 inhibitors?

A

sitagliptin

33
Q

MOA: inhibit breakdown of GLP-1 and GIP incretin hormones that stimulate glucose dependent insulin secretion

A

DPP-4

34
Q

efficacy of DPP4

A

reduced fasting plasma glucose and post-prandial

35
Q

side effects of DPP4

A

well tolerated
hypoglycemia in 0.5-2%, higher in combination therapy
pancreatitis

36
Q

contraindication of DPP4 inhibitors?

A

hypersensitivity

37
Q

what medications are SGLT2 inhibitors?

A

Canaglifozin
dapagliflozin
empaglifozin

38
Q

MOA: inhibit glucose reabsorption in proximal tubule of kidney
increase loss of glucose in urine

A

SGLT2 inhibitors

39
Q

efficacy of SGLT2

A

Reduces fasting plasma glucose by about 20mg/dL

40
Q

side effects of SGLT2?

A

Genital mycotic infections (10-15%)
urinary tract infections
dehydration
increase in LDL cholesterol
hyperkalemia
ketoacidosis
fracture risk- decreased bone density
amputation risk

41
Q

side effects of SGLT2?

A

Genital mycotic infections (10-15%)
urinary tract infections
dehydration
increase in LDL cholesterol
hyperkalemia
ketoacidosis
fracture risk- decreased bone density
amputation risk

42
Q

what is an important “good side effect” of SGLT2

A
  • reduces progression of kidney disease (dapagliflozin)
  • Reduced CV risk (empagliflozin, canagliflozin)
  • approved to treat heart failure and reduce CV deaths and hospitalization (dapagliflozin and empagliflozin)
43
Q

contraindications of SGLT2 inhibitors

A
  • Severe renal impairment (GFR<45, ESRD or on dialysis) newer trials show efficacy down to 30
  • caution with hypotension, hyperkalemia
  • not approved for use in type 1 but off label use may be considered (may cause ketosis)
44
Q

which medications target prandial and fasting glucose?

A

metglitinides
acarbose
DPP4 inhibitors
GLP-1

45
Q

side effects of GLP-1 receptor agonists

A
  • GI disturbance (Nausea!!) usually subsides
  • pancreatitis
  • hypoglycemia (rare as a single agent, more common with SU)
  • May have increased risk of medullary thyroid cancer
46
Q

what are contraindication for GLP-1 receptor agonists?

A

severe renal impairment (risk of dehydration, worsening renal function)

47
Q

Peptide hormone that is made in the beta cells in the pancrease. Helps to lower blood glucose by pushing glucose into the tissues
suppresses glucose output from the liver

A

insulin

48
Q

intermediate acting insulin
Onset 2H, peak 4-6H, duration 12-16H

A

NPH

49
Q

somewhat short acting
Onset 30-60min, Peak 2-4H, Duration 6-8H

A

regular

50
Q

what are the long acting insulin medications
what is the onset? duration?

A

Glargine (onset 2H, duration 24)
detemir (onset 2h, 14-16 duration)
degludec (90 min onset, 24h duration)

ALL PEAKS ARE FLAT

51
Q

rapid acting insulin medication
what is the onset, peak, duration?

A

Lispro (onset 5-15min, peak 1h, duration 4-5h)
aspart(onset 5-15min, peak 1h, duration 4-5h)

52
Q

what can be a good strategy in type 2 paitents not controlled on oral agents?

A

Basal insulin alone
can use NPH or glargine/detemir

53
Q

how do you dose multiple daily injections?

A

use long acting analog(glargine, detemir) as basal once daily- 50% total daily dose
use rapid acting (lispro/aspart) with meals (add up to 50% total daily dose)

54
Q

how do you dose pre-mixed insulins?

A

give 2/3 of total daily dose in the morning, 15-30 minutes before breakfast
don’t skip lunch
give 1/3 of total daily dose in the evening, 15-30 minutes before dinner

55
Q

how do you dose twice daily split mixed regimen?

A

by mixing separate insulins (NPH can mix with regular or rapid acting)
sometimes will move evening NPH to bedtime to cover am fasting sugars better

56
Q

What is the only “long-acting” insulin that can be mixed?

A

NPH

endocrine (2 decks)

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