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CDCES > medications > Flashcards

medications Flashcards

1
Q

What is the mechanism of action of biguanides?

A

Increase insulin sensitivity
Decreases liver glucose production
Reduces GI glucose absorption

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2
Q

What are biguanides?

A

Metformin
Glucophage
ends in phage

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3
Q

What is the first line tx for T2DM?

A

ILI + Metformin

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4
Q

What are the benefits of biguanides?

A
  • Lower LDL & TG
  • weight neutral
  • potentially CA protective
  • no HYPO
  • Decrease CVD risk
  • Affordable
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5
Q

What meds are approved for peds?

A

Metformin & liraglutide, have to be 10 years old

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6
Q

eGFR recs for metformin

A

Do not initiate <45

STOP <30

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7
Q

Side effects of metformin

A
  • GI: bloating, diarrhea, abdominal pain
  • B12 deficiency & worsening neuropathy with LT use
  • Lactic acidosis of prescribed wrong
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8
Q

how to reduce diarrhea in metformin

A
  • XR form

- Gradual dose titration

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9
Q

Sulfonylureas

A

end in ide

glyburide, glimepiride, glipizide

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10
Q

Side effects of sulfonylureas

A

Hypo esp. in reduced kidney/liver function

  • weight gain
  • does not lower CVD risk
  • doesn’t work as well after 5 years
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11
Q

How do sulfonylureas work

A
  • IDE- insulin down easy
  • secretors
  • stimulates sustained insulin release
  • effective at lowering BG
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12
Q

Meglinitinides
“ide”
how do they work?

A

stimulate rapid insulin burst
aka secretors
Insulin Down Easier

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13
Q

Side effects of meglinides

A
  • Cause HYPO
  • better for inconsistent meals d/t shorter 1/ 2 life
  • weight gain
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14
Q

SGLT-2 i
ends in __________
how does it work

A

flozin
increase urination
decreases renal glucose reabsorption

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15
Q

s/s of SGLTi-2

A
  • Glycosuria- high glucose in urine
  • Increase UTIs & candida/yeast infections
  • Fournier’s gangrene (genital infection)
  • osmotic diuresis –> increased urination, dehydration, hypotension
  • Potential for DKA
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16
Q

benefit of SGLT-2

A

Good luck for

  • reducing CVD risk
  • Preserves kidney function
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17
Q

GLP-1

mechanism of action

A
  • tide
  • imitate GI incretin hormone, GLP-1
  • Suppress glucagon secretion
  • increase insulin secretion
  • delays gastric emptying
  • reduce appetite
  • changes tide in gut
  • INJECTIBLE
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18
Q

Benefits of GLP-1

A
  • weight loss
  • reduce risk of CV events
  • beta cell protective factor
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19
Q

disadvantages of GLP-1

A
  • black box warning for thyroid tumor
  • report s/s of pancreatitis
  • nausea when starting
  • $$$$$$$$
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20
Q

Dpp-4 inhibitors

ends in _________

A

liptin

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21
Q

DPP-4 inhibitor mechanism of action

A

inhibit DPP-4 enzyme that breaks down GI incretin hormone GLP-1

  • extend duration of GLIP-1
  • first hits your lips then your gut
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22
Q

s/s of dpp-4 i

A

DISABLING joint pain- tell MD immediately
headache/flu like s/s
increase risk of HF
increase risk of pancreatitis

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23
Q

benefit of dpp4-i

A

no weight gain

no hypo

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24
Q

TZD
ends in ________
mechanism of action

A

end in zone
increase insulin sensitivity
puts your cells in the zone

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25
Q

benefit of TZD

A

decrease FFA

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26
Q

s/s of TZD

A
  • increase fracture risk esp in elderly
  • may worsen/cause CHF
  • monitor for edema/wt gain
  • does not lower CVD risk
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27
Q

Bolus insulin is ________

A

fast acting

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28
Q

Name the bolus insulins and their duration

A 
Gary Loves Red Apples
Glulisine <5 H
Lispro <5 H
Regular (human insulin) 5-8 H
Aspart 3-5 H
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29
Q

Name the basal insulins and their duration

A 
Nancy Does Good Deeds
NPH (human) 12 H
Detemir 24 H
Glargine 24 H
Degludec 42 H
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30
Q

What’s recommended if HF or CKD predominates?

A

1st- SGLT2 i

2nd- GLP-1

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31
Q

IF pt has HF what should be avoided?

A

TZD

NO saxagliptin

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32
Q

When does CKD predominate?

A

UACR >30 or esp >300

eGFR 30-60

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33
Q

When does HF predominate?

A

HFrEF (LVEF<45%)

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34
Q

When does ASCVD predominate?

A

age >55 w/ coronary, carotid, or lower extremity artery stenosis >50%

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35
Q

What’s recommended if ASCVD predominates?

A
  1. GLP-1 RA

2. SGLT2i

36
Q

What insulins have demonstrated CVD safety

A

Degludec

U100 glargine

37
Q

Which SGLTi2 are most effective?

A

canagliflozin
empagliflozin
dapagliflozin

38
Q

What meds are good if you need to minimize hypo risk?

A
  • Metformin
  • Dpp-4
  • GLP-1
  • SGLT2i
  • TZD
39
Q

What meds are good if you need to minimize risk of wt gain? or promote wt loss?

A
  • Metformin
  • GLP-1 RA
  • SGLT2-I
  • then DPP-4i
40
Q

If cost is a major barrier, recommend:

A
  • Metformin
  • SU
  • TZD
41
Q

Which GLP-1 is best?

A

Semaglutide –> Liraglutide –> dulaglutide –> exenatide –> lixisenatide

42
Q

What should be considered before insulin in T2DM?

A

GLP-1 RA

43
Q

What to do w/ insulin if hypoglycemia occurs?

A
  • try to determine cause

- lower dose by 10-20%

44
Q

In T2DM, how to start basal insulin

A

10 U/day

0.1-0.2 IU/kg/d

45
Q

When to start prandial insulin in T2DM

A

reached basal dose >0.5 IU/kg

if A1c is above target but fasting goal is met

46
Q

How to start prandial insulin in T2DM

A
  • 4 IU/day or 10% of basal at largest meal
  • if A1c <8%, can lower basal by 4 IU or 10%
  • titrate by increase dose 1-2 IU or 10-15% twice weekly
47
Q

If wanting to switch from bed time NPH to 2x/day NPH

A
  • decrease total dose to 80%

- 2/3 AM, 1/3 PM

48
Q

When should insulin be considered in T2DM right away?

A
  • s/s catabolism
  • A1c >10%
  • BG >/=300
  • T1DM v. T2DM is being ?
49
Q

T1DM insulin recommendations

A
  • multiple prandial + basal or pump
  • rapid acting insulin analog to reduce hypo risk
  • match prandial insulin dose to CHO intake, pre-prandial BG and predicted PA
50
Q

DCCT of 7% reduce microvascular complications by ____%

A

50

51
Q

What are human insulins

A

Regular (short acting)- Humulin/novolin R’s
NPH (intermediate) Humlin N, Novolin N
Premix 70/30 (Humulin 70/30 or Novolin 70/30)

52
Q

Timing

T1DM

A

Basal- longer duration, more consistent plasma concentration

Rapid acting quicker onset and peak, shorter duration v. human insulin

53
Q

proper storage of insulin

A
  • no extreme heat/cold
  • never in freezer, direct sunlight, glovebox
  • never expired
  • open- can be stored at room temp; usually good for 28 days
  • unopened- in fridge
54
Q

T1DM insulin recs

A

50% basal, 50% bolus
based on wt in kg
0.4-1 u/kg/day
higher during puberty, illness, pregnancy

55
Q

what does basal insulin do

A

regulate overnight, fasting BG

56
Q

what does bolus insulin do

A

regulate postprandial BG

CHO counting can help with this

57
Q

where to inject insulin

A

abdomen
thigh
butt
upper arm

58
Q

how to inject insulin

A
  • rotate sites to avoid lipohypertrophy (accumulation of subq fat)
  • NOT in muscle
  • use short needle 4 mm
59
Q

If someone w/ T1DM used SGLT2 i what could happen?

A

2-4x increase risk of DKA

small improvement in A1c/weight when used with insulin

60
Q

What is pramlinitide

A
  • only FDA approved oral med for T1DM
  • reduce A1c by 0-0.3%
  • reduce wt 1-2 kg
61
Q

When should pancreas islet transplantation be considered?

A
  • total pancrectomy
  • renal transplant
  • recurrent DKA
  • severe HYPO, ongoing
62
Q

Why is pancreas islet transplant seldom used?

A
  • need to be on immunosuppressive tx for life

- CGM’s and closed loop pump-sensor systems are available

63
Q

Why would pancreas islet transplant even be considered?

A

can normalize BG

reduce microvascular complications

64
Q

In T2DM, how long should Metformin be used for?

A
  • as long as tolerated, not contraindicated

- can be used along w/ insulin

65
Q

when choosing oral meds for T2DM what should be considered?

A
  • pt preference
  • risk of hypo
  • CVD comorbidities
  • impact on wt
  • cost
  • side effects
66
Q

how often to re-evaluate meds regimen in T2DM

A

q 3-6 months

67
Q

When should metformin be started?

A

At time of T2DM dx

68
Q

how long is monotherapy effective in T2DM

A

usually only a few years before additional tx needed

69
Q

Each new med added to Metformin lowers HgbA1c by?

A

0.7-1%

70
Q

Which GLP-1 is available in oral medication form? What’s the s/s?

A 
Oral semaglutide
robust WL
lower risk of hypo
increase GI side effects
\$\$\$\$\$\$\$\$\$\$\$\$
71
Q

goal of basal insulin in T2DM

A
  • restrain hepatic GLU production

- limit HYPER overnight & b/w meals

72
Q

How to reduce risk of HYPO overnight w/ T2DM on insulin

A

Long-acting analog instead of NPH

73
Q

A person w/ T2DM on insulin may benefit from NPH & regular human insulin when

A
  • relax A1C goal
  • low rates of HYPO
  • significant insulin resistance
  • cost concerns
74
Q

When to use concentrated insulin in T2DM

A
  • high insulin resistance
75
Q

U500 is x times more concentrated than U100

A

5x

]*has a special tiny syringe that MUST be used

76
Q

a 3 mL pen of U500 has how many units of insulin? how long is it good for?

A

1,500 units

3 days

77
Q

a 20 mL vial of U500 has how many units of insulin? good for how long?

A

10,000 units

good for 40 days

78
Q

What is benefit of GLP-1 over basal insulin in T2DM?

A

less hypo, less wt gain

79
Q

combination injectable therapy

what is it?

A

insulin glargine + lixisenatide

insulin degludec + liraglutide

80
Q

what is nasal glucagon
who can use it
how much does it raise BG

A

Basquimi
age 4+
nasally absorbed
67-73 pt rise

81
Q 
glucagon
who is it approved for
how much does it raise BG
how is it administered
what are the types
A

age 2+
20-30 pts and it’s short lived; need CHO immediately after
subq
Gvoke pre-filled syrings or Gvoke hypo pen

82
Q

how to dose glucagon injection

A

adults and kids 2-12 who are >/=45 kg take 1 mg

kids 2-12 <45 kg take 0.5 mg

83
Q

Glucagon emergency kit
approved for what ages
how to dose
how to administer

A 
all ages
adults- 1 mg
kids <6 or <25 kg- 0.5 mg
kids >/= 6 or >25 kg- 1 mg
subq or IM
MUST mix the glucagon powder with filled syringe to reconstitute it
84
Q

How much do Initial meds reduce A1c

A

O.5-2%

85
Q

Each new added class of meds has what effect on A1C

A

0.7-1%

CDCES (13 decks)

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