Non-insulin agents

Question 1

metformin class

Answer 1

biguanide

Question 2

metformin MOA

Answer 2

decrease hepatic glucose production, improve insulin sensitivity, decrease intestinal absorption of glucose

Question 3

name the sulfonylureas

Answer 3

glipizide, glyburide, glimepiride

Question 4

sulfonylurea MOA

Answer 4

stimulate pancreatic beta cells to secrete insulin

Question 5

name the meglitinides

Answer 5

repaglinide, nateglinide

Question 6

meglitinide MOA

Answer 6

stimulates pancreatic beta cells to secrete insulin

Question 7

name the thiazolidinediones (TZDs)

Answer 7

pioglitazone, rosiglitazone

Question 8

TZD MOA

Answer 8

insulin sensitizers: improve glucose uptake in muscle and fat, selective agonist for PPAR gamma, decrease hepatic glucose output, inhibit lipolysis, preserve beta cell function

Question 9

name the GLP-1s

Answer 9

semaglutide, dulaglutide, exenatide, liraglutide, lixisenatide

Question 10

GLP-1 MOA

Answer 10

increases glucose dependent insulin secretion, slows gastric emptying, promotes satiety, decreases glucagon secretion

Question 11

name the DPP-4i

Answer 11

sitagliptin, saxagliptin, linagliptin, alogliptin

Question 12

DPP-4i MOA

Answer 12

enhances levels of GLP-1 and other incretin hormones, stimulates glucose-dependent insulin synthesis and secretion and suppresses glucagon

Question 13

name the SGLT-2is

Answer 13

canagliflozin, empagliflozin, dapagliflozin, ertigliflozin

Question 14

SGLT-2i MOA

Answer 14

reduces urinary glucose reabsorption and increases urinary glucose excretion

Question 15

name the alpha glucosidase inhibitors

Answer 15

acarbose, miglitol

Question 16

alpha glucosidase inhibitor MOA

Answer 16

inhibits maltase, isomaltase, sucrase, and glucoamylase in the small intestine, delaying breakdown of starches and certain sugars, decreases post-prandial glucose peak

Question 17

name the bile acid sequestrant

Answer 17

colesevelam

Question 18

bile acid sequestrant MOA

Answer 18

binds bile acids in the intestines, MOA regarding glucose control not known

Question 19

name the dopamine agonist

Answer 19

bromocriptine mesylate

Question 20

dopamine agonist MOA

Answer 20

affects circadian rhythm and leads to increased insulin sensitivity and glucose disposal

Question 21

name the amylin mimetic

Answer 21

pramlintide

Question 22

amylin mimetic MOA

Answer 22

slows gastric emptying, suppresses glucagon, promotes satiety

Question 23

metformin side effects

Answer 23

GI– diarrhea, abdominal discomfort, stomach upset
metallic taste
vitamin b12 deficiency
lactic acidosis

Question 24

sulfonylurea side effects

Answer 24

hypoglycemia, weight gain

Question 25

meglitinides side effects

Answer 25

hypoglycemia, weight gain

Question 26

TZD side effects

Answer 26

weight gain (water weight), edema, new onset/worsening HF, increased fracture risk in upper/lower limbs of postmenopausal women, increased risk bladder cancer and macular edema

Question 27

GLP-1 side effects

Answer 27

n/v/d decreased appetite risk of thyroid c cell tumors assoc with cases of acute pancreatitis case reports of AKI or worsening renal function

Question 28

DPP-4 side effects

Answer 28

generally well tolerated, assoc. with cases of acute pancreatitis, increased hospitalization for heart failure, bullous pemphigoid requiring hospitalization, arthralgias

Question 29

SGLT-2i side effects

Answer 29

genital mycotic infections, UTIs, increased urination, increased risk of necrotizing fasciitis of the perineum (fournier's gangrene), hypotension, dehydration (increased risk AKI, syncopem, falls), euglycemic DKA canagliflozin-- increased risk of bone fracture

Question 30

alpha glucosidase inhibitor side effects

Answer 30

flatulence, diarrhea, abdominal pain, bloating

Question 31

bile acid sequestrant side effects

Answer 31

constipation, dyspepsia, nausea

Question 32

dopamine agonist side effects

Answer 32

nausea, fatigue, headache, vomiting, hallucinations, somnolence (think CNS effects)

Question 33

amylin mimetic side effects

Answer 33

nausea, anorexia, vomiting, fatigue, abdominal pain, dizziness

Question 34

metformin counseling points

Answer 34

take with first bite of meal to prevent GI side effects, titration

Question 35

metformin dosing

Answer 35

IR 500-1000 mg BID titrate slowly to 1000 mg BID XR 500-2000 mg once or twice daily

Question 36

metformin renal considerations

Answer 36

contraindicated when eGFR<30 do not start with eGFR 30-45 reduce dose if eGFR<45

Question 37

metformin advantages

Answer 37

minimal hypoglycemia risk, does not cause weight gain, may cause modest weight loss, decreases triglycerides & LDL, increases HDL, A1c reduction 1-2%

Question 38

the hypoglycemic action of sulfonylureas can be potentiated by what drugs

Answer 38

NSAIDs, clarithromycin, salicylates, sulfonamides, chloramphenicol, coumarins, probenecid, MAOi, beta blockers

Question 39

avoid what class/use with caution in older adults

Answer 39

sulfonylureas

Question 40

meglitinides counseling

Answer 40

take it when you are eating! if not eating, don't take it

Question 41

meglitinides renal considerations

Answer 41

can be used in renal insufficiency

Question 42

coadministration of what drugs with meglitinides increases risk of hypoglycemia

Answer 42

clopidogrel, cyclosporine, gemfibrozil, ketoconazole

Question 43

TZD contraindications

Answer 43

NYHA Class III-IV HF

Question 44

do not use GLP-1 agonists with what class

Answer 44

DPP-4

Question 45

when to avoid GLP-1

Answer 45

family history of medullary thyroid carcinoma, gastroparesis, people on DPP-4

Question 46

counseling for SGLT-2

Answer 46

drink plenty of water, use good hygiene, stop 72 hours before surgery

Question 47

when to avoid alpha glucosidase inhibitors

Answer 47

SCr>2 CrCL<25

Question 48

counseling point for alpha glucosidase inhibitors

Answer 48

use glucose tabs or milk to treat hypoglycemia (sucrose not effective) skip the dose if not eating

Question 49

when are alpha glucosidase inhibitors contraindicated

Answer 49

any type of bowel disease

Question 50

acarbose may increase ____ levels, which is dose related

Answer 50

liver transaminase

Question 51

who should not receive bile acid sequestrants

Answer 51

patients with history of bowel obstruction, serum triglyceride >500, history of pancreatitis

Question 52

counseling points for bile acid sequestrants

Answer 52

may decrease absorption of fat soluble vitamins and other drugs, administer other drugs at least 4 hours prior

Question 53

dopamine agonist counseling points

Answer 53

take within 2 hours after waking in the morning, with food

Question 54

do not use dopamine agonists in _____

Answer 54

patients with severe psychotic disorders

Question 55

dopamine agonist drug interactions

Answer 55

CYP3A4 inhibitors

Question 56

amylin mimetic should only be used in ____

Answer 56

patients using mealtime insulin

Question 57

avoid amylin mimetics in ____

Answer 57

people with hypoglycemic unawareness, gastroparesis

Question 58

amylin mimetics cause weight ____

Answer 58

gain