Brainscape's Knowledge GenomeTM

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


See full index

Therapeutics 2 Exam 3 -Diabetes pt 2 > Non-Insulin Overview > Flashcards

Non-Insulin Overview Flashcards

1
Q

How does Metformin work?

A

-Decreases hepatic production of glucose
-Increases intestinal glucose utilization
-Decreases glucose uptake into circulation

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

Who should Metformin be used in?

A

-Consider in all Type 2 patients
*adjunct to diet in uncontrolled patients

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

What are the benefits of Metformin?

A

-Reduces risk of mortality and CV death
-Decreases lipids
-Minimal hypoglycemia (no insulin release)
-Weight neutral/positive
-CHEAP

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

Does metformin cause insulin release?

A

NO -lower risk of hypoglycemia

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

Who should metformin be avoided in?

A

-Acute decompensated hospitalized heart failure patients/ unstable heart failure patients/ heart failure with severe renal or hepatic disease

-Alcoholics

-Patients at risk for lactic acidosis

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

What are the side effects of metformin?

A

-GI effects (diarrhea, nausea, vomiting, gas)
-Vitamin B12 malabsorption/deficiency
-Dementia Risk?

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

How do SGLT2 inhibitors work?

A

Inhibition of SGLT2 leads to glucose excretion in the urine

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

What non-insulin products can be used as initial therapy?

A

SGLT2 Inhibitors
GLP-1 Agonists

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

Who are SGLT2 inhibitors recommended for?

A

Type 2 patients with or at high risk for:

-atherosclerotic cardiovascular disease
-heart failure
-chronic kidney disease

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

What affect do SGLT2 inhibitors have on weight?

A

Can cause significant weight loss

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

What is another important statistic that SGLT2 inhibitors impact?

A

SGLT2 inhibitors lower blood pressure which can either be a positive or negative depending on the patient

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

What are the side effects of SGLT2 inhibitors?

A

-UTI’s
-Genital fungal infections
-Increased urination
-Hypotension
-Hyperkalemia
-Increased cholesterol

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

Are SGLT2 inhibitors expensive?

A

YES, major reason why they may not be used

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

What patients should SGLT2 inhibitors not be used in?

A

-Patients with repeat UTI’s
-Patients with bladder control issues
-Dialysis patients

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

What are the contraindications associated with SGLT2 inhibitors?

A

-DKA (this drug triggers it in Type 2 patients)
-Severe Genital Infections
-Canagliflozin: bone fractures, decreased bone mineral density, leg and foot amputation
-Canagliflozin+ Dapagliflozin: Acute Kidney injury
-

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

What are the benefits of using SGLT2 inhibitors?

A

-Weight loss
-CV benefits (improve outcome of MACE)
-Renal benefits

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

Do GLP-1 agonists have glucose dependent or independent insulin secretion?

A

Glucose dependent

*insulin only released when BS is elevated

18
Q

In Type 2 diabetes which is preferred first: Insulin or GLP-1 Agonists?

A

GLP-1 Agonists

19
Q

What contraindications are associated with GLP-1’s?

A

-In severe renal disease
-History of pancreatitis
-Thyroid tumors (history or family history)
-Gastroparesis
-Proliferative retinopathy

20
Q

What side effects are associated with GLP-1’s?

A

-Nausea
-Pancreatitis
-thyroid C-cell tumors
-Gall bladder disease

21
Q

What other drug class should NEVER be used with GLP-1 agonists?

A

DPP-IV inhibitors

22
Q

What A1C indicates that insulin needs to be started?

A

A1C > 10

23
Q

What is the singular dual GLP-1 RA and GIP RA?

A

Tirzepatide (Mounjaro)

24
Q

Is the mechanism of action of Dual GLP-1 RA and GIP RA glucose dependent?

A

YES

25
Q

What are the adverse effects of Dual agonists?

A

Same as GLP-1!
Unique: Tachycardia

26
Q

What affect do DPP-IV inhibitors have on weight?

A

Weight neutral

27
Q

What adverse effect is unique to DPP-IV inhibitors?

A

Nasopharyngitis (nasal irritation)

28
Q

What warnings are associated with DPP-IV’s?

A

Joint Pain
***Heart Failure

29
Q

Which DPP-IV inhibitor is best to choose if the patient has a heart failure risk?

A

Sitagliptin

30
Q

Which DPP-IV inhibitor is not eliminated through the kidneys?

A

Linagliptin

31
Q

When would you use a sulfonylurea?

A

-If patient has already tried several other things
-If patient cannot afford newer drug options

32
Q

When should the second generation sulfonylureas (glipizide and glyburide) be taken?

A

30 minutes before meals

33
Q

Which sulfonylurea is preferred in renal disease and to prevent hypoglycemia?

A

Glipizide

34
Q

What are the main adverse effects of sulfonylureas?

A

**Hypoglycemia
-Weight gain
-Sulfa reactions

35
Q

What is a contraindication for using sulfonylureas?

A

Sulfa allergies

36
Q

Who should we cautiously use sulfonylureas in?

A

-Elderly
-Irregular dietary intake
-Alcoholics
-Patients taking other hypoglycemic agents

37
Q

Who are the best candidates for sulfonylureas?

A

Type 1 Patients
Short diabetes duration (newly diagnosed)
FBS < 250
High fasting c-peptide levels

38
Q

Should sulfonylureas be taken long-term?

A

NO
-often fail after 5 years or a few months

39
Q

What is one down side of TZD’s?

A

Take a long time to work!
(12 weeks)

40
Q

At what LFT should TZD’s not be started at?

A

> 2.5 times normal

41
Q

At what LFT should TZD’s be discontinued?

A

> 3 times normal

Therapeutics 2 Exam 3 -Diabetes pt 2 (8 decks)

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