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Pharmacotherapeutics Endo > Non-insulin meds > Flashcards

Non-insulin meds Flashcards

1
Q

What is the DOC for newly diagnosed DM2 pt’s?

A

Metformin (which is a biguanide)

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2
Q

What is are ADR’s of Metformin?

A

GI - d/n/v/f

can lead to vitamin B12 deficiency long term

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3
Q

When should you d/c Metformin in clinical situations?

5 conditions

A
  • cardiovascular collapse
  • respirator failure
  • acute MI
  • acute CHF
  • septicemia
    (want to d/c in situations predisposing pt’s to hypoxia)
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4
Q

At what GFR is Metformin not recommended?

A

GFR of 30-45mL/min

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5
Q

What are contraindications for Metformin?

A
  • severe renal dysfunction (GFR<35ml/min)
  • acute or chronic metabolic acidosis

(use caution in pt’s with heart failure, hepatic impairment, renal impairement, elderly (avoid in pt’s >80))

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6
Q

In which situation should Metformin be discontinued for diagnostic testing?

A

when pt is undergoing testing that needs IV radiographic contrast agents

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7
Q

What are the drugs in the Thiazolidinediones class?

A
  • Pioglitazone (Actos)

- Rosiglitazone (Avandia)

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8
Q

What is the MOA of sulfonylrureas?

A

Stimulate insulin secretion by blocking the ATP-sensitive K+ channels

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9
Q

What are ADRs for thiazolidinediones?

A
  • edema
  • heart failure
  • URI
  • anemia
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10
Q

What is the BBW for Thiazolidinediones?

A

Heart failure risk

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11
Q

What should you do before prescribing Thiazolidinediones?

A

baseline liver enzymes (due to risk of liver failure)

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12
Q

What are ADRs of α-Glucosidase Inhibitors?

A

farting, diarrhea, bloating, cramping

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13
Q

What drugs are in the class Dipeptidyl Peptidase-4 (DPP-4) Inhibitors? (four drugs)

A

Alogliptin (Nesina)
Linagliptin (Tradjenta)
Saxagliptin (Onglyza)
Sitagliptin (Januvia)

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14
Q

Which of the DPP-4 inhibitors does not need dose adjustments for renal/hepatic failure?

A

Linagliptin

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15
Q

What drugs are in the class SGLT2 Inhibitors?

A

Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)

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16
Q

What is the MOA of SGLT2 Inhibitors?

A

will inhibit the SGLT2 transporter in proximal renal tubules to reduce the reabsorption of glucose. (they can also help weight loss and BP)

17
Q

What are the ADRs for SGLT2 Inhibitors?

A
  • vaginal yeast infections*
  • UTIs*
  • Hyperkalemia
  • Increased LDL
18
Q

What are the CI’s for SGLT2 Inhibitors?

A

Severe renal impairment, ESRD, dialysis

19
Q

What should you be careful about when prescribing SGLT2 Inhibitors in terms of DDIs?

A
  • be careful with other drugs that work for the kidneys like ACEIs, ARBs, duiretics
20
Q

Which of the SGLT2 Inhibitors has a BBW for leg and foot amputations?

A

Canagliflozin

21
Q

Which SGLT2 Inhibitors showed trends for reduced CV?

A

Empagliflozin (jardiance)

22
Q

Which pt population should you be cautious with when prescribing Sulfonylureas?

A

elderly pt’s due to risk of hypoglycemia/falls

23
Q

Which drugs are in the class Meglitinides?

A

Nateglinide (Starlix)

Repaglinide (Prandin)

24
Q

which two classes of non-insulin drugs should not be prescribed together?

A

Meglitinides and Sulfonylureas

25
Q

Which drug is a synthetic amylin Analog?

A

Pramlintide (Symlin, Symlinpen)

26
Q

What are the ADR’s of APramlintide (Symlin, Symlinpen) and what cautions should you take when prescribing it?

A

ADRs: hypoglycemia, GI upset, n/v/anorexia

Warning: avoid use in pt’s w/ diabetic gastroparesis or / hypoglycemic unawareness

27
Q

What are some injectable GLP-1 agonists? (5)

A 
Exenatide (Byetta, Bydureon)
Liraglutide (Victoza)
Albiglutide (Tanzeum)
Dulaglutide (Trulicity)
Lixisenatide (Adlyxin)
28
Q

What are the ADRs of GLP-1 agonists?

A

GI issues: n/v/d/c

29
Q

What is the BBW for GLP-1 agonists?

A

thyroid tumors in animal studies, pancreatitis risk (so avoid in pt’s w/ thyroid disease), severe GI disease or gastroparesis, avoid in pt’s w/ gallbladder disease and hypersensitivity

30
Q

Which of the GLP-1 receptor agonists can have anti-drug antibodies formed against them?

A

Exenatide
liraglutide
lixisenatide

31
Q

Which GLP-1 agonist causes tachycardia, PR interval prolongation, AV block?

A

Dulaglutide

32
Q

Which of the GLP-1 receptor agonists increases resting heart rate?

A

Liraglutide

33
Q

Which GLP-1 receptor agonist has a new indication to reduce the risk of major adverse CV events in adults w/ type II DM ?

A

Liraglutide

Note: the brand Saxenda of liraglutide is indicated for weight loss

Pharmacotherapeutics Endo (2 decks)

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