Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

T2DM > Medications in Patients at High Cardiovascular Risk > Flashcards

Medications in Patients at High Cardiovascular Risk Flashcards

1
Q

What are two adverse effects of sulfonylureas?

A

Weight gain and hypoglycemia

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

What are some adverse effects of thiazolidinedione (glitazones)?

A

Weight gain, fluid retention, and exacerbation of heart failure.

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

Which glucose-lowering medications are associated with weight gain?

A

Thiazolidinediones, sulfonylureas, and insulin are glucose-lowering medications associated with weight gain.

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

What is the evidence on the effects of third-generation sulfonylureas on cardiovascular mortality?

A

There is no evidence to evaluate the effects of third-generation sulfonylureas on cardiovascular mortality.

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

Are first- and second-generation sulfonylureas associated with increased cardiovascular mortality?

A

Yes, first- and second-generation sulfonylureas may be associated with increased cardiovascular mortality.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In adults with type 2 diabetes and high cardiovascular risk, how does linagliptin compare to glimepiride in terms of long-term cardiovascular risk and risk of hypoglycemia?

A

Linagliptin has similar long-term risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke compared to glimepiride, and decreased risk of hypoglycemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which medication, linagliptin or glimepiride, has decreased risk of hypoglycemia in adults with type 2 diabetes and high cardiovascular risk?

A

Linagliptin has decreased risk of hypoglycemia.

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

What is the effect of pioglitazone on the risk of major adverse cardiovascular events in patients with type 2 diabetes?

A

Pioglitazone may decrease the risk of major adverse cardiovascular events in patients with type 2 diabetes.

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

What is the potential risk associated with pioglitazone use in patients with type 2 diabetes?

A

Pioglitazone may increase the risk of heart failure in patients with type 2 diabetes.

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

Does saxagliptin decrease the risk of cardiovascular events in patients with diabetes and a history of cardiovascular disease or cardiovascular risk factors?

A

No, saxagliptin does not decrease the risk of cardiovascular events in patients with diabetes and a history of cardiovascular disease or cardiovascular risk factors.

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

What is the effect of saxagliptin on the risk of hospitalization for heart failure?

A

Saxagliptin appears to increase the risk of hospitalization for heart failure.
+ ALOGLIPTIN

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

Do DPP-4 inhibitors reduce rates of all-cause or cardiovascular death, myocardial infarction, and stroke in adults with cardiovascular disease and diabetes?

A

No, DPP-4 inhibitors may not reduce rates of all-cause or cardiovascular death, myocardial infarction, and stroke in adults with cardiovascular disease and diabetes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the potential effect of DPP-4 inhibitors in adults with cardiovascular disease and diabetes?

A

DPP-4 inhibitors may not reduce rates of all-cause or cardiovascular death, myocardial infarction, and stroke in adults with cardiovascular disease and diabetes.

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

What is the potential benefit of metformin as initial treatment for adults with overweight and type 2 diabetes?

A

Metformin as initial treatment may reduce mortality and risk of myocardial infarction.

BUT AS ADD ON : NOT EFFECTIVE

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

What is the expanded FDA approval for semaglutide (Ozempic)?

A

Semaglutide (Ozempic) receives expanded FDA approval to reduce risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes and established cardiovascular disease.

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

What are the major adverse cardiovascular events (MACE) that semaglutide (Ozempic) is approved to reduce risk of?

A

Semaglutide (Ozempic) is approved to reduce the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke in adults with type 2 diabetes and established cardiovascular disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Do GLP-1 receptor agonists reduce all-cause mortality in adults with cardiovascular disease and diabetes?

A

Yes, GLP-1 receptor agonists decrease all-cause mortality in adults with cardiovascular disease and diabetes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the indication for sotagliflozin (Inpefa)?

A

Sotagliflozin (Inpefa) is indicated to reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits in adults with heart failure or type 2 diabetes, chronic kidney disease, and other cardiovascular risk factors (FDA Label 2023 May)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Does empagliflozin improve all-cause mortality in patients with type 2 diabetes and low to medium cardiovascular risk?

A

No, empagliflozin does not improve all-cause mortality in patients with type 2 diabetes and low to medium cardiovascular risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the potential benefit of empagliflozin in patients with type 2 diabetes and low to medium cardiovascular risk?

A

Empagliflozin might improve the composite of cardiovascular outcomes in patients with type 2 diabetes and low to medium cardiovascular risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the effect of empagliflozin on heart failure and renal adverse events in patients with heart failure with reduced ejection fraction?

A

Empagliflozin reduces the risk of hospitalization for worsening heart failure and renal adverse events regardless of diabetes status in adults with heart failure with reduced ejection fraction receiving recommended heart failure therapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Who benefits from the use of empagliflozin in patients with heart failure with reduced ejection fraction?

A

Adults with heart failure with reduced ejection fraction receiving recommended heart failure therapy benefit from the use of empagliflozin, regardless of diabetes status.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the effect of dapagliflozin on major adverse cardiovascular events (MACE) in patients with type 2 diabetes and cardiovascular disease?

A

dapagliflozin may not reduce MACE in patients with type 2 diabetes and cardiovascular disease.

24
Q

What are the potential benefits of dapagliflozin for patients with type 2 diabetes and cardiovascular disease?

A

Dapagliflozin may slightly reduce hospitalization for heart failure and renal adverse events in patients with type 2 diabetes and cardiovascular disease.

25
Q

What are the potential risks associated with canagliflozin?

A

The potential risks associated with canagliflozin include increased risk of amputation, fracture, and genital infection.

26
Q

What are the potential benefits of canagliflozin in patients with type 2 diabetes at high cardiovascular risk?

A

Canagliflozin may reduce cardiovascular events and progression of albuminuria in adults with type 2 diabetes at elevated risk of cardiovascular disease.

27
Q

Which type of diabetes are SGLT2 inhibitors associated with a lower rate of hospitalization for heart failure? COMPARED TO GLP1I??

A

SGLT2 inhibitors are associated with a lower rate of hospitalization for heart failure in adults with type 2 diabetes.

28
Q

What is the relative reduction in all-cause death with SGLT2 inhibitors?

A

The relative reduction in all-cause death with SGLT2 inhibitors is about 13%-15%.

29
Q

What is the relative reduction in hospitalization for heart failure with SGLT2 inhibitors?

A

The relative reduction in hospitalization for heart failure with SGLT2 inhibitors is about 30%.

30
Q

Which medication should be avoided in patients with high risk of heart failure and type 2 diabetes mellitus?

A

Saxagliptin should be avoided.

31
Q

What are the indicators of high ASCVD risk?

A

The indicators of high ASCVD risk include age ≥ 55 years old with coronary, lower-extremity, or carotid artery stenosis > 50% or with left ventricular hypertrophy heart failure established kidney disease.

32
Q

What is the cutoff age for indicating high ASCVD risk?

A

The cutoff age for indicating high ASCVD risk is ≥ 55 years old.

33
Q

In which patients with stable heart failure can metformin be continued for glucose lowering?

A

Metformin may be continued for glucose lowering in patients with stable heart failure if their estimated glomerular filtration rate is greater than 30 mL/minute/1.73m^2.

34
Q

What type of medication is preferred as a second-line agent for patients with high risk of or coexisting heart failure?

A

SGLT2 inhibitors with evidence of reducing heart failure progression are preferred second-line agents.

35
Q

What type of medication can be added as a second-line agent if the patient does not tolerate or has contraindications to SGLT2 inhibitors or if estimated GFR is not adequate?

A

GLP-1 receptor agonist with proven cardiovascular disease benefit can be added as a second-line agent.

36
Q

In which patient population are SGLT2 inhibitors with evidence of reducing heart failure progression preferred as second-line agents?

A

SGLT2 inhibitors with evidence of reducing heart failure progression are preferred second-line agents for patients with high risk of or coexisting heart failure (particularly if left ventricular ejection fraction < 45%) or chronic kidney disease.

37
Q

What is the preferred first-line pharmacologic agent for treatment of type 2 diabetes?

A

Metformin is the preferred first-line pharmacologic agent for treatment of type 2 diabetes.

38
Q

What medications should be given as part of the glucose-lowering regimen in patients with type 2 diabetes and atherosclerotic cardiovascular disease?

A

A glucagon-like peptide-1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor with demonstrated cardiovascular disease benefit should be given as part of the glucose-lowering regimen.

39
Q

When should metformin be continued as part of the treatment for type 2 diabetes?

A

Metformin should be continued as long as tolerated and not contraindicated in the treatment of type 2 diabetes.

40
Q

What are some potential effects of metformin?

A

Metformin has been reported to decrease triglycerides, total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B, while increasing high-density lipoprotein cholesterol. It may also result in weight loss and modulate endothelial function and oxidative stress.

41
Q

What are some reported benefits of GLP-1 receptor agonists?

A

GLP-1 receptor agonists are reported to improve lipids, reduce blood pressure, and reduce body weight.

42
Q

What are the possible mechanisms that may underlie the cardiovascular benefits of SGLT2 inhibitors?

A

The possible mechanisms that may underlie the cardiovascular benefits of SGLT2 inhibitors include improved endothelial function, decrease in arterial stiffness, decrease in body weight, nephron remodeling, reduced arterial pressure, reduced arterial stiffness, increased ketone bodies, increased glucagon secretion, and inhibition of sodium/hydrogen exchanger in cardiac muscle.

43
Q

How do SGLT2 inhibitors affect blood pressure?

A

SGLT2 inhibitors may affect blood pressure through diuretic effects, improved endothelial function, decreased arterial stiffness, decreased body weight, and nephron remodeling.

44
Q

What are the effects of SGLT2 inhibitors on plasma volume and cardiac preload?

A

SGLT2 inhibitors reduce plasma volume and cardiac preload through natriuresis and glycosuria.

45
Q

By how much can SGLT2 inhibitors decrease systolic blood pressure?

A

SGLT2 inhibitors can decrease systolic blood pressure by about 4-6 mm Hg.

46
Q

What is the typical decrease in diastolic blood pressure seen with SGLT2 inhibitors?

A

The typical decrease in diastolic blood pressure with SGLT2 inhibitors is about 1-2 mm Hg.

47
Q

What is the recommendation for insulin-based glycemic control in patients with acute coronary syndromes and hyperglycemia?

A

It is recommended to consider insulin-based glycemic control in patients with acute coronary syndromes and hyperglycemia (> 180 mg/dL [> 10 mmol/L]) using target range based on comorbidities (Weak recommendation).

48
Q

What is the recommendation for patients on metformin plus a GLP-1 receptor agonist or SGLT2 inhibitor who are not at HbA1c goal?

A

Consider adding the other class (GLP-1 receptor agonist or SGLT2 inhibitor) with a proven cardiovascular benefit.

49
Q

What is the uncertainty regarding the cardiovascular effects of combining GLP-1 receptor agonists and SGLT2 inhibitors?

A

The cardiovascular effects of combining these two classes are uncertain.

50
Q

What is the glycemic benefit of combining GLP-1 receptor agonists and SGLT2 inhibitors?

A

Combining GLP-1 receptor agonists and SGLT2 inhibitors provides a glycemic benefit.

51
Q

What is the definition of high-risk patients in terms of diabetes duration and target organ damage?

A

High-risk patients refer to those with diabetes mellitus of duration ≥ 10 years without target organ damage, but with any other additional risk factor.

52
Q

What is the definition of moderate-risk patients in terms of age, diabetes duration, and other risk factors?

A

Moderate-risk patients include younger patients (< 35 years old with type 1 diabetes or < 50 years old with type 2 diabetes) with diabetes of duration < 10 years and without other risk factors.

53
Q

What are the criteria for categorizing patients as high-risk or moderate-risk in terms of cardiovascular risk?

A

The criteria for categorizing patients as high-risk include diabetes mellitus of duration ≥ 10 years without target organ damage, but with any other additional risk factor. The criteria for categorizing patients as moderate-risk include younger patients (< 35 years old with type 1 diabetes or < 50 years old with type 2 diabetes) with diabetes of duration < 10 years and without other risk factors.

54
Q

What are the criteria for patients at very-high risk?

A

Patients with established cardiovascular disease target organ damage, early onset type 1 diabetes mellitus of duration > 20 years, or ≥ 3 major risk factors (including age, hypertension, dyslipidemia, obesity, and smoking).

55
Q

What are examples of target organ damage in patients at very-high risk?

A

Examples of target organ damage in patients at very-high risk include left ventricular hypertrophy, proteinuria, renal impairment, or retinopathy.

T2DM (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions