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Diabetes > Medications > Flashcards

Medications Flashcards

1
Q

What are the brand names for Metformin?

A

Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet

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2
Q

What is the MOA for Metformin?

A

decreases hepatic glucose output, increases insulin sensitivity, and decreases intestinal glucose absorption

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3
Q

By how much does metformin affect a persons A1C?

A

decrease by 1-1.5%

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4
Q

Does metformin cause hypoglycemia?

A

no

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5
Q

does metformin cause weight gain?

A

no, may potentially have some modest loss

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6
Q

what is the big benefit of metformin?

A

well tolerated, GI side effects usually subside over time, no weight gain, good decrease in A1C and may potentially have some CVD benefit

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7
Q

What is the dosing of metformin?

A

IR: 500 mg PO daily or BID to start then titrate up to 2000 mg
ER: start 500 mg PO daily with dinner then titrate to 2000 mg

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8
Q

what are the side effects of metformin?

A

diarrhea, flatulence, nausea, dyspepsia

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9
Q

What are some notes to give with metformin?

A

make sure to take with a meal to decrease nausea. For the ER tablet make sure to take with dinner and swallow whole. The ER tablet may leave a ghost tablet in stool

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10
Q

What is the black boxed warning with metformin?

A

there is an increased risk for lactic acidosis with renal disease, alcoholism and hypoxia

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11
Q

What are the warnings associated with metformin?

A

can cause a vitamin B12 deficiency, stop prior to an iodinated contrast media, and do not begin if the eGFR is between 30-45

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12
Q

when is metformin contraindicated?

A

if the eGFR is less than 30

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13
Q

what are medications are in the thiazolidinediones (TZD) class?

A

pioglitazone and rosiglitazone

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14
Q

What is the brand name for pioglitazone?

A

Actos

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15
Q

What is the brand name for rosiglitazone?

A

Avandia

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16
Q

What is the MOA for TZD’s?

A

increase muscle cell sensitivity to insulin to increase blood glucose entry

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17
Q

By how much do TZD’s affect an A1c?

A

by 1%

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18
Q

Can TZD’s cause hypoglycemia?

A

not by itself, however it will enhance the effect of insulin so the insulin dose may need to be decreased in combination

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19
Q

Can TZD’s affect weight?

A

yes, they cause weight gain

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20
Q

What is the dosing for pioglitazone?

A

start 15-30 mg daily, then max at 45 mg

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21
Q

What is the dosing for rosiglitazone?

A

start 4-8 mg daily, then max at 8 mg

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22
Q

Do you need to dose adjust for renal impairment in TZD’s?

A

no, but these medications are generally not used due to fluid retention

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23
Q

What are side effects for TZD’s?

A

edema, weight gain, bone fractures, URTI’s

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24
Q

what is a note to know about rosiglitazone?

A

increases LDL/HDL/Total Cholesterol/BP

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25
Q

What is a boxed warning with TZD’s?

A

do NOT use w/ NYHA Class III or IV HF

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26
Q

What warnings are associated with TZD’s?

A

hepatic failure; edema, including maculor; can cause or worsen HF; fractures (esp. in females); can stimulate ovulation, may need contraception if premenopausal

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27
Q

What type of cancer should you avoid pioglitazone with?

A

bladder cancer

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28
Q

What medications are SGLT2 inhibitors?

A

canagliflozin, empagliflozin, dapagliflozin, ertugliflozin

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29
Q

What is brand name fore canagliflozin?

A

Invokana

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30
Q

What is brand name for empagliflozin?

A

Jardiance

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31
Q

What is brand name for dapagliflozin?

A

Farxiga

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32
Q

What is brand name for ertugliflozin?

A

Steglatro

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33
Q

What is the MOA for SGLT2i?

A

increase BG renal excretion

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34
Q

How much does SGLT2i affect A1c?

A

0.7-1%

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35
Q

Can SGLT2i cause hypoglycemia?

A

not by itself, but enhances the effect of insulin. in combo insulin dose may need to be reduced

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36
Q

Does SGLT2i cause weight change?

A

weight loss (only about 5 lbs)

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37
Q

What SGLT2i has heart failure and renal benefit?

A

canagliflozin and empagliflozin

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38
Q

What SGLT2i is able to decrease HF hospitalization?

A

dapagliflozin

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39
Q

What is the dose for canagliflozin?

A

start 100 mg PO QAM, before 1st meal, max 300 mg

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40
Q

What is the dose for emagliflozin?

A

start 10 mg PO QAM, max 25 mg

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41
Q

Do SGLT2i need to be dosed differently with renal impairement?

A

yes, decrease dose with renal impairment

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42
Q

What are side effects of SGLT2i?

A

UTI’s; genital fungal infections; weight loss; increased urination and increased thirst

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43
Q

What happens if someone is taking a SGLT2i and needs surgery?

A

discontinue 3 days prior to surgery to decrease risk of ketoacidosis, restart when normal oral intake is resumed. steglatro should be d/c 4 days prior to surgery

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44
Q

what is the boxed warning with canagliflozin?

A

amputation risk; avoid with foot problems/peripheral neuropathy

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45
Q

What are the warnings with SGLT2i?

A

increased LDL; hyperkalemia; fluid loss, hypotension; ketoacidosis, even with BG < 250; severe UTI’s, genital fungal infxns; risk of fournier’s gangrene (rare)

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46
Q

Which SGLT2i has a warning for bone fractures and should be avoided in those with a fracture risk?

A

canagliflozin

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47
Q

When are SGLT2i contraindicated?

A

eGFR < 30

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48
Q

What medications are DPP-4 inhibitors?

A

sitagliptin, linagliptin, saxagliptin, alogliptin

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49
Q

What is brand name for sitagliptin?

A

Januvia

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50
Q

What is brand name for linagliptin?

A

Tradjenta

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51
Q

What is brand name for saxagliptin?

A

Onglyza

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52
Q

What is brand name for alogliptin?

A

Nesina

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53
Q

What is the MOA for DPP-4i?

A

increase incretin -> less glucagon -> lowers BG

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54
Q

How much do DPP-4i affect A1c?

A

1%

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55
Q

Can DPP-4i cause hypoglycemia?

A

not by themselves, but enhance effect of insulin

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56
Q

Can DPP-4i cause weight change?

A

no

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57
Q

What class should DPP-4i not be used with?

A

GLP-1 RA due to a similar MOA

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58
Q

what is the dose for sitagliptin?

A

100 mg daily

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59
Q

What is the dose for linagliptin?

A

5 mg daily

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60
Q

What DPP-4i does NOT have to be dose adjusted with renal impairment?

A

linagliptin

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61
Q

what are the side effects of DPP-4i?

A

can cause nasopharyngitis (common cold), headache

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62
Q

What side effects does saxagliptin have that the others do not?

A

edema; UTI’s; and hypoglycemia when used with insulin/SU’s

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63
Q

what are the warnings associated with DPP-4i’s?

A

pancreatitis; severe arthralgia (joint pain); acute renal failure

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64
Q

What type of toxicity can alogliptin cause?

A

hepatotoxicity

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65
Q

What condition should you not use alogliptin or saxagliptin in?

A

HF

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66
Q

What medications are part of sulfonylureas?

A

glipizide, glimepiride, glyburide

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67
Q

What is brand name for glipizide?

A

glucotorol, glucotrol XL

68
Q

What is brand name for glimepiride?

A

amaryl

69
Q

What is brand name for glyburide?

A

glynase

70
Q

What is the MOA for SU?

A

increase insulin secretion

71
Q

how much do SU decrease the A1c?

A

0.8%

72
Q

Can SU’s cause hypoglycemia?

A

yes

73
Q

Can SU’s cause weight change?

A

gain

74
Q

What medication should not be used with SU’s?

A

insulin or meglitinides

75
Q

What is the dose for glipizide?

A

start 5 mg daily, max 40 mg daily. if it is the IR formulation take 30 mins before breakfast and the other formulations with breakfast

76
Q

What is the dose for glimipiride?

A

start 1-2 mg daily, max 8 mg daily

77
Q

What is the dose for glyburide?

A

start 2.5-5 mg daily, max 20 mg daily

78
Q

What is important to counsel on Glucotorol XL?

A

OROS formulation; ghost tablet in stool; will decrease efficacy after long-term use due to beta cell function declining

79
Q

Who are SU’s contraindicated in?

A

those with a sulfa allergy; it is not likely to cross react, use cautiously in those with severe sulfa allergy

80
Q

What are the warnings associated with SU’s?

A

hypoglycemia and beer’s criteria due to hypoglycemia

81
Q

Which SU’s have the highest risk on the beers criteria?

A

glyburide and 1st gens such as chlorpropamide

82
Q

What medications are meglitinides?

A

repaglinide and nateglinide

83
Q

What is brand name for repaglinide?

A

prandin

84
Q

What is brand name for nateglinide?

A

starlix

85
Q

What is the MOA for meglitinides?

A

increase insulin secretion (meal time)

86
Q

How does a meglitinide affect A1c?

A

by 1%

87
Q

Do meglitinides cause hypoglycemia?

A

yes, especially if the dose is taken and they skip their dose

88
Q

Do meglitinides cause weight change?

A

yes, gain

89
Q

What is the dosing for repaglinide?

A

start 0.5-1 mg PO TID 15-30 mins before meals, start at 0.5 if A1c is close to goal

90
Q

What is the dosing for nateglinide?

A

start 60-120 mg PO TID 15-30 mins before meals, start at 60 if A1c is close to goal

91
Q

what are the side effects for meglitinides?

A

hypoglycemia, weight gain

92
Q

What is important to counsel patients with meglitinides regarding taking their dose?

A

skip meal, skip dose

93
Q

What warnings are associated with meglitinides?

A

hypoglycemia

94
Q

What medications should not be used with meglitinides?

A

insulin or SU’s

95
Q

What medications are apart of the GLP-1 RA?

A

liraglutide, dulaglutide, exenatide, exenatide ER, lixisenatide, semaglutide

96
Q

What GLP-1 RA comes in oral form?

A

semaglutide as Rybelsus

97
Q

What is the brand name for liraglutide?

A

victoza

98
Q

What is the brand name for liraglutide used for weight loss?

A

Saxenda

99
Q

What is the brand name for dulaglutide?

A

trulicity

100
Q

What is the brand name for exenatide?

A

byetta

101
Q

what is the brand name for exenatide ER?

A

bydureon

102
Q

What is the brand name for lixisenatide?

A

adlyxin

103
Q

what is brand name for semaglutide?

A

ozempic

104
Q

What is the MOA for GLP-1 RA?

A

increase incretin -> less glucagon -> lowers BG and slows gastric emptying -> increase satiety

105
Q

How does GLP-1 RA affect A1C?

A

1%

106
Q

Can GLP-1 RA cause hypoglycemia?

A

not by themselves, but in combo with a drug that causes hypoglycemia can worsen low BG

107
Q

What affect do GLP-1 RA have on weight?

A

loss

108
Q

What GLP-1 RA have a benefit on ASCVD?

A

liraglutide, dulaglutide, semaglutide

109
Q

What medication should you not use with a GLP-1 RA?

A

DPP-4i

110
Q

What is the dose for liraglutide?

A

0.6 mg SC daily x 1 week, then 1.2 mg SC daily; can increase to 1.8 mg SC daily

111
Q

What is the dose for dulaglutide?

A

start 0.75 mg SC once weekly; can increase to 1.5 mg SC weekly

112
Q

Which GLP-1 RA have to be given within 60 mins of meals?

A

byetta and adlyxin

113
Q

Do we need to dose adjust with renal impairment in GLP-1 RAs?

A

exenatide is the only one we need to decrease dose

114
Q

who is exenatide contraindicated in?

A

CrCl < 30 mL/min

115
Q

Who is lixisenatide contraindicated in?

A

< 15 mL/min

116
Q

What are the side effects with GLP-1 RA?

A

nausea/vomiting; diarrhea; decreased appetite/weight loss; dyspepsia; injection site reactions

117
Q

How often should byetta be used?

A

twice daily

118
Q

Which GLP-1 RAs come with pen needles?

A

those that are weekly injections

119
Q

What is a boxed warning for GLP-1 RA, except for byetta and adlyxin?

A

do not use if personal/family history of medullary thyroid CA (MTC)

120
Q

What is a boxed warning for all GLP-1 RA?

A

dont use if history of multiple endocrine neoplasia (MEN2)

121
Q

What are the warnings with GLP-1 RA?

A

pancreatitis; AKI/CKD (kidney damage), from fluid loss/dehydration (from vomiting, diarrhea); hypersensitivity, including anaphylaxis, angioedema; gallbladder disease; do not use with gastroparesis

122
Q

what is a specific warning for bydureon?

A

serious injection-site reactions such as abscess or skin nodules

123
Q

What is a specific warning for ozempic?

A

diabetic retinopathy

124
Q

What is brand for pramlintide?

A

symlin pen

125
Q

T/F: pramlintide can be used in type 1 and type 2 diabetes

A

true

126
Q

What is the MOA of pramlintide?

A

synthetic analog of amylin, slows gastric emptying, increases satiety

127
Q

How does pramlintide affect A1C?

A

decrease by 0.3%

128
Q

Can pramlintide cause hypoglycemia?

A

yes

129
Q

Can pramlintide cause weight change?

A

weight loss

130
Q

What is the benefit for pramlintide?

A

weight loss, less insulin

131
Q

What is the dose for pramlintide?

A

T1: start at 15 mcg, can increase to 60 mcg/dose
T2: start at 60 mcg, can increase to 120 mcg/dose

132
Q

Whose contraindicated to pramlintide?

A

those with gastroparesis and hypoglycemia unawareness

133
Q

What are the side effects of pramlintide?

A

nausea/vomiting, anorexia, headache, weight loss

134
Q

What should we counsel patients to do when taking pramlintide?

A

skip if < 30 g carbs; inject at meal times; do not mix with insulin

135
Q

What is the boxed warning for pramlintide?

A

severe hypoglycemia when used with insulin (3 hrs after administration); must decrease meal time insulin dose by 50%

136
Q

What medications are alpha-glucosidase inhibitors?

A

acarbose and miglitol

137
Q

What is the brand name for acarbose?

A

precose

138
Q

What is the brand name for miglitol?

A

glyset

139
Q

What is the MOA for alpha-glucosidase inhibitors?

A

inhibits sucrose breakdown in gut which decreases glucose absorption

140
Q

Can alpha-glucosidase inhibitors cause hypoglycemia?

A

no

141
Q

Can alpha-glucosidase inhibitors cause weight change?

A

no

142
Q

How do you dose alpha-glucosidase inhibitors?

A

start both at 25 mg PO TID with the first bite of each meal. can start with one meal to decrease GI effects. dont take if skipping meal

143
Q

What are side effects with alpha-glucosidase inhibitors?

A

flatulence, diarrhea, abdominal pain

144
Q

What are the warnings associated with alpha-glucosidase inhibitors?

A

They will not cause hypoglycemia, however if it does occur due to another drug the low BG cannot be treated with sucrose; treat with hypoglycemia with glucose tablets or gel

145
Q

what is a bile-acid binding resin?

A

colesevelam (Welchol)

146
Q

When is a bile-acid binding resin used?

A

for diabetes AND dyslipidemia

147
Q

Does bile-acid binding resin cause hypoglycemia?

A

no

148
Q

Does bile-acid binding resin cause weight change?

A

no

149
Q

How do you dose colesevelam?

A

3.75 g/day in 1-2 divided doses (large tablets)

150
Q

What is a counseling point with colesevelam?

A

decreases ADEK vitamins, take a multivitamin at a different time

151
Q

What are the side effects for bile-acid binding resin?

A

constipation and increased TGs

152
Q

T/F: colesevelam has no drug interactions

A

false!! has many

153
Q

Who are bile-acid binding resin contraindicated in?

A

those with TG > 500 mg/dL, history of hypertriglyceridemia-induced pancreatitis; bowel obstruction

154
Q

What is a dopamine agonist used for DM?

A

Bromocriptine (Cycloset)

155
Q

when is bromocriptine used?

A

for diabetes and parkinsons (Parlodel)

156
Q

can bromocriptine cause hypoglycemia?

A

not by itself

157
Q

Can bromocriptine cause weight change?

A

yes, weight gain

158
Q

how do you dose bromocriptine?

A

start 0.8 mg PO QAM; increase weekly to max 4.8 mg/day

159
Q

What are side effects of bromocriptine?

A

dizziness, fatigue, nausea, headache

160
Q

T/F: bromocriptine has many drug interactions

A

true

161
Q

what are the warnings with bromocriptine?

A

hypotension/syncope; cardiovascular effects

162
Q

when is bromocriptine contraindicated?

A

syncopal migraine, breastfeeding

163
Q

what is the brand name for the combo metformin/pioglitazone?

A

Actoplus Met

164
Q

What is the brand name for the combo metformin/sitagliptin?

A

Janumet, Janumet XR

165
Q

What is the brand name for the combo metformin/canagliflozin?

A

invokamet, invokamet XR

Diabetes (2 decks)

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