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DCES exam 2021 > Misc > Flashcards

Misc Flashcards

1
Q

Which DM meds may cause weight gain?

A

Insulin
SU
TZD

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2
Q

Which DM meds may cause low blood glucose?

A

Sulfonylureas

Insulin

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3
Q

Which DM meds usually don’t cause low blood glucose?

A 
Biguanides
DPP-4 inhibitors
GLP-1 receptors 
SGLT inhibitors 
Alpha glucosidase inhibitors 
Thiazolidinediones
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4
Q

Which medications may cause hyperglycemia?

A

Corticosteroids, hormones, protease inhibitor, diuretics, beta blockers, statins, transplant immunosuppressants, niacin, atypical antipsychotics (clozapine, risperidone,olanzapine, quetiapine)

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5
Q

How does biguanide (Metformin) work?

A

Decreases hepatic glucose production, increases insulin sensitivity

*may improve lipid profile

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6
Q

How much A1c reduction can be expected with biguanide (metformin)?

A

1-2%

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7
Q

What are the contraindications for biguanide (metformin)?

A

Serum creatinine >1.5 (male) or >1.4 (female), acidosis (acute or chronic), hepatic dysfunction, excessive ETOH, DM1, DKA

Do not initiate if GFR is between 30-45, reduce to 1000 mg if taking

Contraindication of GFR < 30

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8
Q

Side effects of biguanide (metformin)?

A

Wt loss, N/V, epigastric pain, bloating, gas

XL can minimize side effects
Taking with food will help limit GI side effects

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9
Q

What is the max daily dose of metformin?

A

2550 mg/day (liquid or pill form)

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10
Q

How should metformin be initiated?

A

250 (children) -500 (adults) mg daily, titrate up every 1-2 weeks

Prescribed once or twice a day, should be taken with first bite of meal

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11
Q

What medications are SU, and how should they be taken?

A

Glyburide
Glipizide
Glimepiride

  • all renally cleared, caution w/ irregular eating pattern
  • taken once of twice daily with or just before meals
  • pill only
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12
Q

How do SUs work?

A

Increase release of insulin from the pancreas

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13
Q

How much A1c reduction can be expected from SU?

A

1-2%

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14
Q

What are the contraindications for SU?

A

Type 1 DM, DKA

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15
Q

What are the side effects of SUs?

A

Hypoglycemia, weight gain

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16
Q

What medications are Dipeptidyl Peptidase-4 Inhibitors (DPP 4 inhibitors)

A

Sitagliptin, Saxagliptin, Linagliptin

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17
Q

How do Dipeptidyl Peptidase-4 Inhibitors (DPP 4 inhibitors) work?

A

Inhibits breakdown of incretin and glucagon like peptide 1 (GLP-1). This reduces glucagon secretion, slows gastric emptying time and promotes satiety

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18
Q

What are the side effects associated with Dipeptidyl Peptidase-4 Inhibitors (DPP 4 inhibitors)?

A

pancreatitis, pulmonary infections

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19
Q

When are SLGT-2 inhibitors typically used in a pt’s treatment regimen?

A

2nd or 3rd line options after metformin, diet, and exercise (as an oral option)

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20
Q

Which medications are Sodium Glucose Co Transporter 2 Inhibitors (SGLT2 inhibitors) and how are they taken?

A

Canagliflozin, dapagliflozin, ertugliflozin, empaglifozin

*All day medication. Taken with or without food. Rec to take first thing in AM bc they cause urinary frequency

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21
Q

How do Sodium Glucose Co Transporter 2 Inhibitors (SGLT2 inhibitors) work?

A

Reduces reabsorption of glucose in the kidney, lowers renal threshold for glucose excretion

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22
Q

Which conditions are contraindicated with Sodium Glucose Co Transporter 2 Inhibitors (SGLT2 inhibitors)?

A

Severe renal impairment, dialysis, DM1, DKA, UTIs, genital infections

23
Q

Which medication are GLP-1 agonists and how are they given?

A

Exenatide, liraglutide, dulaglutide

*Only used in DM2. Available in injection pen form. Should be discarded 30 days after use. Daily or weekly injections available

24
Q

How do GLP-1 agonists work?

A

Increases glucose dependent insulin secretion, reduces glucagon secretion, slows gastric emptying time, promotes satiety

25
Q

Which conditions are contraindicated with GLP-1 agonists?

A

Medullary thyroid carcinoma, multiple endocrine neoplasia syndrome

26
Q

What are the side effects of GLP-1 agonists?

A

Pancreatits, ARF, N/V/D, weight loss (3-4 kg), injection site redness, retinopathy progression

27
Q

Which medications are Thiazolidinediones?

A

Pioglitazone (15-45 mg) rosiglitazone (2-8 mg)

28
Q

How do Thiazolidinediones work?

A

Improve insulin sensitivity, decreases free fatty acids

29
Q

When are Thiazolidinediones contraindicated?

A

NYHA class III/IV HF, acute liver disease (transaminase should be checked periodically), bladder CA, DM1, DKA

30
Q

What are the side effects of Thiazolidinediones?

A

weight gain, fluid retention, bone fracture, hepatic impairment

31
Q

Which medications are Alpha Glucosidase (AG) Inhibitors and how should they be taken?

A

Acarbose, miglitol, voglibose

*25 mg TID with first bite of each main meal. Tolerance until maintenance dose of 50-100 mg/day. Adjunct to diet/exercise in DM2.

32
Q

How do Alpha Glucosidase (AG) Inhibitors work?

A

Inhibitor of pancreatic alpha amylase and intestinal brush border alpha glucosidases, causes delayed absorption of CHO and glucose from GI tract

33
Q

What are the contraindications with Alpha Glucosidase (AG) Inhibitors?

A

DKA, cirrhosis, IBD, colonic ulceration, intestinal obstruction,

34
Q

What are the side effects associated with Alpha Glucosidase (AG) Inhibitors?

A

flatulence (tolerance occurs over time), diarrhea, abd pain

35
Q

Which medication used to treat DM2 is a bile acid sequestrant and how is it taken?

A

Colesevelam

  • Administer with meals and a liquid. Large tablet size
36
Q

How does Colesevelam work in DM2?

A

Binds acids in intestine to eliminate cholesterol and lipids. Actions for DM management unknown

37
Q

What are contraindications associated with Colesevelam?

A

Gastroparesis, severe GI motility disorders, h/o major GI tract surgery or bowel obstruction

38
Q

What are some side effects associated with Colesevelam?

A

N/D/C, HA, fatigue, GI reflux hyper or hypoglycemia

39
Q

Which medication is an Amylinomimetic and how is it taken?

A

Pramlintide

*Used in both DM1 and DM2 when takin insulin
Initial dose for DM2 is 60 mcg, titrated upwards as tolerated to 120 mcg w/ each meal over 250 kcals per meal. Does not induce hypoglycemia by itself but can have profound use w/ insulin

40
Q

How does does an Amylinomimetic (Pramlintide) work?

A

Amylin affects glucose control through several mechanisms: slowed gastric emptying, regulation of post prandial glucagon, reduction of food intake

41
Q

What is the main side effect associated with Amylinomimetic (Pramlintide) and how can it be minimized?

A

Nausea (generally resolved by 4 weeks). Can be minimized by slow upward titration and is less common in pt’s with DM2

42
Q

Which medication is a dopamine agonist?

A

Bromocriptine

43
Q

How does a dopamine agonist (Bromocriptine) work?

A

Mechanisms unknown for how it reduces BG

44
Q

When is a dopamine agonist (Bromocriptine) contraindicated?

A

DKA prone, migraines, DM1, breastfeeding

45
Q

Which medications are Meglinides?

A

repaglinide, nateglinide

46
Q

What are the side effects of Meglinides (repaglinide, nateglinide)

A

hypoglycemia, weight gain

47
Q

When should blood glucose be reviewed to see if metformin is effective?

A

Fasting-liver releases most glucose in early morning hours

48
Q

What is considered a safe oral supplement for DM patients?

A

Alpha lipoic acid (ALA), also known as thioctic acid. May help those with diabetic neuropathy, has a low side effect profile

49
Q

When should the first follow up be conducted after initial session on taking oral meds?

A

2-4 weeks; f/u at 3-6 month intervals thereafter

50
Q

How long do TZDs take to achieve max effect?

A

~8-12 weeks to achieve max effect.

51
Q

True or false: TZDs may improve lipid profile

A

True

52
Q

For a pt taking, an alpha glucosidase inhibitor how is hypoglycemia treated?

A

Hypoglycemia must be treated with glucagon or dextrose

53
Q

How do Meglinides (repaglinide, nateglinide) work and how should they be taken?

A

Increase release of insulin from pancreas
*take BEFORE meals. When no meal is eaten do NOT take medication (skip med). Caution w/ renal impairment, esp repaglinide

DCES exam 2021 (35 decks)

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