Brainscape's Knowledge GenomeTM

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


See full index

Therapeutics 2 Drugs - Fall 2018 > Non- Insulin medications > Flashcards

Non- Insulin medications Flashcards

1
Q

Mechanism of action of Metformin

A
  • Improves insulin sensitivity
  • Increases tissue uptake and utilization of glucose by muscle
  • Decreases hepatic production of glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical applications of Metformin

A
  • T2DM adject therapy

- Use for all type 2 DM patients if tolerated and not contraindicated

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

First line therapy for adjuctive therapy for type 2 DM

A

Metformin

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

A1C change in Metformin

A

Decrease by 1.5-2%

usually seen within the first 3 months of treatment

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

Does Metformin target the FBG or PPG? What is the change?

A

FBG: decrease 60-80mg/dL

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

How is Metformin eliminated in the body?

A

Excreted unchanged in the urine

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

Advantages of Metformin (8)

A

Less risk of hypoglycemia due to no insulin release

Benefit on lipids: ↓ TG and LDL by 8-15%

No weight gain or even weight loss (2-3 kg)

Cost-effective

↑ fibrinolysis = CV protection

Has been shown to ↓ macrovascular complications and the risk of total mortality in clinical trials

↓ risk of stroke and all-cause mortality when compared to insulin and sulfonylureas

↓ diabetes-related death and myocardial infarctions vs. conventional treatment in UKPDS trial

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

Metformin Disadvantages

A

May cause lactic acidosis (LA)–> Rare

Current studies point to a weak causal relationship between metformin and lactic acidosis

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

Contraindications of Metformin

A 
Contraindicated in HF pts that are class III and IV:
Patients that are class I or II HF can use metformin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Alcoholics and Metformin

A

Watch excessive intake and avoid use with heavy intake

Increased risk of LA in these patients

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

Lactic Acidosis and Metformin Use

A

Avoid use in these pts:

  • post MI
  • COPD exacerbation
  • Hepatic Failure
  • Shock
  • Surgery
  • Stop metformin when patients are admitted to the hospital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Side effects of Metformin

A

GI effects- diahrrea, fatulence, nausea, and vomitting
- Take with a large meal to help
start with a low dose and titrate up

Vitamin B12 malabsorbtion or deficency

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

Dosing Metformin

A

Initial dose- 500mg BID (can start at pod) with meals

Titrate dose weekly and increase by 250-500mg

Max dose 2gm/d

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

Dosing Metformin in Renal Deficiency

A 
>60- monitor SCr 
60-45- Continue use but monitor SCr 3-6 months
45-30- Do not start Metformin 
If already on, reduce dose by 50%
<30- DO NOT USE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name the GLP-1 agonists

A 
Liraglutide (Victoza)
Dulaglutide (Trulicity)
Semaglutide (Ozempic)
Exenatide (Byetta, Bydureon)
Lixisenatide (Adylyxin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mechanism of Action of GLP-1 agonists

A

-Stimulating Beta-cell growth and differentiation and insulin gene expression
-Will only increase insulin release when elevated glucose levels present
-Has been shown to inhibit Beta-cell death
Inhibits glucagon secretion, delays gastric emptying, and decreases appetite
o Decrease glucose production by the liver
o Not absorbing the glucose as quickly
o Increases satiety

  • GLP-1 agonist medications are resistant to DPP-IV
  • Increases in both first and second-phase insulin secretion after meals occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A1C changes with GPL-1 agonists

A

Decrease in A1C by 0.7-1.6%

18
Q

Do GLP-1 agonists target FBG, PPG, or both? What is the change?

A

Long acting GLPs- target FBG

Short acting GLPs- target PPG

19
Q

Weight changes with GLP-1s

A

Weight loss!!

1.5-3kg (10lb after 2 years)

20
Q

Adverse Effects

A

Nauses and Vomiting- very problematic titrate dose up
Symptoms decrease in 4-8 weeks
Hypoglycemia when used in combination with other products
Acute Pancreatitis (do not use if pt has history of pancratitis_

Black box warning for Thyroid cancer (mostly for pts with hx or FH)

21
Q

Dosing of Trulicity (Dulaglutide)

A

0.75mg SQ once weekly

22
Q

Dosing of Ozempic (Semaglutide)

A
  1. 25mg SQ x4 weeks

0. 5mg SQ once weekly (can titrate to 1g if needed)

23
Q

Dosing of Victoza (Liraglutide)

A

0.6mg SQ x 7 days then 1.2-1.8 mg SQ daily

24
Q

Dosing of Byetta (Exenatide)

A

5mcg SQ BID x 1 month then titrate to

10mcg SQ BID

25
Q

Dosing of Bydureon (Exenatide)

A

2mg SQ x once weekly

26
Q

Dosing of Adylyxin (Lixisenatide)

A

10mcg Sq x 10 days then 20mcg SQ daily

27
Q

When can Dulaglutide (Trulicity) be administered

A

Any time of the day, regardless of meal time

28
Q

What GLP-1s include needles?

A

Trulicity, Ozempic, and Bydureon

29
Q

When can Exenatide be administered?

A

60 minutes prior to morning and evening meals

30
Q

When can Lixisenatide be administered?

A

One hour before the first meal of the day

31
Q

When can Liraglutide (Victoza) be administered?

A

Any time of day, independent of meals

32
Q

What conditions are contraindicated with GLP-1 agonists?

A

Pancretitis

Thyroid cancer hx

33
Q

AE of DDP-IV inhibitors

A 
Nasopharyngitis 
Upper respiratory tract infections (URIs) 
Headache (HA)
Some reports of acute pancreatitis
Joint pain 
HF risk
34
Q

Drug interactions with DDP-IV inhibitors

A

Small increase in digoxin concentrations with sitagliptin
Drug interactions between saxagliptin and ketoconazole/itraconazole, PIs, clarithromycin, telithromycin, and rifampin - ↓ saxagliptin AUC by
76%

35
Q

Name the DDP-IV inhibitors

A 
"glipitins" 
Sitagliptin
Saxagliptin
Linagliptin
Alogliptin
36
Q

Dosing of Sitagliptin

A

CrCl >50: 100mg d
CrCl 30-50: 50mg d
CrCl < 30 or ESRD on dialysis: 25mg d

37
Q

Dosing of Saxagliptin

A

2.5-5mg once daily

CrCl<50 : 2.5mg daily

38
Q

Dosing of Linagliptin

A

5mg once daily

no change for renal disease

39
Q

Dosing of Alogliptin

A

25mg d
CrCl 30-60: 12.5mg
CrCl <30 or ESRD on dialysis: 6.25mg

40
Q

Name the D. Sodium Glucose Transporter 2 (SGLT2) Inhibitors

A

Canagliflozin (Invokana®)
Dapagliflozin (Farxiga®)
Empagliflozin (Jardiance®)
Ertugliflozin (Steglatro®)

Therapeutics 2 Drugs - Fall 2018 (5 decks)

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